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Training manual on how to teach medical ethics to undergraduate medical students by non expert faculty staff
 

Training manual on how to teach medical ethics to undergraduate medical students by non expert faculty staff

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a manual to help medical educators to teach bioethics for medical students, even those who are not academically qualified in bioethics.

a manual to help medical educators to teach bioethics for medical students, even those who are not academically qualified in bioethics.

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    Training manual on how to teach medical ethics to undergraduate medical students by non expert faculty staff Training manual on how to teach medical ethics to undergraduate medical students by non expert faculty staff Document Transcript

    • FACULTY OF MEDICINE, KING FAHAD MEDICAL CITY. KING SAUD BIN ABDULAZIZ UNIVERSITY FOR HEALTH SCIENCES (RIYADH, SAUDI ARABIA) Training manual on How to Teach Medical Ethics to Undergraduate Medical Students by Non-Expert Faculty Staff Ghaiath Hussein Version 1.1 (Updated 5/22/2012
    • Training manual on How to Teach Medical Ethics to Undergraduate Medical Students by Non-Expert Faculty Staff Ghaiath M. A. Hussein, MBBS, MHSc. (Bioethics) – 2012 © 2012 Department of Medical Ethics, Faculty of Medicine, Taibah University This document is not issued to the general public, and all rights are reserved by the Faculty of Medicine, Taibah University and the author. The document may not be reviewed, abstracted, quoted, reproduced or translated, in part or in whole, without the prior written permission of Faculty of Medicine, Taibah University and the author. No part of this document may be stored in a retrieval system or transmitted in any form or by any means – electronic, mechanical or other – without the prior written permission of Faculty of Medicine, Taibah University. Requests for permission should be directed to Faculty of Medicine, Taibah University address: College of Medicine, Taibah University PO box 42317, Madinah, 41541 Saudi Arabia . The views expressed in documents by named author are solely the responsibility of this author.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 2 of 30
    • Contents 1. Purpose and Structure of this manual ................................................................................................................. 4 2. What do ethics, bioethics, and medical ethics mean?......................................................................................... 4 Ethics in healthcare (bioethics) ................................................................................................................................ 4 Ethics in Islam........................................................................................................................................................... 6 3. Why do we need to teach medical ethics (and professionalism) to medical students? ..................................... 7 4. What to teach in medical ethics and professionalism? ....................................................................................... 9 5. How to teach medical ethics and professionalism for undergraduate medical students? ............................... 13 Overview: ............................................................................................................................................................... 13 Target: .................................................................................................................................................................... 13 Language: ............................................................................................................................................................... 13 Setting: ................................................................................................................................................................... 13 Length/duration of sessions: ................................................................................................................................. 14 Teaching Methodology: ......................................................................................................................................... 15 6. How to evaluate ethics and professionalism in medical students? ................................................................... 19 Student and Course Evaluation .............................................................................................................................. 19 Attendance and active participation...................................................................................................................... 20 Assignments ........................................................................................................................................................... 20 Assessment of assignments: .............................................................................................................................. 20 Mid-Term Exam ...................................................................................................................................................... 21 Research report & Research presentation............................................................................................................. 21 Suggested structure of the research .................................................................................................................. 21 The case study .................................................................................................................................................... 22 A Fiqhi study ....................................................................................................................................................... 