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Paper by Prof. Omar Hasan Kasule, Sr
Institute of Medicine, Universiti Brunei Darussalam.
Abstract (379 words)
This papers reports results of a cross sectional self-administered questionnaire study on ethical knowledge among medical students at the Institute of Medicine of Universiti Brunei Darussalam. The primary objective of the research was to establish the general level of knowledge and understanding medical students to provide a baseline that can be used to assess student progress as they move through the medical course. The results of data analysis would be used in refining the design of the ethico-legal section of the undergraduate medical curriculum. The questionnaire had previously been used in a similar study [1]. The questionnaire had a total of 40 scenarios distributed as follows: knowledge of ethics 8 (4 general and 4 Islamic), attitude & practice 21 (15 general and 6 Islamic), and opinions 11 (Islamic). After explaining the aims and procedures of the study as well as obtaining written consent, students were asked to complete and return the questionnaire. Students had to choose the best of 3-4 alternative solutions for the ethical dilemma in each scenario. Each alternative had, unknown to the student, an embedded interpretation based on general and Islamic ethical principles. The interpretation was the one coded for statistical analysis. Knowledge scenarios were coded as ‘do know’, ‘do not know’, ‘not sure’, or ‘avoid. Attitude and practice alternatives were coded as ‘avoid’, ‘take action’, ‘refer’, or ‘report’. Opinion alternatives were coded as ‘acceptable’, ‘not acceptable’ or ‘not sure’. SPSS and STATA statistical packages were used for data management and data analysis. Proportions were computed with 95% confidence intervals. Cross tabulations were made and associations were tested using Fisher’s exact test because of the small numbers. Twenty nine out of a study population of 30 students returned questionnaires. The gender distribution was 14 males and 15 females. There was no significant variation of gender by year of study. Year of study, gender, and ethnicity had no significant statistical effect on ethics KAP. The conclusion from the analysis was that the proportion of students with expected knowledge of ethics was about 55%. Students were more likely to confront ethical dilemmas to find a solution than they were likely to avoid them, report them, or refer them to someone else. The proportions preferring taking action were 64.8% for general scenarios and 85.9% for Islamic scenarios. Ethical opinions were in high agreement with Islamic ethical principles.
Reference
1. Naznin Muhammad et al. The impact of the teaching of medical ethics in the medical and allied health sciences curriculum in International Islamic University Malaysia. Paper being submitted to the International Medical Journal (personal communication)
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Key words: ethics knowledge medical students
INTRODUCTION
Cross sectional self-administered questionnaire
Medical students at IM, UBD
Results used for curriculum planning
40 Scenarios: knowledge, attitude & practice, opinion
20 general & 20 Islamically-oriented
KNOWLEDGE
A female Muslim patient preparing for a chest X-ray becomes very uncomfortable and adamantly refuses to be touched by one of the only two male radiographers attached to the hospital. Do you
- advise the patient that this is acceptable for the sake of health? (DO KNOW)
- call your superior, to have him explain the procedure to the patient? (NOT SURE)
- call for a chaperone? (DO KNOW)
- have the hospital call a female radiographer from a nearby hospital? (DO KNOW)
ATTITUDE AND PRACTICE
The health team is doing blood grouping, among other tests and you become aware,
from the records, that a friend of yours, also a patient, cannot be the biological father
of the child he is bringing up. Do you
A. do nothing? (AVOID)
B. warn your friend about the non-paternity? (TAKE ACTION – breach confidentiality)
C. amend the records so that the truth is forever concealed? (TAKE ACTION –
change records)
D. ask your supervisor what to do? (REFER – refer to higher authority)
OPINION
The ethical committee on which you sit proposes that a new treatment should be tried
on inmates in an institution for the criminally insane, because the issue of informed
consent can be put on one side. Do you
A. agree that this is a good idea? (NOT ACCEPTABLE)
B. dismiss the idea from the start unless number of factors relating to medical ethics
are properly considered? (ACCEPTABLE)
