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Teaching ethics in the medical schools






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    Teaching ethics in the medical schools Teaching ethics in the medical schools Presentation Transcript

    • ethics in the curriculum of biomedical & related programs in africa: past, present and future Omotade O. O. College of Medicine University of Ibadan, Ibadan, Nigeria
    • Which biomedical and related programs?
      • Faculties and Departments of Sciences in Universities, Polytechnics and Research Institutes.
      • Faculties and Departments of Social Sciences
      • Colleges of Medicine
      • Schools and Colleges of Nursing and Allied health professionals
      • Other tertiary educational and research establishments who carry out research or interaction with humans……..
    • Curriculum (and ethics) in the past
      • Certain things typified curriculum in the past and these are:-
        • Based on colonial templates and not transferable to non-related colonies
        • Non uniform curriculum for Africa per se
        • It’s easier to access the colonial overlords than next door neighbour hence harmonization of curriculum was hardly practicable.
        • Whatever principles of ethics (legal codes) operated in the individual countries were either direct transfer from colonial programs or modifications of same
    • Curriculum and ethics in the now
      • Not much change (as the map of Africa)
        • Whatever changes are being pushed from outside the continent
        • Colonial allegiance much more than language differences still a major barrier
        • Collaborations (rays of hope) are subject/project/donor driven and not ethics or curriculum driven
        • Current diversity is welcomed but there must be unity in the diversity (way forward!)
    • Curriculum and ethics in the future
      • Whatever is promoting people talking together should be continued and intensified!
      • Recommendations and communiqués should be acted upon!
        • Some of the expected major actors
        • Africans! Africans!! and Africans!!!
        • African Union (both political and scientific machinery)
        • International Communities, Bodies and Institutions
        • Universities and Colleges on Africa (AAU)
        • Lovers of Africa
        • Etc etc………
    • Practical suggestions of how to include ethics in the curriculum case study:-
      • Medical schools, and Universities !
    • Justification:-
      • Though medicine is based on empirical and scientific principles, doctor-patient relationship and the practice of medicine is a profoundly human endeavour.
      • Critical thinking skills and analytical techniques from various humanities disciplines is known to help physicians and future physicians understand the implications and context of their actions.
      • Patients’ views and perceptions on illness and treatment (often irrational to physicians and students) have a bearing on their outcome.
      • Introduction of medical humanities and ethics can provide insight into such concepts as professionalism, communication, empathy and a critical evaluation of biomedical research and policy
      • Skills in ethical reasoning, improvement in medical decision making, easier recognition of ethical issues in day-today practice.
      • Handling dilemmas daily encountered in practice while in training and afterwards
      • Laying the background for inter-disciplinary collaboration often needed for result-oriented biomedical research
      • Guiding principles:-
        • Ethics contribute to high quality patient care and professional behaviour
        • Knowledge of ethics could allow medical trainees to become better practitioners of medicine
        • Ethics taught, learned and evaluated along with the general medical knowledge is better incorporated into practice.
        • Ethics is better taught and retained when students are still impressionable and malleable.
    • Goals:-
        • To incorporate ethical concerns and issues into all phases of the education of medical students
        • To help prepare students to understand their own values and be ethically aware medical practitioners
        • To provide students with the knowledge, skills and attitudes required to be able to make ethically-informed decisions
        • Reflect on their own beliefs about ethics and consider and challenge opposing beliefs
    • Goals in brief
      • Improve the quality of patient care
      • Teaching should focus on cognitive skills , behavioural skills and character development
      • Teaching should be integrated into all stages of a physicians education, including medical schools, residency and continuing education
        • But can ethics be taught?
        • Can character or virtue be taught?
        • Are there enough people to teach?
        • Will teaching ethics make any difference?
    • Implementation
      • Taking into account the different curriculum in Africa’s medical schools, introducing formal training in ethics would highlight principles for general discussion.
        • Formal training in ethics should be undertaken throughout the period of study in the medical school (from the pre-clinical years till graduation)
        • Training format should include didactic lectures, seminar presentations, case presentations and attendance at IRBs and cERC meetings
    • Implementation (contd.)
        • To ensure that courses are taken seriously, there must be compulsory, elective and required courses should have their examinations and scores that count towards graduation. Individual or group projects should be part of graduation requirements.
        • Clinical ethical teaching should be started from the first year right through to the graduating years.
        • Non-medical students who intend to undertake research with human subjects should be allowed to participate in the programme
    • Implementation (contd.)
        • Students groups should be given advisors drawn from a multidisciplinary pool of appropriately trained staff members from Law, Social sciences, Medicine, Medical Humanities, Nursing, and other interested faculties.
        • Provision should be made for those who would ultimate specialize in medical ethics by a gradual build up of facilities and faculty members capable of imparting postgraduate level training in Biomedical ethics.
    • Suggested input into curriculum
        • First year :- type of courses and no of units to be determined by each institution
          • - The nature of man in health and in sickness
          • - Differences between the sexes and between the ages
          • - History and development of biomedical ethics
          • - Introduction to the principles of biomedical ethics including patient confidentiality, informed consent, privacy, autonomy, non-maleficence, beneficence and justice.
          • - Case studies of situations expressing adherence or non-adherence to these principles.
          • - Term papers and assignments
      • Second year
        • Rights and responsibilities (patients and health workers) in health care
        • Practical application of reasoning skills to some of the clinical cases discussed in the first year.
        • International and national guidelines directing research and clinical practice.
        • Case studies of situations expressing adherence or non-adherence to ethical principles.
        • Being a good doctor
        • Dealing with drug company promotions
        • Term papers and assignments
      • Third year
        • Medicine and the Law
        • Conflict of interests
        • Medical mistakes
        • Malpractices
        • Professionalism
        • Informed consent (revisited)
        • Patient participation in research
        • Vulnerable subjects
        • Breaking bad news (I)
        • Ethics in paediatrics
      • Fourth year
      • - breaking bad news (II)
      • - do-not-resuscitate orders
      • - withholding and withdrawing treatments
      • - end of life decisions, advance directives etc.
      • - legalising abortions (seminar forum, for and against)
      • - care of the elderly
      • - care of the disabled
      • - ethics, law and the child.
      • - confidentiality revisited (STIs and Family planning)
      • - case follow up in Paediatric and/Obstetric unit for write up
    • Fifth year
      • - breaking bad news (III)
      • - informed consent in surgery and invasive procedures
      • - patient participation in research
      • - involving children and other vulnerable subjects in research
      • - ethical issues in research, randomization, placebo controlled trials
      • - ethics and the law in mental health
      • - community consent how culturally appropriate and how legal
      • - project
      • - seminars
    • Additional facilities and resources needed for appropriate establishment of this programme in the Medical schools
      • On-going staff development in the area of biomedical ethics
      • Establishment of Centres for Biomedical Ethics
      • Provision of resources materials by way of journals, books and virtual libraries
      • Possibility of a combined degree in medicine and bioethics for excellent students.
      • Collaboration with other establishments with and outside Africa for appropriate development of ethics in our medical schools
      • Postgraduate programme in biomedical ethics.
    • Thank you for listening
      • Meanwhile let’s discuss