Teaching ethics in the medical schools

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Teaching ethics in the medical schools

  1. 1. ethics in the curriculumethics in the curriculum of biomedical & relatedof biomedical & related programs in africa: past,programs in africa: past, present and futurepresent and future Omotade O. O.Omotade O. O. College of MedicineCollege of Medicine University of Ibadan,University of Ibadan, Ibadan, NigeriaIbadan, Nigeria
  2. 2. Which biomedical and related programs?Which biomedical and related programs? • Faculties and Departments of Sciences inFaculties and Departments of Sciences in Universities, Polytechnics and ResearchUniversities, Polytechnics and Research Institutes.Institutes. • Faculties and Departments of SocialFaculties and Departments of Social SciencesSciences • Colleges of MedicineColleges of Medicine • Schools and Colleges of Nursing and AlliedSchools and Colleges of Nursing and Allied health professionalshealth professionals • Other tertiary educational and researchOther tertiary educational and research establishments who carry out research orestablishments who carry out research or interaction with humans……..interaction with humans……..
  3. 3. Curriculum (and ethics) in the pastCurriculum (and ethics) in the past • Certain things typified curriculum in theCertain things typified curriculum in the past and these are:-past and these are:- Based on colonial templates and notBased on colonial templates and not transferable to non-related coloniestransferable to non-related colonies Non uniform curriculum for Africa per seNon uniform curriculum for Africa per se It’s easier to access the colonial overlords thanIt’s easier to access the colonial overlords than next door neighbour hence harmonization ofnext door neighbour hence harmonization of curriculum was hardly practicable.curriculum was hardly practicable. Whatever principles of ethics (legal codes)Whatever principles of ethics (legal codes) operated in the individual countries were eitheroperated in the individual countries were either direct transfer from colonial programs ordirect transfer from colonial programs or modifications of samemodifications of same
  4. 4. Curriculum and ethics in the nowCurriculum and ethics in the now Not much change (as the map of Africa)Not much change (as the map of Africa) Whatever changes are being pushed fromWhatever changes are being pushed from outside the continentoutside the continent Colonial allegiance much more thanColonial allegiance much more than languagelanguage differences still a major barrierdifferences still a major barrier Collaborations (rays of hope) areCollaborations (rays of hope) are subject/project/donor driven and not ethics orsubject/project/donor driven and not ethics or curriculum drivencurriculum driven Current diversity is welcomed but there must beCurrent diversity is welcomed but there must be unity in the diversity (way forward!)unity in the diversity (way forward!)
  5. 5. Curriculum and ethics in the futureCurriculum and ethics in the future  Whatever is promoting people talking together shouldWhatever is promoting people talking together should be continued and intensified!be continued and intensified!  Recommendations and communiqués should beRecommendations and communiqués should be acted upon!acted upon! Some of the expected major actorsSome of the expected major actors  Africans! Africans!! and Africans!!!Africans! Africans!! and Africans!!!  African Union (both political and scientific machinery)African Union (both political and scientific machinery)  International Communities, Bodies and InstitutionsInternational Communities, Bodies and Institutions  Universities and Colleges on Africa (AAU)Universities and Colleges on Africa (AAU)  Lovers of AfricaLovers of Africa  Etc etc………Etc etc………
  6. 6. Practical suggestions of how toPractical suggestions of how to include ethics in the curriculuminclude ethics in the curriculum case study:-case study:- Medical schools, and Universities !Medical schools, and Universities !
  7. 7. Justification:-Justification:-  Though medicine is based on empirical andThough medicine is based on empirical and scientific principles, doctor-patientscientific principles, doctor-patient relationship and the practice of medicine is arelationship and the practice of medicine is a profoundly human endeavour.profoundly human endeavour.  Critical thinking skills and analyticalCritical thinking skills and analytical techniques from various humanities disciplinestechniques from various humanities disciplines is known to help physicians and futureis known to help physicians and future physicians understand the implications andphysicians understand the implications and context of their actions.context of their actions.