C. ask about physical protection for the investigators? (AVOID)
D. point out that when the results are published the subjects must be anonymised?
(AVOID)
METHODS
STUDY POPULATION
Response 31 students
20 Year 1, 11 Year 2
16 Male; 15 Female
No remarkable gender or ethnic variation
Reserch with small numbers
RESULTS
TABLE #1: GENERAL SCENARIOS
n | Percentage | ||
Knowledge | Do know | 91 | 51.1% |
Do not know | 76 | 42.7% | |
Not sure | 11 | 6.2% | |
Total | 178 | 100% | |
Attitude & Practice | Take action | 221 | 64.8% |
Avoid | 35 | 10.3% | |
Refer | 27 | 7.9% | |
Report | 58 | 17.0% | |
Total | 341 | 100% |
TABLE #2: ISLAMICALLY-ORIENTED SCENARIOS
N | Percentage | ||
Knowledge | Do know | 112 | 51.6% |
Do not know | 44 | 20.3% | |
Not sure | 36 | 16.6% | |
Avoid | 6 | 2.8% | |
Refer | 19 | 8.8% | |
Total | 217 | 100% | |
Attitude & Practice | Take action | 159 | 85.9% |
Avoid | 3 | 1.6% | |
Refer | 20 | 10.8% | |
Report | 3 | 1.6% | |
Total | 185 | 99.9% | |
Opinions | Acceptable | 205 | 82.7% |
Not acceptable | 38 | 15.3% | |
Avoid | 5 | 2.0% | |
Total | 248 |
TABLE #A: Gender and Ethnic Distribution by Year of Study
Gender | Ethnicity | Year 1 | Year 2 | P value |
Male | Malay | 4 | 2 | 0.573 |
Chinese | 5 | 2 | ||
Indian | 0 | 2 | ||
Pakistani | 1 | 0 | ||
Total | 10 | 6 | ||
Female | Malay | 5 | 2 | 1.000 |
Chinese | 5 | 3 | ||
Indian | - | - | ||
Pakistani | - | - | ||
Total | 10 | 5 |
TABLE #B: Distribution of student responses to knowledge scenarios (general)
Do know | Do not know | Not sure | Avoid | P-value | ||
Gender | Male | 45 | 40 | 5 | 5 | .0.632 |
Female | 46 | 36 | 6 | 1 | ||
Total | ||||||
Ethnicity | Malay | 39 | 28 | 6 | 3 | Ns |
Chinese | 42 | 41 | 4 | 3 | ||
Indian | 6 | 6 | 0 | 0 | ||
Pakistani | 4 | 1 | 1 | 0 | ||
Total | ||||||
Year of Study | Year 1 | 59 | 47 | 9 | 4 | 0.815 |
Year 2 | 32 | 29 | 2 | 2 | ||
Total |
TABLE #C: Distribution of student responses to knowledge scenarios (Islamic)
Do know | Do not know | Not sure | Avoid | P value | ||
Gender | Male | 62 | 20 | 16 | 5 | 0.490 |
Female | 50 | 24 | 20 | 1 | ||
Total | ||||||
Ethnicity | Malay | 49 | 19 | 13 | 3 | |
Chinese | 52 | 19 | 19 | 3 | ||
Indian | 8 | 4 | 2 | 0 | ||
Pakistani | 3 | 2 | 2 | 0 | ||
Total | ||||||
Year of Study | Year 1 | 72 | 30 | 22 | 4 | |
Year 2 | 40 | 14 | 14 | 2 | 0.992 | |
Total |
TABLE #D: Distribution of student responses to attitude and practice scenarios (general)
Avoid | Take action | Report | Refer | Total | P | |
Gender | Male | 115 | 30 | 12 | 19 | 0.947 |
Female | 106 | 28 | 15 | 16 | ||
Total | ||||||
Ethnicity | Malay | 92 | 24 | 13 | 14 | |
Chinese | 106 | 29 | 13 | 17 | ||
Indian | 16 | 3 | 0 | 3 | ||
Pakistani | 7 | 2 | 1 | 1 | ||
Total | ||||||
Year of Study | Year 1 | 146 | 37 | 17 | 20 | 0.743 |
Year 2 | 75 | 21 | 10 | 15 | ||
Total |
TABLE #E: Distribution of student responses to attitude and practice scenarios (Islamic)
Avoid | Take action | Report | Refer | Total | P | |
Gender | Male | 79 | 1 | 13 | 2 | 0.682 |
Female | 80 | 2 | 7 | 1 | ||
Total | ||||||
Ethnicity | Malay | 69 | 2 | 5 | 1 | 0.234 |
Chinese | 78 | 0 | 10 | 2 | ||
Indian | 8 | 1 | 3 | 0 | ||
Pakistani | 4 | 0 | 2 | 0 | ||
Total | ||||||
