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Does Medical School Educate for Professional Values? Brezis M, Butt O, Haimov T, Shapiro S, Ilan U, Cohen R, Tal M, Rubinow A Hadassah-Hebrew University.

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Presentation on theme: "Does Medical School Educate for Professional Values? Brezis M, Butt O, Haimov T, Shapiro S, Ilan U, Cohen R, Tal M, Rubinow A Hadassah-Hebrew University."— Presentation transcript:

1 Does Medical School Educate for Professional Values? Brezis M, Butt O, Haimov T, Shapiro S, Ilan U, Cohen R, Tal M, Rubinow A Hadassah-Hebrew University Medical Center Jerusalem, Israel

2 Professional schools, such as medical, nursing, business and law schools, do not educate for values Professor Lee Schulman President, Carneggie Foundation for Education


4 Ex-Finance Minister Hirschson Sentenced to 65 Months In Jail In the Holy Land… The corruption industry MP Benizri (Shas) gets 18 months jail for corruption Former Minister & Party Leader Deri Begins Serving 3 year Term Prison for Corruption Deputy Head of Oncology convicted of taking bribes from patients Tax Authority Director resigns amid corruption allegations Top gynecologist charged with fabricating medical data (head of hospital's Helsinki Committee)

5 Misconduct is a global challenge

6 One-third of researchers surveyed in China admit to plagiarism, falsification or fabrication of data. Nature (2010) UK journal Acta Crystallographica retracted 70 published crystal structures - fabrications by researchers at Jinggangshan University in Jiangxi province. Tainted Heparin from China Cause 81 Deaths in U.S. Lead in Toys Tainted milk scandal resurfaces in China

7 Industrys Misconduct Involves Professionals

8 Cheating at Israeli Universities Self Reported Cheating at Nine Law Faculties N=788 students Cheshin Y, 2002, 2005


10 Rate of Students Admitting Violations (2, at exams, assignments or clinical activities) 80% 97% 31% 80% 97% 31% O. Butt The Medical Teacher 2009 Cheating at Medical School Response rate Teachers viewed students dishonesty problems as not part of their job to deal with them E.g., performing intimate examinations without receiving patients consent

11 No easy solutions to cheating Technical ( e.g. camera surveillance): limited and easily defeated by students creativity Disciplinal: heavy to implement because of legal implications

12 Physicians in Health Care Corruption Fabricated ResearchFabricated Research Pharmaceuticals or DevicesPharmaceuticals or Devices Dubious Research on PollutionDubious Research on Pollution Misconduct in ManagementMisconduct in Management

13 T. Haimov, The Medical Teacher, 2009 Survey of Final Year Medical Students in a Leading Faculty (representing 1/3 of students concluding studies in Israel) Percentage of Students % Lifestyle Education

14 Practicing a healthful behavior was shown to be the most consistent and powerful predictor of physicians counseling patients about related prevention issues Nutrition 2009, 25: 532 & review from the Centers for Disease Control and Prevention 2009

15 חינוך לבריאות בקרב תלמידי רפואה: האם הקמפוס בעין כרם מעודד אורח חיים בריא? המצוי והרצוי דו"ח שהוכן ע"י סטודנטים לרפואה שנה ג' קיץ 2010


17 Healthy Living Center at Mayo Clinic (Rochester, MN) FORTUNE Magazine: Mayo Clinic One of Best Companies to Work For השקעה של 1$ לקידום בריאות בעבודה מניב 6$ בפריון העבודה

18 Percentage % Attitude Towards Organ Donation Survey of Medical Students (N=192) and Teachers (N=68)

19 In recent years, our school has changed the admission process with inclusion of psychological testing to select students with a more desirable personality. Our school has also introduced a program of humanistic courses. Has cheating decreased?

20 % In your opinion, was there a cheating problem at the last exam? No I cheated myself I helped others cheating 1-5 students cheated 5-10 students cheated students cheated Over 30 students cheated N=96

21 % Do you see a problem in cheating? I dont have a problem with this behavior I have a problem with this behavior and I oppose it

22 Students see a system of competitive evaluation & incentives (e.g. scholarships), exclusively based on factual knowledge and not on attitudes, behavior, skills & values You, teachers, look only at our grades Knowledge is less important than the ability to admit you dont know and the skills to find out answers to what you dont know At medical school students unlearn to say I dont know

23 A cab hits in hit-and-run accident. 15% of cabs are blue, 85% are green. An eyewitness states cab in accident was blue; its testimony has sensitivity & specificity of 80%. What is the chance that a blue cab caused the accident? Overconfidence Among Medical Students in Cognitive Biases (à la Kahneman & Tversky) Dont know 1% % You donated blood, out of good health. HIV test is positive. The sensitivity and specificity of the test are 99% each. What are is chance you are HIV carrier? % Dont know 1%

24 Should Oocyte Cryopreservation Be Allowed for Personal Reasons? Medical Students General Population %Yes Dont know *p<0.01N=290 N=580 * Overconfidence Among Medical Students in Ethical Question

25 Overconfidence & Assertiveness Are Detrimental to Critical Professional Abilities Admit I do not know Admit I do not know Tolerate uncertainty & ambivalence Tolerate uncertainty & ambivalence Respect patients & familys views Respect patients & familys views Team work Team work Admit error/suboptimal performance Admit error/suboptimal performance Ability to change & improve Ability to change & improve

26 A potential solution might be in granting students, early on in the curriculum, responsibility for patient care, aligning pedagogic and professional goals. Early clinical experience with suffering, disease and death, will expose students to values such as empathy, caring and responsibility to the other - fundamental steps in finding existential meaning. Brezis M. Caring in medicine: missed opportunity for healing? J Eval Clin Pract 2009:990-2 Conceptual Solution to Cheating

27 ConclusionConclusion Education for professional values during medical school deserves a new paradigm. Medical students disclose problematic attitudes and behavior related to honesty, lifestyle & overconfidence. Dad, Im considering a career in organized crime Government or private sector? Thanks to Ms. Lois Gordon for graphic assistance

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