  8. 8. Patients’ views and perceptions on illness and treatmentPatients’ views and perceptions on illness and treatment (often irrational to physicians and students) have a(often irrational to physicians and students) have a bearing on their outcome.bearing on their outcome.  Introduction of medical humanities and ethics canIntroduction of medical humanities and ethics can provide insight into such concepts as professionalism,provide insight into such concepts as professionalism, communication, empathy and a critical evaluation ofcommunication, empathy and a critical evaluation of biomedical research and policybiomedical research and policy  Skills in ethical reasoning, improvement in medicalSkills in ethical reasoning, improvement in medical decision making, easier recognition of ethical issues indecision making, easier recognition of ethical issues in day-today practice.day-today practice.  Handling dilemmas daily encountered in practice whileHandling dilemmas daily encountered in practice while in training and afterwardsin training and afterwards
  9. 9. Laying the background for inter-Laying the background for inter- disciplinary collaboration often needed fordisciplinary collaboration often needed for result-oriented biomedical researchresult-oriented biomedical research  GuidinG principles:-GuidinG principles:- Ethics contribute to high quality patient care andEthics contribute to high quality patient care and professional behaviourprofessional behaviour Knowledge of ethics could allow medical trainees toKnowledge of ethics could allow medical trainees to become better practitioners of medicinebecome better practitioners of medicine Ethics taught, learned and evaluated along with theEthics taught, learned and evaluated along with the general medical knowledge is better incorporatedgeneral medical knowledge is better incorporated into practice.into practice. Ethics is better taught and retained when studentsEthics is better taught and retained when students are still impressionable and malleable.are still impressionable and malleable.
  10. 10. Goals:-Goals:- To incorporate ethical concerns and issues intoTo incorporate ethical concerns and issues into all phases of the education of medicalall phases of the education of medical studentsstudents To help prepare students to understand theirTo help prepare students to understand their own values and be ethically aware medicalown values and be ethically aware medical practitionerspractitioners To provide students with the knowledge, skillsTo provide students with the knowledge, skills and attitudes required to be able to makeand attitudes required to be able to make ethically-informed decisionsethically-informed decisions Reflect on their own beliefs about ethics andReflect on their own beliefs about ethics and consider and challenge opposing beliefsconsider and challenge opposing beliefs
  11. 11. Goals in briefGoals in brief Improve the quality of patient careImprove the quality of patient care Teaching should focus on cognitive skills ,Teaching should focus on cognitive skills , behavioural skills and character developmentbehavioural skills and character development Teaching should be integrated into all stagesTeaching should be integrated into all stages of a physicians education, including medicalof a physicians education, including medical schools, residency and continuing educationschools, residency and continuing education But can ethics be taught?But can ethics be taught? Can character or virtue be taught?Can character or virtue be taught? Are there enough people to teach?Are there enough people to teach? Will teaching ethics make any difference?Will teaching ethics make any difference?
  12. 12. ImplementatIonImplementatIon Taking into account the different curriculumTaking into account the different curriculum in Africa’s medical schools, introducing formalin Africa’s medical schools, introducing formal training in ethics would highlight principles fortraining in ethics would highlight principles for general discussion.general discussion. Formal training in ethics should be undertakenFormal training in ethics should be undertaken throughout the period of study in the medicalthroughout the period of study in the medical school (from the pre-clinical years till graduation)school (from the pre-clinical years till graduation) Training format should include didactic lectures,Training format should include didactic lectures, seminar presentations, case presentations andseminar presentations, case presentations and attendance at IRBs and cERC meetingsattendance at IRBs and cERC meetings
  13. 13. ImplementatIon (contd.)ImplementatIon (contd.) To ensure that courses are taken seriously, thereTo ensure that courses are taken seriously, there must be compulsory, elective and requiredmust be compulsory, elective and required courses should have their examinations and scorescourses should have their examinations and scores that count towards graduation. Individual orthat count towards graduation. Individual or group projects should be part of graduationgroup projects should be part of graduation requirements.requirements. Clinical ethical teaching should be started fromClinical ethical teaching should be started from the first year right through to the graduatingthe first year right through to the graduating years.years. Non-medical students who intend to undertakeNon-medical students who intend to undertake research with human subjects should be allowedresearch with human subjects should be allowed to participate in the programmeto participate in the programme
  14. 14. ImplementatIon (contd.)ImplementatIon (contd.) Students groups should be given advisors drawnStudents groups should be given advisors drawn from a multidisciplinary pool of appropriatelyfrom a multidisciplinary pool of appropriately trained staff members from Law, Social sciences,trained staff members from Law, Social sciences, Medicine, Medical Humanities, Nursing, and otherMedicine, Medical Humanities, Nursing, and other interested faculties.interested faculties. Provision should be made for those who wouldProvision should be made for those who would ultimate specialize in medical ethics by a gradualultimate specialize in medical ethics by a gradual build up of facilities and faculty membersbuild up of facilities and faculty members capable of imparting postgraduate level trainingcapable of imparting postgraduate level training in Biomedical ethics.in Biomedical ethics.