Year of Study | Year 1 | 105 | 1 | 12 | 2 | 0.794 |
Year 2 | 54 | 2 | 8 | 1 | ||
Total |
TABLE #F: Distribution of student responses to opinion (Islamic)
Avoid | Acceptable | Not Acceptable | Avoid | P | |
Gender | Male | 109 | 17 | 2 | 0.759 |
Female | 96 | 21 | 3 | ||
Total | |||||
Ethnicity | Malay | 86 | 16 | 2 | 1.000 |
Chinese | 99 | 18 | 3 | ||
Indian | 13 | 3 | 0 | ||
Pakistani | 7 | 1 | 0 | ||
Total | |||||
Year of Study | Year 1 | 136 | 22 | 2 | 0.498 |
Year 2 | 69 | 16 | 3 | ||
Total |
DISCUSSION
REFERENCES
Cowley C. The dangers of medical ethics. J Med Ethics. 2005 Dec;31(12):739-42.
The dominant conception of medical ethics being taught in British and American medical schools is at best pointless and at worst dangerous, or so it will be argued. Although it is laudable that medical schools have now given medical ethics a secure place in the curriculum, they go wrong in treating it like a scientific body of knowledge. Ethics is a unique subject matter precisely because of its widespread familiarity in all areas of life, and any teaching has to start from this shared ethical understanding and from the familiar ethical concepts of ordinary language. Otherwise there is a real risk that spurious technocratic jargon will be deployed by teacher and student alike in the futile search for intellectual respectability, culminating in a misplaced sense of having "done" the ethics module. There are no better examples of such jargon than "consequentialism", "deontology", and the "Four Principles". At best, they cannot do the work they were designed to do and, at worst, they can lead student and practitioner into ignoring their own healthy ethical intuitions and vocabulary.
Wofford JL , Ohl CA.
Teaching appropriate interactions with pharmaceutical company representatives: the impact of an innovative workshop on student attitudes.
BMC Med Educ. 2005 Feb 8;5(1):5.
The dominant conception of medical ethics being taught in British and American medical schools is at best pointless and at worst dangerous, or so it will be argued. Although it is laudable that medical schools have now given medical ethics a secure place in the curriculum, they go wrong in treating it like a scientific body of knowledge. Ethics is a unique subject matter precisely because of its widespread familiarity in all areas of life, and any teaching has to start from this shared ethical understanding and from the familiar ethical concepts of ordinary language. Otherwise there is a real risk that spurious technocratic jargon will be deployed by teacher and student alike in the futile search for intellectual respectability, culminating in a misplaced sense of having "done" the ethics module. There are no better examples of such jargon than "consequentialism", "deontology", and the "Four Principles". At best, they cannot do the work they were designed to do and, at worst, they can lead student and practitioner into ignoring their own healthy ethical intuitions and vocabulary.
Wofford JL , Ohl CA.
Teaching appropriate interactions with pharmaceutical company representatives: the impact of an innovative workshop on student attitudes.
BMC Med Educ. 2005 Feb 8;5(1):5.
