What is the Future of Ethics Education in Medical Schools?

By Micah Hester

In 2004, Lisa Lehman and colleagues noted that “Despite widespread agreement that ethics should be taught [in medical schools], there is little formal consensus concerning what, when, and how medical ethic is best taught” (2004, 682).  Eleven years later, the Project to Rebalance and Integrate Medical Education (PRIME) group in its Romanell Report (2015) followed like Lehman when saying, “Despite broad consensus on the importance of teaching medical ethics and professionalism, there is no consensus about the specific goals of medical ethics education for future physicians, the essential knowledge and skills learners should acquire, the best methodologies and processes for instruction, and the optimal strategies for assessment.”  In other words, we know that the content, form, place, and number of hours in the curriculum devoted to the ethics (and related concerns such as professionalism and values clarification) varies greatly.  There are roughly 170 medical schools (both allopathic and osteopathic) in the United States and Canada, and there are roughly 170 different ways that ethics is taught to medical students across the continent…

Of course, this phenomenon is not unique to ethics training in medical schools.  There are many more undergraduate colleges and many more ways, say, introduction to philosophy is taught.  Be that as it may while the PRIME group developed objectives for education, there has not been much push to take up those objectives across the country.  We are left with this question:  What, then, does the future look like for ethics education in medical school?  I would suggest three things must become our focus as educators.

  1. Content:  A basic question, not always asked, is- What should every medical student, regardless of school or curricular style, be exposed to regarding ethics? Of course, there is room for variances but as PRIME has suggested, we need to agree upon and implement consistent objectives.
  2. Evaluation:  Let’s face it, medical ethics education is but a small aspect of personal and professional development. Students come to school having already developed interests and values (even if not always well considered), and the pressures and culture of medical education affect attitudes and ideals. As such, medical ethics education would do well to aim at developing ethical sensitivity and reflection in light of the ethics content (see #1) provided.  Sensitivity and reflection can be evaluated, but we have done little to develop and validate out evaluative methods.  One suggestion in the literature is the use of Medical Ethics Bowl (Merrick, et al 2016—full disclosure, I’m one of the authors) as robust analytic process that provides substantive evaluation and feedback.
  3. Creative expansion:  The pressures of the curricular schedule continue to squeeze the ability to deliver content successfully.  Developing new modalities and identifying new venues for ethics training is a must.  Again, Medical Ethics Bowls (see #2) can deliver content while providing evaluation, and the content is garnered through active learning and adult-centered educational processes.  Interprofessional educational opportunities allows for content delivery to multiple professions at once. Also, better integration of humanities and communications content with ethics can make ethics education more effective with greater scope and impact.

While I applaud the PRIME initiative and the subsequent development of the Academy for Professionalism in Health Care, more must be done to create a dialogue among medical ethics educators about medical ethics education itself.  The American Society for Bioethics and Humanities (ASBH) itself has been slow to take up the educational aspect of professional bioethics and humanities, preferring to focus on scholarship and research into specific ethical issues and humanistic considerations.  That is, ASBH focuses almost exclusively on educating and developing bioethicists, giving little support to the education that bioethicist can provide others.

It is time to make medical ethics education a priority.

 hester-b
Micah Hester, PhD, is Chief of Medical Humanities and Professor of Medical Humanities and Pediatrics at the University of Arkansas for Medical Sciences (UAMS).  He also serves as clinical ethicist at both UMAS and Arkansas Children’s Hospital.

4 thoughts on “What is the Future of Ethics Education in Medical Schools?

  1. Do you think medical students should be encouraged to think critically about ethical issues and debate it in classes? I am a medical student that started a blog on my views of certain ethical issues. I think that while doing research and thinking critically about these issues my ethical reasoning has been expanded.

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  2. Yes, design curriculum around the questions of what is it that we want students to know or do as a result of our interventions and how will we know if students actually know or do it (whatever *it* is) well enough. Accreditation standards, e.g. LCME, offer vague directives for ethics-related education outcomes like, teach students to be ethical and be compassionate, etc. I think the EPAs are promising for future ethics education development in medical schools. PS There is an affinity group at the ASBH devoted to teaching ethics to health professions students which has had a sizeable audience at the group’s meeting, and I am encouraged by this interest among the conference attendees at least.

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  3. Entirely agree we need to trumpet the importance of ethics education during medical school and beyond. Integration with other topics, from foundational sciences to clinical medicine to other humanities is key. I suspect the diversity of approaches around the country signals not that we are lost, but that there are many good ways to achieve our goals. What we need to define better, despite recent high quality early efforts like PRIME, are curricular sufficiency metrics so those interested in teaching ethics can make a case for adequate curricular inclusion more effectively, whatever specific form it takes. Comparative research, too, may help us focus our efforts on promising approaches like the one you mention, although I suspect we’ll find the most important ways we affect our students are also the hardest to measure. Looking forward to working with you and others as this evolves.

    Thanks for writing!
    Tim Lahey, MD MMSc
    Associate Professor of Medicine, Dartmouth’s Geisel School of Medicine
    Director of Education, The Dartmouth Institute for Health Policy and Clinical Practice
    Chair, Clinical Ethics Committee, Dartmouth-Hitchcock Medical Center

    Like

  4. I am agarre with this concern about what And who teach ethics in medical school
    In Mexico now is obligatory to teach palliative care and general hospitals had a committe in bioethics
    So I would like to know much about PRIMe program
    Best rewards

    Like

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