Presentation on theme: "Planning to Teach Bioethics. Plan of Presentation zWhy should we teach? zWho should we teach? zWhat should we teach? zHow should we teach? zHow should."— Presentation transcript:
Planning to Teach Bioethics
Plan of Presentation zWhy should we teach? zWho should we teach? zWhat should we teach? zHow should we teach? zHow should we evaluate? zHow should we learn?
Why should we teach? zPerformance z(and quality) z(and moral distress)
Who should we teach? zMedical students zResidents zFellows zPracticing physicians zHealth care teams
What should we teach? Depends on zprofession zlevel of “student” zspecialty
What should we teach? Critical issues zFormal vs informal curriculum zTheory vs practice zPrinciples vs decision tools vs paradigm cases
What should we teach? Medical students zIntegrated curriculum zStudent-specific ethical dilemmas (Hicks et al) yconflict between medical education and patient care yresponsibility beyond one's capabilities yperceived substandard patient care
I should call the staff back... An intern and clinical clerk are asked to close a surgical wound; staff then leaves the OR. Neither the intern or the clerk has performed this procedure before.
Is this being done incorrectly? Will this affect the clinical outcome? Intern attempts to close the incision, appears to be having difficulty.
How can I call my staff without humiliating my resident? Intern now clearly has difficulty. Patient beginning to rouse from anesthetic.
Clerk decides not to call staff. Intern finishes closing. If I call for help, I’ll look incompetent, get less opportunities and it may affect my mark. Wound infection
How should we teach? zLecture zTeacher’s cases yPaper yVideo yStandardized patient zLearner’s cases zRole play zBedside encounter zExtracurricular activities
Teaching Medical Ethics the University of Chicago Program Concepts (“5 C’s”) Teaching should be C linically cased Real patient C ases should serve as the teaching focus Teaching should be C ontinuous Ethics teaching should be C oordinated with the students’ other learning objectives C linicians should be participate actively in the teaching effort both as instructors and as role models
Teaching Bioethics Faculty of Medicine, PSU Year 1 : 3 hours General Philosophy Year 2 : 16 hours Foundation to Clinical Practice and Medical Ethics I Introduction to Ethics Meta-ethics Ethical reasoning I Foundation to Clinical Practice and Medical Ethics II Doctor-patient relationship Ethical reasoning II Ethical reasoning III
Teaching Bioethics Faculty of Medicine, PSU Year 3 : 21 hours Foundation to Clinical Practice and Medical Ethics III Principles of Bioethics Autonomy Beneficence and Non-maleficence Foundation to Clinical Practice and Medical Ethics IV Difficult patients Justice and resource allocation Breaking bad news Difficult of life and death Medical codes of ethics Ethics and law
Teaching Bioethics Faculty of Medicine, PSU Year 4 : 12 hours Health and Diseases of Adults and Elderly Consent Confidentiality Substitute decision-making Doctor-patient relationship Preoperative to Postoperative Care Consent Truth telling and withholding information Conflict of interest (student issue) Family and Community Medicine Public health ethics
Teaching Bioethics Faculty of Medicine, PSU Year 5 : 15 hours Health and Diseases of Adults and Elderly Quality end-of-life care Preoperative to Postoperative Care Refusal of treatment Medical negligence Health and Diseases from Conception to Adolescence Involving children in decision making Resource allocation Health and Diseases of Women Maternal-fetal dilemma Medical futility Reproductive technology
Year 5 (continued) Emergency Medicine and accidents Ethics in emergency Selected Ambulatory Care Medical negligence Mistake Year 6 : 6 hours Socio-economic issues in health care Termination of medical care Palliative care Medico-legal issues Teaching Bioethics Faculty of Medicine, PSU
Students Direct Formal Curricular activities Extra-curricular activities Informal Indirect Extra-curricular activities Role models Staff development Teaching “Bioethics” How should we teach?
Small group discussion Problem-based learning 63.3% Team-taught lecture 16.3% Simulated patient Role play 12.2% Cultural tour, Exhibition 8.2% How should we teach?
RCPSC Bioethics Requirements z“The academic program must provide opportunities for residents to gain an understanding of the basic principles of biomedical ethics as it relates to the specialty” z“That the Royal College extend evaluation of bioethics in all of its current methods of evaluation of programs and residents”
RCPSC Bioethics Project Goals zTo integrate bioethical knowledge and skills into the clinical practice of residents zTo assist Canadian post-graduate program directors to teach bioethics zTo develop model curricula in medicine, surgery, OBGYN, and psychiatry zTo develop evaluation strategies
RCPSC Bioethics Project Medicine Curriculum Topics ztruth telling zconsent zcapacity zsubstitute decision making zconfidentiality zconflict of interest zappropriate use of life-sustaining treatment zeuthanasia / assisted suicide zresource allocation zresearch ethics
How shall we evaluate? zKnowledge yMutliple choice, true / false zAnalysis yEssay question zPerformance yChart review yOSCE yIn-training evaluation
Knowledge/Analysis Essay question Modified essay question (MEQ) Multiple choice question (MCQ) Performance Chart review Objective structured clinical examination (OSCE) Direct observation In-training evaluation How shall we evaluate?