23 Ethical approval for their research..................................................................................................................... 23 Format and styling in writing and citation ......................................................................................................... 23 The presentation associated with the research................................................................................................. 24 Practicum (Clinical & Research Ethics practical activities logbook) ....................................................................... 24 Final Exam .............................................................................................................................................................. 28 Course evaluation .................................................................................................................................................. 28How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 3 of 30
    • 1. Purpose and Structure of this manual This manual is not a textbook on ethics and it is not a training manual on ethics. It is a manual designed for teachers interested in teaching medical ethics for undergraduate medical students to help them achieve the best possible outcome, even if they do not have an academic qualification in bioethics. It falls in 4 main chapters, which try to help in answering the 4 main questions, I assume, anyone interested in teaching medical ethics may ask. They are; 1- What do we mean by these terminologies (ethics, bioethics, medical ethics and the other healthcare ethics disciplines)? 2- Why do we need to teach ethics to medical students? 3- How do we teach bioethics to medical students? 4- How to assess the bioethics educational process? 2. What do ethics, bioethics, and medical ethics mean? Ethics in healthcare (bioethics) Ethics has been defined as a system of moral principles or standards governing conduct; a system of principles by which human actions and proposals may be judged good or bad, right or wrong; a set of rules or a standard governing the conduct of a particular class of human action or profession; any set of moral principles or values recognized by a particular religion, belief or philosophy; and the principles of right conduct of an individual. (UNESCO/IUBS/Eubios Living Bioethics Dictionary version 1.4) Bioethics is a branch of ethics. It is derived from Greek bio- (means life) and ethicos (means moral). More precisely, it is the science/art that aims at identification, analysis, and resolution of the ethical issues in the fields related to human life and health. Medical/clinical ethics aims, by definition, to help the healthcare providers to identify, analyze and resolve ethical issues they encounter during their practice. Ethical issues arise when there are conflicting values, beliefs, commitments and priorities either between the healthcare team and the patients (or their families), or among the healthcare members themselves. These issues increase in their scope and complexity in proportion to the complexity of the provided service. For instance, it is easy to observe that the primary care ethical issues are quite few and trivial if compared to the ethical issues in secondary or tertiary care institutions.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 4 of 30
    • This is partially explained by the fact that patients (and maybe doctors as well) have higher expectations to have a higher level of service. For example, no family would expect to have aggressive heroic measures to be taken to save their patients life in a rural primary care center of clinic. Contrarily, they would not take it as easy in a tertiary specialized big hospital in the middle of a big city. The gap between the patients and family expectations, on one side, and the doctors ability to utilize the available facilities that are overcrowded or not sufficient on the other side is the main source of ethical issues. This is quite natural that the family sees their patient as the patient that should be given the ultimate and priority care, while doctors have moral commitments towards other patients who are in dare need for that time and facilities. Indeed, there are many other sources for ethical issues related to the doctors poor attitude, miscommunication, poor leadership, lack of competence, and ignorance to name some. Historically, medical ethics may be traced to guidelines on the duty of physicians in antiquity, such as the The Code of Hammurabi dating to ca. 1780 BC, and the Hippocratic Oath ca. 400 BC. In the medieval and early modern period, the field is indebted to Muslim medicine such as Ishaq bin Ali Rahawi (who wrote the Conduct of a Physician, the first book dedicated to medical ethics), Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West) and Ali ibn Sahl Rabban al-Tabari who produced one of the first encyclopedia of medicine and medical code of ethics in 970 G. Contemporarily, the American Medical Association adopted its first code of ethics, in 1847. However, this field has grown as an academic specialty in the western hemisphere, especially North America only in the last few decades. Nevertheless, ethics has been discussed and taught for centuries in the old world. Ethical principles are also deeply rooted in the Islamic and other religious teachings. Currently, there are growing factors that are shifting the field of bioethics to be internationally spreading beyond the dominant trend of North American and European dominance, especially our region including the Saudi Arabia. These could be summarized as follows: 1 - The complexity and expansion of the healthcare service are accompanied by more complex and diverse ethical issues that need to be resolved. 2 - The increased awareness of the people about their rights, accompanied by aggressive media coverage of healthcare, especially medical errors.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 5 of 30
