The clinical medical humanities program at Loyola University of Chicago.
TL;DR: The paper offers several guidelines to the person or persons who would organize and direct a clinical medical humanities program, describes obstacles that the Loyola program faced when it was getting started, and presents the purpose, focus, and curricular topics of the program.
Abstract: The authors emphasize that an effective medical humanities program must be based on clinically oriented training. They then describe in detail such a program at Loyola University of Chicago Medical Center; the program consists of a four-year required curriculum that is clinically reinforced by having the students accompany attending physicians on rounds and is taught by faculty representing a wide range of disciplines in medicine and other fields. The paper offers several guidelines to the person or persons who would organize and direct a clinical medical humanities program, describes obstacles that the Loyola program faced when it was getting started, presents the purpose, focus, and curricular topics of the program, and discusses its future. The authors conclude that the use of the clinically oriented approach will continue to prevail in medical humanities teaching, both at Loyola and in medical humanities programs overall. This approach challenges good teachers to make their best efforts at reconciling their own disciplines with that of medicine; in this process, a new medical humanities discipline emerges that is not so much an application of the humanities to medicine as it is an evocation of humanities themes from the clinical encounter itself.
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TL;DR: The background to its inclusion in undergraduate curriculum and the consensus that has arisen on the design of ethics curricula are examined, using Harden’s curriculum and S.I.C.E.S models as templates.
Abstract: Medical ethics education, it has been said, has 'come of age' in recent years in terms of its formal inclusion in undergraduate medical curricula. This review article examines the background to its inclusion in undergraduate curricula and goes on to examine the consensus that has arisen on the design of ethics curricula, using Harden's curriculum and S.P.I.C.E.S models as templates. While there is consensus on content for undergraduate medical ethics education, there is still significant debate on learning and teaching methods. Despite the broad agreement on the need to apply adult education principles to ethics teaching, there would appear to be some tension between balancing the need for experiential learning and achieving the 'core curriculum'. There are also as yet unresolved difficulties with regards to resources for delivery, academic expertise, curriculum integration and consolidation of learning. Assessment methods also remain contentious. Although there is consensus that the ultimate goal of medical ethics, and indeed of medical education as a whole, is to create 'good doctors', the influence of the 'hidden curriculum' on students' development is only beginning to be recognized, and strategies to counteract its effects are in their infancy. The need for proper evaluation studies is recognized. It is suggested that the areas of debate appearing in the literature could be used as a starting point for evaluation studies, which would form the empirical basis of future curriculum development.
214 citations
TL;DR: The context of medical education itself is looked at to look beyond formal bioethics instruction to the ‘informal curriculum’ that is so central to the moral development of medical students and residents.
Abstract: As some formal bioethics instruction has become the norm in American medical schools, a trend has emerged toward increased attention to context in both bioethics education and bioethical decision-making. A focus on classical dilemmas and a textbook knowledge of principles is yielding its previous dominance to permit a more detailed examination of ethical behaviour in actual practice in medicine. After documenting and analysing this emerging trend in bioethics education and its parallel in bioethics theory and research, we turn to the context of medical education itself to look beyond formal bioethics instruction to the 'informal curriculum' that is so central to the moral development of medical students and residents. A qualitative research strategy is being used to study the informal curriculum through analysing tape-recorded informal conversations students and residents have with their friends and colleagues at work about issues bearing on their professional development. Data presented are documenting 'the unwritten code' for medical students on a surgical clerkship and the senior residents' informal ways of producing a 'practical ethics of conduct' that shapes understanding of what is good, skilful, and right on that surgical service. How conceptions of appropriate conduct are conveyed, rewarded and sanctioned also reveals how professional demeanour is taught, permitting discussion about what should be retained and what changed. The context in which ethical issues arise enhances understanding of ethical practice in medicine.
108 citations
TL;DR: It is argued that there are both ethical strengths and weaknesses in the practice of using students as surrogate patients, and strategies to promote free and informed involvement of students as surrog patients are suggested.
Abstract: Until recently, most clinical teachers and medical students have regarded using medical students as surrogate patients for peer teaching of physical examinations and clinical skills as practical and uncontroversial. Recent changes to medical curricula and changes in hospitalized patient populations have led to questions about the ethical acceptability of this practice. This paper explores the ethical issues inherent in the use of medical students as surrogate patients. It suggests that, ethically, there are parallels with two situations: when students conduct physical examinations on patients and when students participate as subjects in research. Drawing on accepted ethical practice in these two germane areas, the paper argues that there are both ethical strengths and weaknesses in the practice of using students as surrogate patients. Strategies to promote free and informed involvement of students as surrogate patients are suggested.
51 citations
TL;DR: A literature review focused on medical ethics education among North American medical schools reveals that instruction in ethics is considered to be vitally important for medical students, and “deliberative curriculum inquiry” by means of a targeted Delphi technique may be a useful methodology.
Abstract: Efforts to reform medical education have emphasized the need to formalize instruction in medical ethics. However, the discipline of medical ethics education is still searching for an acceptable identity among North American medical schools; in these schools, no real consensus exists on its definition. Medical educators are grappling with not only what to teach (content) in this regard, but also with how to teach (process) ethics to the physicians of tomorrow.
46 citations
TL;DR: This work outlines the current approach to teaching medical ethics and believes successful medical ethics teaching requires medical schools to commit significant material and moral support.
41 citations