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.
- 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.
- 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.
- 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.
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.