    • 3 - The increasing interest in teaching medical ethics to medical students in more Saudi medical colleges. 4 - The ongoing trend among governmental and private hospitals to obtain international accreditation, which necessitates that they provide "ethics service" to their patients. Ethics in Islam Morality is an integral part of Islam. Moreover, it is considered the purpose for which the Prophet Mohammed (PBUH) was sent. He (PBUH) said, "I was sent to perfect good character." (Maliks Muwatta: 047/8) He (PBUH) has also stated that, "The best amongst you are those who are best in morals" (Sahih Muslim; 30/4750); "Righteousness is good morality, and wrongdoing is that which wavers in your soul and which you dislike people finding out about." (An-Nawawi, 26); "The faithful reaches, by his good character, the rank of the fasting (from food and water) and the standing up (praying to God at night)" among many other advices by the prophet (PBUH) that emphasize the role of morals in the Muslims life. Islam itself is unique in terms of how it unifies what is moral with what is legal. In other words, what is moral is legal/permissible (Halal) and what is immoral is consequently illegal (Haram). This spares the Muslim from the moral-legal discrepancies in other parts of the world, where what is ethical is not necessarily legal, and vice versa. This also what makes us discuss the ethical issues in medical practice within the Islamic context as "Ethical-Fiqhi-Legal" triad. The discussion and resolution of ethical issues from Islamic prospective will largely adopt the Fiqhi methodology, as we will elaborate in the relevant sections of this manual.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 6 of 30
    • 3. Why do we need to teach medical ethics (and professionalism) to medical students? Teaching medical ethics is not intended to make virtuous doctors. We cannot re-bring our students up again, while they are already more than 18 or 20 years old. Thus, it is not practical to think that we need to make them what we think the doctors should be. That being said, it is important to know that teachers do influence their students by different ways. Students are affected by the effect of their teachers as role models, whether good or bad ones. This effect depends on the ability of the students to change and the traits that the teacher has to influence or inspire his/her students. So why do we need to teach bioethics then? Our aim is to provide the student with the guidance on what constitutes an ethical attitude and explain to him/her how to adopt it, and what is not ethical and how to avoid it. The bottom-line is that we aim at making our graduates better doctors who adhere, to their best, to the professional standards to provide the optimum healthcare to their patients. This is typically similar to what we do quite efficiently in our clinical training. The following summarizes the importance of teaching ethics and professionalism, including Islamic ethics, to undergraduate medical students. 1- Training on moral reasoning about ethical issues (and not only the medical facts) makes the physician more competent to deal with his patients as a whole (body and soul), and not merely dealing with their sick bodies. 2- It improves the analytical thinking abilities, and the learning of important skills like asking questions, effective listening, problem solving and conflict resolution skills, which are beneficial not only in the ethical analysis but also in the logical analysis needed for medical practice in general. 3- Empower the attachment of the Muslim doctor to the set of moral framework that was clarified by the Koran, Sunna and the guidance of our ancestors, so that the intentions become purified for Allah in what we do, and not merely a materialistic approach to medicine as a source of income. 4- Acquaint the Muslim doctor to the set of Fiqhi standards that s/he should know, like the conditions of examining a patient of different sex, or the Fiqhi issues related to diseases, like fasting, and prayers.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 7 of 30
    • 5- Moreover, the Muslim doctor may be consulted from Scholars (Ulama) about a certain medical issue that he wants to issue a Fatwa about. Therefore, you should know the basics of Fiqhi approaches to medical practice to be able to help. 6- In addition, it was found that teaching ethics and professionalism to clinicians during their undergraduate medical education will help in improving the outcome of the healthcare they provide. Miles and colleagues1 suggested five main objectives for the teaching of medical ethics: – To teach doctors to recognize the humanistic and ethical aspects of the medical career; – To enable doctors to examine and affirm their personal and professional moral commitments; – To equip doctors with a foundation of philosophical, social and legal knowledge; – To enable doctors to use this knowledge in clinical reasoning; and – To equip doctors with the interaction skills needed to apply this insight, knowledge, and reasoning to human clinical care. 1 S.M. Miles, L.W Lane, J. Bickle, R.M. Walker & C.K. Cassel. Medical Ethics Education: Coming of Age. Academic Medicine 1989; 64: 705–14.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 8 of 30
