Teaching ethics in psychiatry: a one-day workshop for clinical students

Fictional Film in Engineering Ethics Education: With Miyazaki's The Wind Rises as Exemplar

This paper aims to call attention to the potential of using film in engineering ethics education, which has not been thoroughly discussed as a pedagogical method in this field. A review of current approaches to teaching engineering ethics reveals that there are both learning outcomes that need more attention as well as additional pedagogical methods that could be adopted. Scholarship on teaching with film indicates that film can produce ethical experiences that go beyond those produced by both conventional methods of teaching engineering ethics and more arts-based methods such as fiction, as well as connect ethics learning outcomes and issues to the lifeworld of a person. The paper further illustrates the potential of using Miyazaki Hayao's film The Wind Rises for highlighting a range of ethical issues pertaining to engineering. It also discusses the important role educators play in how film can be used effectively in the classroom. Synthesizing a range of sources from film theory to the use of film in business and medical education, the paper makes the case for using film in engineering ethics education and calls for more research on the use of this method.

A systematic scoping review of undergraduate medical ethics education programs from 1990 to 2020

INTRODUCTION

Ensuring medical students are equipped with essential knowledge and portable skills to face complex ethical issues underlines the need for ethics education in medical school. Yet such training remains variable amidst evolving contextual, sociocultural, legal and financial considerations that inform training across different healthcare systems. This review aims to map how undergraduate medical schools teach and assess ethics.

METHODS

Guided by the Systematic Evidence-Based Approach (SEBA), two concurrent systematic scoping reviews were carried out, one on ethics teaching and another on their assessment. Searches were conducted on PubMed, Embase, PsycINFO and ERIC between 1 January 1990 and 31 December 2020. Data was independently analysed using thematic and content analysis.

RESULTS

Upon scrutinising the two sets of full-text articles, we identified 141 articles on ethics teaching and 102 articles on their assessments. 83 overlapped resulting in 160 distinct articles. Similar themes and categories were identified, these include teaching modalities, curriculum content, enablers and barriers to teaching, assessment methods, and their pros and cons.

CONCLUSION

This review reveals the importance of adopting an interactive, multimodal and interdisciplinary team-teaching approach to ethics education, involving community resource partners and faculty trained in ethics, law, communication, professionalism, and other intertwining healthcare professions. Conscientious effort should also be put into vertically and horizontally integrating ethics into formal medical curricula to ensure contextualisation and application of ethics knowledge, skills and attitudes, as well as protected time and adequate resources. A stage-based multimodal assessment approach should be used to appropriately evaluate knowledge acquisition, application and reflection across various practice settings. To scaffold personalised development plans and remediation efforts, multisource evaluations may be stored in a centralised portfolio. Whilst standardisation of curricula content ensures cross-speciality ethical proficiency, deliberative curriculum inquiry performed by faculty members using a Delphi approach may help to facilitate the narrowing of relevant topics.

Teaching emergency situations during a psychiatry residency programme using a blended learning approach: a pilot study

BACKGROUND

Emergency psychiatry is an essential component in the training of psychiatry residents who are required to make patient-centred orientation decisions. This training calls for specific knowledge as well as skills and attitudes requiring experience. Kolb introduced a theory on experiential learning which suggested that effective learners should have four types of abilities: concrete experience, reflective observation, abstract conceptualisation and active experimentation. We aimed to evaluate a resident training programme that we designed for use in an emergency psychiatry setting based on the experimental learning theory.

METHODS

We designed a four-step training programme for all first-year psychiatry residents: (i) theoretical teaching of psychiatric emergency knowledge, (ii) concrete experience of ability teaching involving an initial simulation session based on three scenarios corresponding to clinical situations frequently encountered in emergency psychiatry (suicidal crisis, hypomania and depressive episodes), (iii) reflective observation and abstract conceptualisation teaching based on videos and clinical interview commentary by a senior psychiatrist for the same three scenarios, (iv) active experimentation teaching during a second simulation session based on the same three frequently encountered clinical situations but with different scenarios. Training-related knowledge acquisition was assessed after the second simulation session based on a multiple-choice quiz (MCQ), short-answer questions and a script concordance test (SCT). The satisfaction questionnaire was assessed after the resident had completed his/her initial session in order to evaluate the relevance of teaching in clinical practice. The descriptive analyses were described using the mean (+/- standard deviation). The comparative analyses were conducted with the Wilcoxon or Student's t tests depending on data distribution.