  15. 15. SuggeSted Input IntoSuggeSted Input Into currIculumcurrIculum First yearFirst year:- type of courses and no of units to be:- type of courses and no of units to be determined by each institutiondetermined by each institution - The nature of man in health and in sickness- The nature of man in health and in sickness - Differences between the sexes and between the ages- Differences between the sexes and between the ages - History and development of biomedical ethics- History and development of biomedical ethics - Introduction to the principles of biomedical ethics- Introduction to the principles of biomedical ethics including patient confidentiality, informed consent,including patient confidentiality, informed consent, privacy, autonomy, non-maleficence, beneficence andprivacy, autonomy, non-maleficence, beneficence and justice.justice. - Case studies of situations expressing adherence or non-- Case studies of situations expressing adherence or non- adherence to these principles.adherence to these principles. - Term papers and assignments- Term papers and assignments
  16. 16. Second yearSecond year - Rights and responsibilities (patients and health workers) inRights and responsibilities (patients and health workers) in health carehealth care - Practical application of reasoning skills to some of thePractical application of reasoning skills to some of the clinical cases discussed in the first year.clinical cases discussed in the first year. - International and national guidelines directing researchInternational and national guidelines directing research and clinical practice.and clinical practice. - Case studies of situations expressing adherence or non-Case studies of situations expressing adherence or non- adherence to ethical principles.adherence to ethical principles. - Being a good doctorBeing a good doctor - Dealing with drug company promotionsDealing with drug company promotions - Term papers and assignmentsTerm papers and assignments
  17. 17. Third yearThird year - Medicine and the LawMedicine and the Law - Conflict of interestsConflict of interests - Medical mistakesMedical mistakes - MalpracticesMalpractices - ProfessionalismProfessionalism - Informed consent (revisited)Informed consent (revisited) - Patient participation in researchPatient participation in research - Vulnerable subjectsVulnerable subjects - Breaking bad news (I)Breaking bad news (I) - Ethics in paediatricsEthics in paediatrics
  18. 18. Fourth yearFourth year • - breaking bad news (II)- breaking bad news (II) • - do-not-resuscitate orders- do-not-resuscitate orders • - withholding and withdrawing treatments- withholding and withdrawing treatments • - end of life decisions, advance directives etc.- end of life decisions, advance directives etc. • - legalising abortions (seminar forum, for and against)- legalising abortions (seminar forum, for and against) • - care of the elderly- care of the elderly • - care of the disabled- care of the disabled • - ethics, law and the child.- ethics, law and the child. • - confidentiality revisited (STIs and Family planning)- confidentiality revisited (STIs and Family planning) • - case follow up in Paediatric and/Obstetric unit for write up- case follow up in Paediatric and/Obstetric unit for write up
  19. 19. Fifth yearFifth year • - breaking bad news (III)- breaking bad news (III) • - informed consent in surgery and invasive procedures- informed consent in surgery and invasive procedures • - patient participation in research- patient participation in research • - involving children and other vulnerable subjects in research- involving children and other vulnerable subjects in research • - ethical issues in research, randomization, placebo controlled- ethical issues in research, randomization, placebo controlled trialstrials • - ethics and the law in mental health- ethics and the law in mental health • - community consent how culturally appropriate and how- community consent how culturally appropriate and how legallegal • - project- project • - seminars- seminars
  20. 20. Additional facilities and resources needed forAdditional facilities and resources needed for appropriate establishment of this programme in theappropriate establishment of this programme in the Medical schoolsMedical schools  On-going staff development in the area of biomedicalOn-going staff development in the area of biomedical ethicsethics  Establishment of Centres for Biomedical EthicsEstablishment of Centres for Biomedical Ethics  Provision of resources materials by way of journals,Provision of resources materials by way of journals, books and virtual librariesbooks and virtual libraries  Possibility of a combined degree in medicine andPossibility of a combined degree in medicine and bioethics for excellent students.bioethics for excellent students.  Collaboration with other establishments with andCollaboration with other establishments with and outside Africa for appropriate development of ethics inoutside Africa for appropriate development of ethics in our medical schoolsour medical schools  Postgraduate programme in biomedical ethics.Postgraduate programme in biomedical ethics.
  21. 21. Thank you for listeningThank you for listening • Meanwhile let’sMeanwhile let’s discussdiscuss

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