    • 4. What to teach in medical ethics and professionalism? To answer this question, let’s put our practice in its natural context by answering this long question: while providing healthcare, or conducting research, who is doing what in which context for whom? The following diagram will help us visualize the doctor’s interactions during the provision of healthcare. Country Public Health Hospital health- Laws/ Fatwas allied personnel Bedside Admin., Doctor Patient/family Policies, Resources guidelines As we have mentioned earlier that ethical issues arise from the interaction of humans who have different duties, priorities, and visions. Therefore, doctors can face ethical issues arising from any of their interactions with their patients (or the patients’ families), the colleagues in healthcare team (whether other doctors, nurses, therapists, lab. or radiology technicians), the administration of the facility in which s/he is working, or even with the law or national policies in the country s/he is working in. Therefore, if we need to prepare our students to deal with the ethical issues they may encounter in practice, we have to introduce them to these ethical issues in the safeHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 9 of 30
    • educational environment of the faculty of medicine. This is how we decide what to teach in bioethics for our students. Needs’ assessment may be needed to have a more accurate, evidence-based approach to teaching what is really needed by the students and the clinical teachers, as well.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 10 of 30
    • Phasing of teaching bioethics: when to teach bioethics? Phase Students’ characteristics Educational Objectives (what we want suggested topics to do for/with them?) Pre-clinical  Fresh from high school  No previous personal exposure to patients  ‘Ideal’ figure of the doctor as ‘angel of mercy’  Effect of the personal (good or bad) situations and experiences with the health system  Ethics is inherited from their communities and family (the way they were raised up) Clinical  Students are exposed to and start communicating with patients  Students begin to ‘feel (and maybe act) like doctors’  Students’ imagination becomes more realistic by exposure to the system (how the system really works?)  Feelings of frustration, shock, confusion, coping, surrender… when what they think right/ethical doesn’t match what their seniors do Near-  Students are technically almost doctors graduation  They feel the direct responsibility towards the patients, (specialized) colleagues and the system  Main focus and concern on ‘whatever it takes to get graduated’  Personal clinical specialty preferences start to get established  Near-mature clinical style of practice  Students’ mindsets are more towards ‘clinical analysis’ kind of thinking and doing thingsHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 11 of 30
    • To put it in a more practical way, the topics to be taught would include:1- Foundation and 2- Ethical issues 3- Ethical issues 4- Ethical issues 5- Ethical issues in 6- Ethico-Legal-Fiqhithe basics of bioethics related to doctor- related to doctor- related to the Public Health and Issues (ELFIs) in patient relationships colleagues allocation and health Promotion healthcare interactions management of resources i.Introduction to i.Doctor-patients i. Doctor’s roles i. Resource i.Public health vs. i. Medical the concepts of communication ii. Professionalism allocation in the clinical care, and Malpractice, ethics, bioethics, skills iii. Collegial health-care system PH practice vs. PH Misconduct & and medical ethics ii.Breaking bad news relationships research Medical Errors ii.Comparison (BBN) iv. Conflict ii. Ethical issues in ii.Research Ethics in ii. Financial Aspects resolution between the iii.Informed consent organ Public Health in Practice and - western and Islamic to treatment transplantation iii.Ethics and Conflict of approaches to iv.Privacy and Infectious Disease Interests (COI) medical ethics confidentiality Control: STDs, HIV, iii. Ethical issues iniii.Professional v.Patients TB medical insurance duties of the doctor Autonomy and iv.Ethics of Health towards self, Consent to Promotion and colleagues, treatment Disease patients, and vi.Privacy & Prevention community. Confidentiality v.Ethical Issues iniv.Professionalism in vii.Terminally Environmental and being a medical Incurable Diseases Occupational student and a and the End of Life Health doctor (EOL) Decisions vi.Public Health v.Basic ethical viii.Ethics of public Genetics: principles and health and health Screening guidelines (national promotion Programs and and international) ix.Islamic Fiqhi Individualvi.How to manage Rulings in Major Testing/Counseling ethical issues in Medical Specialties clinical practice? How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 12 of 30
    • 5. How to teach medical ethics and professionalism for undergraduate medical students? Overview: Teaching medical ethics does not depend on the formal structured teaching given by the ethics teacher in an ideal learning format. If the teaching of ethics is really intending making a change in the student’s understanding, attitude and practice; it should consider the following: 1- Students should play an active role in the learning process 2- Minimize the load of theoretical knowledge in favor of practical application 3- Ethics and professionalism can be introduced at any stage of the medical school, but they need to be integral to the clinical teaching. 4- Students learn in the clinical phase from their clinical teachers how to deal with patients. The problem that is usually encountered is the contradiction, or at least the discrepancy, between what is idea as taught in the ethics course and what is practiced in real life by the clinical teachers. This is what is referred to as the ‘hidden curriculum’. Thus, it is advisable to include the clinical teachers in the ethics learning process, as described below. 