BACKGROUND: Pharmaceutical company representatives (PCRs) influence the prescribing habits and professional behaviour of physicians. However, the skills for interacting with PCRs are not taught in the traditional medical school curriculum. We examined whether an innovative, mandatory workshop for third year medical students had immediate effects on knowledge and attitudes regarding interactions with PCRs. METHODS: Surveys issued before and after the workshop intervention solicited opinions (five point Likert scales) from third year students (n = 75) about the degree of bias in PCR information, the influence of PCRs on prescribing habits, the acceptability of specific gifts, and the educational value of PCR information for both practicing physicians and students. Two faculty members and one PCR led the workshop, which highlighted typical physician-PCR interactions, the use of samples and gifts, the validity and legal boundaries of PCR information, and associated ethical issues. Role plays with the PCR demonstrated appropriate and inappropriate strategies for interacting with PCRs. RESULTS: The majority of third year students (56%, 42/75) had experienced more than three personal conversations with a PCR about a drug product since starting medical school. Five percent (4/75) claimed no previous personal experience with PCRs. Most students (57.3%, 43/75) were not aware of available guidelines regarding PCR interactions. Twenty-eight percent of students (21/75) thought that none of the named activities/gifts (lunch access, free stethoscope, textbooks, educational CD-ROMS, sporting events) should be restricted, while 24.0% (8/75) thought that students should be restricted only from sporting events. The perceived educational value of PCR information to both practicing physicians and students increased after the workshop intervention from 17.7% to 43.2% (chi square, p = .0001), and 22.1% to 40.5% (p = .0007), respectively. Student perceptions of the degree of bias of PCR information decreased from 84.1% to 72.9% (p = .065), but the perceived degree of influence on prescribing increased (44.2% to 62.1% (p = .02)). CONCLUSIONS: Students have exposure to PCRs early in their medical training. A single workshop intervention may influence student attitudes toward interactions with PCRs. Students were more likely to acknowledge the educational value of PCR interactions and their impact on prescribing after the workshop intervention.
Berlinger N, Wu AW.
Subtracting insult from injury: addressing cultural expectations in the disclosure of medical error. J Med Ethics. 2005 Feb;31(2):106-8.
This article proposes that knowledge of cultural expectations concerning ethical responses to unintentional harm can help students and physicians better to understand patients' distress when physicians fail to disclose, apologize for, and make amends for harmful medical errors. While not universal, the Judeo-Christian traditions of confession, repentance, and forgiveness inform the cultural expectations of many individuals within secular western societies. Physicians' professional obligations concerning truth telling reflect these expectations and are inclusive of the disclosure of medical error, while physicians may express a need for self-forgiveness after making errors and should be aware that patients may also rely upon forgiveness as a means of dealing with harm. The article recommends that learning how to disclose errors, apologize to injured patients, ensure that these patients' needs are met, and confront the emotional dimensions of one's own mistakes should be part of medical education and reinforced by the conduct of senior physicians.
Subtracting insult from injury: addressing cultural expectations in the disclosure of medical error. J Med Ethics. 2005 Feb;31(2):106-8.
This article proposes that knowledge of cultural expectations concerning ethical responses to unintentional harm can help students and physicians better to understand patients' distress when physicians fail to disclose, apologize for, and make amends for harmful medical errors. While not universal, the Judeo-Christian traditions of confession, repentance, and forgiveness inform the cultural expectations of many individuals within secular western societies. Physicians' professional obligations concerning truth telling reflect these expectations and are inclusive of the disclosure of medical error, while physicians may express a need for self-forgiveness after making errors and should be aware that patients may also rely upon forgiveness as a means of dealing with harm. The article recommends that learning how to disclose errors, apologize to injured patients, ensure that these patients' needs are met, and confront the emotional dimensions of one's own mistakes should be part of medical education and reinforced by the conduct of senior physicians.
Goldie J, Schwartz L, Morrison J. Sex and the surgery: students' attitudes and potential behaviour as they pass through a modern medical curriculum. J Med Ethics. 2004 Oct;30(5):480-6.