RESULTS

The residents' mean MCQ and short-answer question scores and SCT were 7.25/10 (SD = 1.2) 8.33/10 (SD = 1.4), 77.5/100 (SD = 15.8), respectively. The satisfaction questionnaire revealed that 67 % of residents found the teaching consistent.

CONCLUSION

We designed a blended learning programme that associated, classical theoretical learning to acquire the basic concepts, a learning with simulation training to experiment the clinical situations and a video support to improve learning of interview skills and memory recall. The residents indicate that this training was adequate to prepare them to be on duty. However, despite this encouraging point, this program needs further studies to attest of its efficiency.

Evaluating the effectiveness of video cases to improve patient-centeredness in psychiatry: a quasi-experimental study

OBJECTIVES

To evaluate the effectiveness of including interactive video-based patient cases in preparatory lectures on medical students' patient-centredness and attitudes towards psychiatry.

METHODS

This study was designed as a quasi-experimental intervention study. A preparatory lecture on diagnostic interviewing was given to 204 fourth-year medical students before a 4-week psychiatry clerkship. The students were divided into two groups. One group (n=102) received a preparatory lecture including an interactive video case portraying a doctor performing a diagnostic interview with a simulated patient (intervention group). The other group (n=102) received a conventional preparatory lecture using text-based instructional material (control group). We conducted a paired sample t-test to compare the students' confidence in exhibiting patient-centred communication and their attitudes towards psychiatry before receiving the preparatory lecture and after having completed a minimum of three weeks of clerkship training.

RESULTS

A total of 102 students, 51 in each group, completed a questionnaire at both measurement points. In the intervention group, we found a statistically significantly difference for the students' patient-centredness before (M=69.4, SD=10.0) and after (M=73.8, SD=8.6) the intervention t(97)=2.38, p= 0.02, but no changes in attitudes t(98) =1.07, p=0.28. In the control group, we found no changes in patient-centredness or attitudes.

CONCLUSIONS

Video cases in preparatory lectures appear to be better than text-based material at improving students' patient-centredness in psychiatry. However, neither video cases nor text-based material seem to influence the students' attitudes.

Ethics-in-oncology forums

BACKGROUND

We developed an ethics curriculum for hematology/oncology fellows who had already learned medical ethics from medical school and residency programs. The goal of the ethics program was to train fellows in ethics issues specific to hematology/oncology; to raise awareness of ethical issues; and to teach fellows to write, edit, and publish reviews in specific ethical issues.

METHODS

Fellows learned to summarize expert opinions, to understand diversity in cultural concepts relating to ethics, and to crystallize their approaches to ethical dilemmas to selected oncology patients. Fellows were also trained to write ethics discussions in manuscript format, edit the manuscripts, and submit them for publication.

RESULTS

We hypothesized that fellows would learn ethics in oncology by recognizing and choosing an ethical dilemma from among patient population; reviewing the literature for a discussion of relevant ethical issues; presenting the case and facilitating discussion to an ethics-in-oncology committee; hearing faculty and peer input into their cases; and finally writing, editing, and publishing the deliberation. It also increased understanding of health systems management, a new competency required by the Accreditation Council for Graduate Medical Education for board certification.

CONCLUSIONS

Fellows' perceptions about the experience were positive. We recommend that other subspecialty programs consider this format for teaching ethics in their subspecialties.

Education in ethics

Ethics is the system of thought that analyzes moral judgments. Among the key features of ethics are: (1) it must be translatable into moral action; (2) it is a public system rather than a private activity, and no one can act morally without reference to other individuals; and (3) the fundamental ethical principles underpinning medical ethics are those of society in general. Among the purposes of education in ethics are the development of consistent, critical, and reflective attitudes to ethical decision-making; increasing awareness of ethical dilemmas in one's own practice and that of others; and reinforcement of best practices in clinical and research governance. Ethics is the system of thought that analyzes moral judgments. Among the key features of ethics are: (1) it must be translatable into moral action; (2) it is a public system rather than a private activity, and no one can act morally without reference to other individuals; and (3) the fundamental ethical principles underpinning medical ethics are those of society in general. Among the purposes of education in ethics are the development of consistent, critical, and reflective attitudes to ethical decision-making; increasing awareness of ethical dilemmas in one's own practice and that of others; and reinforcement of best practices in clinical and research governance.