5- Teaching ethics is preferably given as interdisciplinary curriculum in terms of teachers and students. This means that it can/should be given by teachers from different professional and academic backgrounds to students of different disciplines (e.g. students from the colleges of medicine, nursing, dentistry, radiology, physiotherapy, etc.) Target: It is advisable, if applicable, to introduce the topics of the course, at least part of it to both undergraduate medical and health-allied students. This will help in building rapports between the healthcare team to be, and train them on proper professional communication. Moreover, when they work on resolving the ethical issues together as students, it would be easier for them to do the same exercise later when they start to practice. Language: As most of the literature is in English and most of the universities teach medicine in English, the language of instruction will be in English. However, some lectures should be presented in both languages or even in Arabic only, like those related to the Fiqhi issues. Setting: The needed setting to teach the medical ethics course topics vary according to the most used format. For example, large lecture halls are needed if there are lectures, and the small class (discussion) rooms are needed for group work and case discussions. There are other technical facilities that are needed, including PCs (or laptop), projector, show screen for presentations, while flipcharts, markers, A4 size blank paper is needed for groups’ discussions and smaller workshops.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 13 of 30
    • Length/duration of sessions: The length is left to the available time, but it is usually between (40-120 minutes) divided into the following: - 20% of the time for theoretical introduction and outline of the presented topic - 40% for practical or interactive students-oriented activity (based on a case, scenario, or ) - 30% group discussion and presentation of what the students discussed in the small groups (or in the interactive session) - 10% conclusions, wrap up and take-home messages (may also include the session’s evaluation) Note: for any session more than 60 minutes, it is advisable to have 5-10 minutes break.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 14 of 30
    • Teaching Methodology: To materialize the characteristics of the teaching methods that we outlined in the ‘Overview’ paragraph, the teaching method will be based on the following modalities: Modality When to use it? How to do it? 1- Interactive sessions - Foundation and principles - PowerPoint presentations are the most common used (lectures) - Outline of presentation method 2- Problem solving and - Almost any ethical issue - Cases are either developed by the faculty, or used from open case discussion can/should be presented as a resource, or used with permission of the author. problem for the students to think - Make sure that each case has clear instructions of the group about and discuss, whether clinical should do, few probing questions, and a clear time allocation or research ethics - Students are divided into smaller groups in the small rooms - Each group assigns a leader, and a note-taker (presenter). A staff facilitator should be around, if not present all the time with the group. - Students are given time to read the case silently, then loudly, then discuss based on the given hints or probing questions, brainstorm, decide on what they will say about each of the points mentioned in the hints, and write them down for presentation for the other students. 3- Assignments done by - Topics that have a room for - Choose a case as indicated above, whether developed for students thinking and personal reflection educational purposes, or a true case from the hospital of - Preferably given on intervals (i.e. media. not with every new topic) to include - Give it the students with clear instructions on what they are more than one topic in the same expected to do, preferable through some probing questions. assignment - Give them a due date that is reasonable for them to think about and reflect, usually 3-7 days should suffice. - Ask them to submit the assignment to you. Typically, theHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 15 of 30
    • facilitators should mark them, or even double mark them by two markers, if feasible, and give feedback to the students, not just the mark or grade. 4- Student seminars - Topics that are not covered in the - It is preferable to have a list of the topics that will not be curriculum, e.g. many of the Islamic covered by facilitators/instructors from the beginning of the rulings (Fatwas) and Fiqhi issues can course. be presented in this way - Distribute this list to the students and let the groups choose their topic of interest from the list. - Make a schedule, ideally from the beginning of the course, of which group will present which topic. - Make sure to invite an expert in the topic to attend the presentation. 5- Case studies and case - This is typical to the class case - Ideally, each group should be given a case to discuss, each presentation discussions (#2) in terms of the covers a different aspect of the topic. However, the same case topics to be covered using this can be given to more than one group. method. - The case should have clear instructions and questions underneath. - The groups are given a period of time (3-7 days) to discuss and present the case, either as presentation to the other students, or as written report, or preferably as both. 6- Mock ethics - This method covers the topics that There are many ways to do that: consultation are commonly presented to the - Make the students attend a ‘real’ ethics committee meeting; meetings ethics committees for consultations. - Invite members of the ethics committee to meet in front of - These include the ethical issues the students as a ‘role play’ to discuss a real or developed related to the end-of-life (EOL) and case; or research ethical review. - Make the students themselves play the role the members of the ethics committee and give them the case (or the research proposal) to be discussed. Let them discuss guided by facilitator or some guiding documents or hints. 7- Watching movies or - This is perfectly well with the topics - There is a list of movies that cover a variety of ethical issuesHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 16 of 30