OBJECTIVE: To examine students' attitudes and potential behaviour to a possible intimate relationship with a patient as they pass through a modern medical curriculum. DESIGN: A cohort study of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS: Students' pre year 1 and post year 1, post year 3, and post year 5 responses to the "attractive patient" vignette of the Ethics in Health Care Survey instrument were examined quantitatively and qualitatively. Analysis of students' multi-choice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to enter a relationship or not were also identified. RESULTS: No significant movement towards consensus was found at any point in the curriculum. There was little improvement in students' performance in terms of knowledge content and their abilities to recognise the values inherent in the vignette. In deciding to enter a relationship with the patient the most frequently used reasoning was that it could be justified if the patient changed their doctor. CONCLUSIONS: Teaching on the subject of sexual or improper relationships between doctors and patients, including relationships with former patients requires to be made explicit. Case based teaching would fit in with the ethos of the problem based, integrated medical curriculum.
OBJECTIVE: To examine students' attitudes and potential behaviour to a possible intimate relationship with a patient as they pass through a modern medical curriculum. DESIGN: A cohort study of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS: Students' pre year 1 and post year 1, post year 3, and post year 5 responses to the "attractive patient" vignette of the Ethics in Health Care Survey instrument were examined quantitatively and qualitatively. Analysis of students' multi-choice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to enter a relationship or not were also identified. RESULTS: No significant movement towards consensus was found at any point in the curriculum. There was little improvement in students' performance in terms of knowledge content and their abilities to recognise the values inherent in the vignette. In deciding to enter a relationship with the patient the most frequently used reasoning was that it could be justified if the patient changed their doctor. CONCLUSIONS: Teaching on the subject of sexual or improper relationships between doctors and patients, including relationships with former patients requires to be made explicit. Case based teaching would fit in with the ethos of the problem based, integrated medical curriculum.
Goldie J , Schwartz L, Morrison J. Students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. J Med Ethics. 2004 Aug;30(4):371-6.
OBJECTIVE: To examine students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. DESIGN: Cohort design. SETTING: University of Glasgow Medical School, United Kingdom. SUBJECTS: A cohort of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS: Students' responses before and after year 1, after year 3, and after year 5 to the assisted suicide vignette of the Ethics in Health Care Survey instrument, were examined quantitatively and qualitatively. Analysis of students' multichoice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to withdraw treatment or not were also identified. RESULTS: Students' answers were found to be consistent with professional consensus opinion precurriculum and remained so throughout the curriculum. There was an improvement in the knowledge content of the written responses following the first year of the curriculum, which was sustained postcurriculum. However, students were found to analyse the section mainly in terms of autonomy, with few responses considering the other main ethical principles or the wider ethical perspective. Students were unclear on their legal responsibilities. CONCLUSIONS: Students should be encouraged to consider all relevant ethical principles and the wider ethical perspective when deliberating ethical dilemmas. Students should have a clear understanding of their legal responsibilities.
Goldie J , Schwartz L, Morrison J. Students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. J Med Ethics. 2004 Aug;30(4):371-6
OBJECTIVE: To examine students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. DESIGN: Cohort design. SETTING: University of Glasgow Medical School, United Kingdom. SUBJECTS: A cohort of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS: Students' responses before and after year 1, after year 3, and after year 5 to the assisted suicide vignette of the Ethics in Health Care Survey instrument, were examined quantitatively and qualitatively. Analysis of students' multichoice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to withdraw treatment or not were also identified. RESULTS: Students' answers were found to be consistent with professional consensus opinion precurriculum and remained so throughout the curriculum. There was an improvement in the knowledge content of the written responses following the first year of the curriculum, which was sustained postcurriculum. However, students were found to analyse the section mainly in terms of autonomy, with few responses considering the other main ethical principles or the wider ethical perspective. Students were unclear on their legal responsibilities. CONCLUSIONS: Students should be encouraged to consider all relevant ethical principles and the wider ethical perspective when deliberating ethical dilemmas. Students should have a clear understanding of their legal responsibilities.