Talking about cases in bioethics: the effect of an intensive course on health care professionals

Educational efforts in bioethics are prevalent, but little is known about their efficacy. Although previous work indicates that courses in bioethics have a demonstrable effect on medical students, it has not examined their effect on health care professionals. In this report, we describe a study designed to investigate the effect of bioethics education on health care professionals. At the Intensive Bioethics Course, a six-day course held annually at Georgetown University, we administered a questionnaire requiring open-ended responses to vignettes both before and after the course. Following the course, respondents defended their responses more carefully and articulated their thoughts more clearly. In addition, after the course respondents seemed to have a more subtle understanding of the relevant issues in the cases and applied theory to these cases more frequently. These findings help to formulate an understanding of the effect of bioethics education on health care professionals.

Teaching medical ethics to orthopaedic surgery residents

Orthopaedic surgery residents will be faced with a variety of ethical issues when they enter clinical practice. A previous survey suggested that they lack knowledge about how to approach several types of medical ethics dilemmas. We developed a medical ethics curriculum for orthopaedic surgery residents and presented it over a one-year period to the residents in one training program. The effect of the educational intervention on the residents' knowledge of medical ethics and their ability to handle hypothetical situations was measured by comparing their responses to a questionnaire, administered before and after the intervention, with those of residents in a training program in which the intervention was not provided. The twenty-five residents at the site of the educational intervention had a mean improvement of 0.10 in the overall score, from a mean score of 0.71 on the baseline survey to a mean score of 0.81 on the follow-up survey. This improvement was significantly greater than the mean improvement of 0.02 for the thirty residents at the control site, who had a mean score of 0.72 on the baseline survey and a mean score of 0.74 on the follow-up survey (p = 0.002). Six residents who participated in the medical ethics curriculum rated it as very useful; seventeen, as somewhat useful; one, as slightly useful; and one, as not at all useful. A medical ethics curriculum can increase orthopaedic residents' knowledge of medical ethics. Whether this curriculum also will lead to behavioral changes requires additional evaluation.

Development and psychometric properties of the Ethics Environment Questionnaire

OBJECTIVES

The author reports on the development and the psychometric properties of the Ethics Environment Questionnaire (EEQ), an instrument by which to measure the opinions of health-care providers about ethics in their clinical practice organizations. The EEQ was developed to increase the number of valid and reliable measures pertaining to ethics in health-care delivery.

METHODS

The EEQ is a 20-item self-administered questionnaire using a Likert-type 5-point format, offering ease of administration. It is applicable to a cross-section of health-care practitioners and health-care facilities. The mean administration time is 10 minutes. The EEQ represents testing on 450 respondents in acute care settings among a cross-section of acute care facilities.

RESULTS

Internal consistency reliability using Cronbach's alpha coefficient is 0.93, and the test-retest reliability is 0.88. Construct, content, and criterion validity are established. The scale is unidimensional, with factor loadings exceeding the minimum preset criterion. Mean score is 3.1 out of 5.0, with scores of 3.5 and above interpreted as reflective of a positive ethics environment.

CONCLUSIONS

The EEQ provides a measure of ethics in health-care organizations among multi-practitioners in clinical practice on a valid, reliable, cost effective, and easily administered instrument that requires minimum investment of personnel time.

Making a situational diagnosis. Psychiatrists at the interface of psychiatry and ethics in the consultation-liaison setting

Psychiatrists bring a unique understanding to clinical ethics, but psychiatrists need a precise awareness of the difference between exercising their clinical expertise and facilitating ethical decisionmaking. The author outlines a schema for recognizing and honoring that distinction and illustrates "pseudoethics," "pseudopsychiatry," and "psychiatry/ethics" consultations. The author describes how to make a "situational diagnosis" that includes patient/family issues, staff issues, joint issues, legal/regulatory issues, and ethical issues, thus enabling the psychiatrist to institute an appropriate "hierarchy of interventions": educational, psychological, and ethical. The literature on ethics education for psychiatric practitioners is reviewed and a program is suggested.