    • documentaries that that you need to make the students available in the internet, and as annex to this manual. You discuss ethical issues. feel for or against an attitude. need to be careful when choosing a movie, especially in a - For example, topics like doctor- conservative milieu, or when you have female and male patient communication, pain students. management, cultural differences, - Avoid movies that have a lot of distraction from the ethical etc. are well covered in a number of concepts that want to cover. If there is no much choice, you drama movies and documentaries. can only show the part of the movie or the documentary that best conveys the ethical message. - This method need to be used with caution, and never be mandatory on any student to attend. Some may refuse due to religious or cultural causes. 8- True story telling (by - Topics that have doctor-patient - Ask a patient or a relative to come and share his/her story or patient, patient interaction/communication (e.g. experience with his/her illness, and how his/her healthcare relative, or a doctor) consent, EOL care, etc.) team managed him/her. - Ask them to be free to talk and to describe what they really felt at the time, whether it was a good or bad experience. - Ask the patient to send a message for the students (what s/he would love these students do (or not) when they become doctors?) - Be cautious, asking a patient to recall some illness experience may be upsetting, depressing, or frustrating to some patients. Be ready for such an incident if it happens. 9- Standardized - This is a more advanced method - The SP is given a scenario with full details about the patient’s patients (SPs) that is based on making professional history, symptoms, and even some signs that could be actors work on simulating a patient simulated. with a given condition. - The students are then divided into groups (or as - This SP is then interviewed by the demonstration for the whole class), each with a SP. student in front of the other - The students are given the task of communicating with this students, and supposed to behave patient for a given purpose, e.g. telling him that he has cancer, like a real patient. or that her mother is candidate for DNR order, etc.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 17 of 30
    • - This could be used in many topics, - One student is chosen to play the role with the SP, who is but it is more efficient in topics that trained to react to any possible question, or action from the needs direct doctor-patient student. In case the student gets stuck, he can ask for ‘freeze’ communications like breaking bad or ‘timeout’, where the SP (actor) keeps the position and news, or taking consent gesture, while the student asks for help from his/her colleagues. - The session ends with discussion and consultations on how to do things (or not) when dealing with a patient.How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 18 of 30
    • 6. How to evaluate ethics and professionalism in medical students? Students •knowledge •comptencies •skills •attitude (bedside) Method Teachers •relevant to topics & •knoweldge culture •ability to deliver •engaging to students •interaction with students Content •clear objectives •relevant methods •applicable concepts Student and Course Evaluation Student evaluation methods should be variable and continuous. They aim at evaluating the students ability to reflect what s/he learnt in hypothetical or simulated situations. Some tools are individual, like assignments, while others depend on group work, like course research. The following table summarizes the suggested students’ evaluation methods and their respective percentage of the total mark. Method Mark/100 Attendance and Active class participation Assignments Mid-term exam Practicum (Clinical & Research Ethics practical activities) Research report and presentation (the report & presentation) Final examHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 19 of 30
    • Total 100 Attendance and active participation In many instances, the physical attendance for at least X% in the lectures is a perquisite by the facultys regulations to attend the exam. Any absence of more than (100-X)% will decline the student from sitting for the exam. However, attendance is not just about signing the attendance sheet! The student should participate and contribute to the session by asking questions, positive contributions in group discussions, and answering questions. Assignments Along the course, the student will be asked to submit few assignments. These assignments are usually about cases with ethical problems. The student should be guided in each assignment by a set of questions that s/he may need to follow in order to attain the best mark. They are intended to be a self-reflection on what the student has learnt so far along the course. Students should be left free to express their understandings and feeling than to focus on reaching a correct answer. Many themes in ethics do not have agreed on clear cut right answers. It is also expected that the student should abide to the professional academic conduct, especially the proper citation without the abuse of internet. Many faculties use software to detect plagiarism; thus the student should be warned not to just copy and paste from the internet. Plagiarism Similarity Score of 20% or more means that your work will be rejected and you will have to resubmit your work. We take academic misconduct seriously. It is a course on ethics and professionalism after all. Assessment of assignments: Your assignments will be assessed based on the following criteria: 1- Originality of content. This means the student needs to reflect themselves in what you submit 2- Novelty of content. This may be difficult to achieve in the topics of ethics, where there are many articles already in the literature. However, the student still needs to add a new flavor to the already discussed topic, or even better to choose a less discussed topic. 3- Strength of arguments. The students need to defend what they present. This means that the students need to present a supported argument to what they submit. A well-supportedHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 20 of 30