Goldie J , Schwartz L, Morrison J. Students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. J Med Ethics. 2004 Aug;30(4):371-6
OBJECTIVE: To examine students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. DESIGN: Cohort design. SETTING: University of Glasgow Medical School, United Kingdom. SUBJECTS: A cohort of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS: Students' responses before and after year 1, after year 3, and after year 5 to the assisted suicide vignette of the Ethics in Health Care Survey instrument, were examined quantitatively and qualitatively. Analysis of students' multichoice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to withdraw treatment or not were also identified. RESULTS: Students' answers were found to be consistent with professional consensus opinion precurriculum and remained so throughout the curriculum. There was an improvement in the knowledge content of the written responses following the first year of the curriculum, which was sustained postcurriculum. However, students were found to analyse the section mainly in terms of autonomy, with few responses considering the other main ethical principles or the wider ethical perspective. Students were unclear on their legal responsibilities. CONCLUSIONS: Students should be encouraged to consider all relevant ethical principles and the wider ethical perspective when deliberating ethical dilemmas. Students should have a clear understanding of their legal responsibilities.
Katz RV, Kegeles SS, Green BL, Kressin NR, James SA, Claudio C.The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits. Dent Clin North Am. 2003 Jan;47(1):1-19
This article is intended to provide a relatively complete picture of how a pilot study--conceived and initiated within an NIDCR-funded RRCMOH--matured into a solid line of investigation within that center and "with legs" into a fully funded study within the next generation of NIDCR centers on this topic of health disparities, the Centers for Research to Reduce Oral Health Disparities. It highlights the natural opportunity that these centers provide for multicenter. cross-disciplinary research and for research career pipelining for college and dental school students; with a focus, in this case, on minority students. Futhermore, this series of events demonstrates the rich potential that these types of research centers have to contribute in ways that far exceed the scientific outcomes that form their core. In this instance, the NMOHRC played a central--and critical, if unanticipated--role in contributing to two events of national significance, namely the presidential apology to the African American community for the research abuses of the USPHS--Tuskegee syphilis study and the establishment of the National Center for Bioethics in Research and Health Care at Tuskegee University. Research Centers supported by the NIH are fully intended to create a vortex of scientific activity that goes well beyond the direct scientific aims of the studies initially funded within those centers. The maxim is that the whole should be greater than the sum of its initial constituent studies or parts. We believe that NMOHRC did indeed achieve that maxim--even extending "the whole" to include broad societal impact. well beyond the scope of important, but mere, scientific outcomes--all within the concept and appropriate functions of a scientific NIH-funded research center.
This article is intended to provide a relatively complete picture of how a pilot study--conceived and initiated within an NIDCR-funded RRCMOH--matured into a solid line of investigation within that center and "with legs" into a fully funded study within the next generation of NIDCR centers on this topic of health disparities, the Centers for Research to Reduce Oral Health Disparities. It highlights the natural opportunity that these centers provide for multicenter. cross-disciplinary research and for research career pipelining for college and dental school students; with a focus, in this case, on minority students. Futhermore, this series of events demonstrates the rich potential that these types of research centers have to contribute in ways that far exceed the scientific outcomes that form their core. In this instance, the NMOHRC played a central--and critical, if unanticipated--role in contributing to two events of national significance, namely the presidential apology to the African American community for the research abuses of the USPHS--Tuskegee syphilis study and the establishment of the National Center for Bioethics in Research and Health Care at Tuskegee University. Research Centers supported by the NIH are fully intended to create a vortex of scientific activity that goes well beyond the direct scientific aims of the studies initially funded within those centers. The maxim is that the whole should be greater than the sum of its initial constituent studies or parts. We believe that NMOHRC did indeed achieve that maxim--even extending "the whole" to include broad societal impact. well beyond the scope of important, but mere, scientific outcomes--all within the concept and appropriate functions of a scientific NIH-funded research center.
Elnicki DM , Lescisin DA, Case S. Improving the National Board of Medical Examiners internal Medicine Subject Exam for use in clerkship evaluation. J Gen Intern Med. 2002 Jun;17(6):435-40.