    • argument also means that the student needs to present the possible counter-arguments to theirs and how they would respond to them. 4- Uniform editing. The great content should be presented in a professional neat outlook and layout. It is advisable to keep the text to 1-2 fonts, to make sure that the sizes of the subheadings are uniform, and to avoid using pictures and colors extensively unless justifiable. 5- Proper citation. Students have to show that they have read well about the topic they are writing on. This is best reflected by the professional use of the suggested readings AND proper citation in a uniform citation style. Mid-Term Exam The mid-term exam will be composed of MCQs, with one best answer, and short essay questions. These may include short cases with questions to answer, or you are asked to "discuss" or "list". The weight of each MCQ and short essay will be mentioned in the questions sheet. Answering in either Arabic or English is allowed; however, each question should be answered in only one language. Research report & Research presentation As a part of the course evaluation, every student has to submit a written work that reflects his/her understanding of what s/he got in the course. This work should reflect his/her abilities to search the literature, organize ideas, develop objectives, develop a research plan, and implement it to discuss the relevant ethical aspects. Each group of students should find an ethical problem related to the objectives of the course, study it guided by your research objectives, and present and discuss its results and conclusions from what they found. Finally, they should have practical recommendations that they come up with at the end of the research. Their research is expected to contribute new knowledge to the scientific community and not a repetition of what is already known about the subject. Suggested structure of the research Typically, the research should contain the following sections: I. Title page: (Header of the FOM; Title of the project; Names and IDs of the research team; Name of the supervisor; and Date of submissionHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 21 of 30
    • II. Table of contents: you are strongly recommended to use the [Add Table of contents from your Word software] III. Acknowledgment: This section is to acknowledge the efforts of those who helped you in your research. IV. Introduction: This is a key section. You need to tell the reader of your research what you are studying, and why do you need to study it ( i.e. the rationale) V. Review of literature: in this section you should show your reader that you really know what you are studying and that what youre studying is not a repetition of work that is already there. Remember: we expect new knowledge from your research. VI. Objectives (general and specific): use action verbs, and make them SMART (Specific, Measurable, Attainable/Acceptable/Achievable. Relevant/Reliable, and Time-bound) VII. Methodology: in this section, you tell the reader how did you do your research. Make sure this sections tells in details about the following: study area, study population, data collections techniques and tools, and data analysis VIII. Results: this section contains the findings of your data collection, preferably as tables and figures. IX. Discussion: In this section you discuss the results in comparison to what other found on the same issue. You are expected to provide justifications for what you found in the results. X. Conclusion & Recommendations: You are expected to provide some practical steps to be taken by relevant stakeholders to improve the situation regarding the topic of your research. XI. References: This section contains the references that you used in your work, especially in the introduction and the review of literature. You are strongly recommended to use reference management software (like Reference Manager, End Note, or RefWorks). Discuss this option with your supervisor. The case study Along the medical ethics course, we aim that the student knows how to define, analyze and be able to use the relevant tools to resolve ethical issues. This is best demonstrated by a case study. In a case study the students are asked to find a case with one or more ethical issues around it. They should be strongly recommended to find a true case, though they have to make sure they completely de-identify it. A case study will be typically composed of these sections: I. The presentation of the case, very similar to the way the students do in clinical rounds with the exception that the students describe the aspects related to the ethical issue the students will discuss, and not only the medical and clinical facts. II. What are the ethical issues in the case? In this section, the students are supposed to list the ethical issues that the students found in the caseHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 22 of 30