OBJECTIVE: To provide a consensus opinion on modifying the National Board of Medical Examiners (NBME) Medicine Subject Exam (Shelf) to: 1) reflect the internal medicine clerkship curriculum, developed by the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM); 2) emphasize knowledge important for a clerkship student; and 3) obtain feedback about students' performances on the Shelf. DESIGN: Two-round Delphi technique. PARTICIPANTS: The CDIM Research and Evaluation Committee and CDIM members on NBME Step 2 Committees. MEASUREMENTS: Using 1-5 Likert scales (5 = highest ratings), the group rated test question content for relevance to the SGIM-CDIM Curriculum Guide and importance for clerkship students' knowledge. The Shelf content is organized into 4 physician tasks and into 11 sections that are generally organ system based. Each iteration of the Shelf has 100 questions. Participants indicated a desired distribution of questions by physician task and section, topics critical for inclusion on each exam, and new topics to include. They specified the types of feedback clerkship directors desired on students' performances. Following the first round, participants viewed pooled results prior to submitting their second-round responses. RESULTS: Of 15 individuals contacted, 12 (80%) participated in each round. The desired distribution by physician task was: diagnosis (43), treatment (23), mechanism of disease (20), and health maintenance (15). The sections with the most questions requested were the cardiovascular (17), respiratory (15), and gastroenterology (12) sections. The fewest were requested in aging/ethics (4) and neurology, dermatology, and immunology (5 each). Examples of low-rated content were Wilson's Disease, chancroid and tracheal rupture (all <2.0). Health maintenance in type 2 diabetes, hypertension, and cardiovascular disease all received 5.0 ratings. Participants desired feedback by: section (4.6) and physician task (3.9), on performances of the entire class (4.0), and for individual students (3.8). CONCLUSION: Clerkship directors identified test content that was relevant to the curricular content and important for clerkship students to know, and they indicated a desired question distribution. They would most like feedback on their students' performance by organ system-based sections for the complete academic year. This collaborative effort could serve as a model for aligning national exams with course goals.
Nilstun T , Cuttini M, Saracci R. Teaching medical ethics to experienced staff: participants, teachers and method. J Med Ethics. 2001 Dec;27(6):409-12
Almost all articles on education in medical ethics present proposals for or describe experiences of teaching students in different health professions. Since experienced staff also need such education, the purpose of this paper is to exemplify and discuss educational approaches that may be used after graduation. As an example we describe the experiences with a five-day European residential course on ethics for neonatal intensive care personnel. In this multidisciplinary course, using a case-based approach, the aim was to enhance the participants' understanding of ethical principles and their relevance to clinical and research activities. Our conclusion is that working with realistic cases encourages practising nurses and physicians to apply their previous knowledge and new concepts learnt in the course, thus helping them to bridge the gap between theory and practice.
Lowe M, Kerridge I, Bore M, Munro D, Powis D.Is it possible to assess the "ethics" of medical school applicants? J Med Ethics. 2001 Dec;27(6):404-8
Questions surrounding the assessment of medical school applicants' morality are difficult but they are nevertheless important for medical schools to consider. It is probably inappropriate to attempt to assess medical school applicants' ethical knowledge, moral reasoning, or beliefs about ethical issues as these all may be developed during the process of education. Attitudes towards ethical issues and ethical sensitivity, however, might be tested in the context of testing for personality attributes. Before any "ethics" testing is introduced as part of screening for admission to medical school it would require validation. We suggest a number of ways in which this might be achieved.
Questions surrounding the assessment of medical school applicants' morality are difficult but they are nevertheless important for medical schools to consider. It is probably inappropriate to attempt to assess medical school applicants' ethical knowledge, moral reasoning, or beliefs about ethical issues as these all may be developed during the process of education. Attitudes towards ethical issues and ethical sensitivity, however, might be tested in the context of testing for personality attributes. Before any "ethics" testing is introduced as part of screening for admission to medical school it would require validation. We suggest a number of ways in which this might be achieved.
Savulescu J, Crisp R, Fulford KW, Hope T.Evaluating ethics competence in medical education. J Med Ethics. 1999 Oct;25(5):367-74
We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across institutions.
We critically evaluate the ways in which competence in medical ethics has been evaluated. We report the initial stage in the development of a relevant, reliable and valid instrument to evaluate core critical thinking skills in medical ethics. This instrument can be used to evaluate the impact of medical ethics education programmes and to assess whether medical students have achieved a satisfactory level of performance of core skills and knowledge in medical ethics, within and across institutions.