    • III. What are the ethical and Fiqhi principles at stake? In this section, the students are supposed to list the ethical principles followed by the Fiqhi and Islamic issues related to the case. IV.Ethical case analysis: This section reflects the way the students analyze the case, using any of the analysis frameworks and tools (e.g. 4-boxes model) that the students have gone through in this course. V. Fiqhi Case analysis: In this section, the students should present the Fiqhi approach to their case, for example what are the Goals of Shariya )‫ (مقاصد الشريعة‬involved, which Fiqhi Maxims )‫(القواعد الفقهية‬ are applicable and if there are previous Fatwas on the issue. VI.Case resolution: although the students may not be always able to resolve the issue, or suggest definitive steps to be taken; the students should present their approach to resolve the case. A Fiqhi study A Fiqhi study is a different format that can reflect their ability to search and analyze. As the students know, many of the practices and medical interventions have been studied by the Scholars (Ulama). Many issues have been discussed in many conferences and had resolutions from Fatwa and Fiqhi complexes. However, it is quite impossible for us as teachers to present to the students along this course each and every fatwa or religious approach to medical practice in different specialties. Therefore, we encourage that few groups of the students present a Fiqhi study to present the Islamic approach to a given issue related to illness, diseases, or medical practice. The students are strongly recommended to approach NEW topics. For example a study on cleanliness or fasting for patients (taharat al-maridh) is not acceptable, as there are already tens of books on the issues. May be the students can consider Islamic approach to ethical issues in specialties, like Emergency Medicine, Oncology, Anesthesia, etc. Ethical approval for their research Usually the research at their level are classified as "Low-Risk, Low Vulnerability" studies, so they rarely need a full ethical review. However, NO data collection should take place without a written permission from the faculty, preferable from the deans office. Students should consult their supervisor and the course coordinator on whether their research needs one and how to obtain it. Format and styling in writing and citation Their work should follow the following instructions: i. Make a separate page for title ii. All sections of the proposed format for each kind of research work the students want to submit should be there. iii. Preferably, start each section in a separate page iv. Any omission of any section should be justified v. All their work should be in Arial Font, double spaced, size of font should be as follows:How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 23 of 30
    • Main headers/titles (size 18); Subtitles (size 16); Sub-subtitles (size 14); and The rest of the text (size 12). vi. Using Photos should be justified, with proper acknowledgment of the source and copyright vii. Don’t use colors other than black unless justifiable and needed. In total, not more than two colors allowed. viii. Citation should be either in AMA, Vancouver, or Harvard Styles. Arabic references and Fiqhi studies need to be agreed on with an expert relevant scholar. The presentation associated with the research The presentation is the way the students tell others in summary about their research or case study. It should summarize the whole work in 15 minutes presentation. Although there is no objection to PowerPoint presentations; innovation in presenting their works will be highly appreciated and will receive extra marks for that. Innovative ideas and ways of presentation may include making a short movie, a role play, use of posters, or models, etc. Each student will be individually evaluated, so make sure the students know the research thoroughly. This means that the work among the group members should be organized fairly with all group involved. The students need to make sure with their supervisor that their presentation is relevant to the objectives. The students should make sure that a copy of their presentation is ready on the PC of the hall at least one day before the presentation. Practicum (Clinical & Research Ethics practical activities logbook) As a part of their training in bioethics, the students need to actively participate in activities related to ethics. The students need to attend a total of at least 4 hours in bioethics-related activities, within or outside the KFMC. These activities include (for example and not exhaustive): - Ethics book review - Public awareness campaign - Producing short film (documentary) on an ethical issueHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 24 of 30
    • - Ethics education material - Short Play or scene - Movie review - Ethics consultation meeting - Research ethics review meeting - Other activities that may think relevant Activity , Description and purpose of Suggested steps (as given to the student) Deliverable product activity 1. Ethics book review (3 marks) 1. Go to the COM or the KFMC library A written book review of - This aims to make you read a book 2. Ask the librarian on the books on not less than 1500 words on ethics, and tell us what you think ethics about it. 3. Discuss with our group on which book - You are NOT asked to read it as to choose (reading the content is the most ‘reading a textbook for an exam’, first step you should do when deciding on rather to read with critical reflection reading a book) and critique. 4. You all read it all, or divide the chapters among your group (chapter for each). 5. Read and summarize the book (or chapter) your opinions and reflections on what you read 6. Each student should write down a review on what s/he read. 7. The group should assign the members to do the collective final review. 8. The group will present to the whole batch when doneHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 25 of 30
    • 2. Public awareness campaign (5 1. Meet with one or more of the main 1. The educational marks) related departments in the FOM or KFMC material - This refers to a set of activities that (e.g. public relations, patients’ affairs, 2. The activity report aim at enhancing the knowledge and admission office, religious affairs, medical 3. Certificates from the attitudes of the targeted by these errors committee, medical ethics collaborating department activities about a given cause. committee, etc.) with your names on them 2. Ask the department you managed to 4. Any educational or meet for their areas of gap of knowledge advocacy material that you or attitudes. In simple words, what are developed for the campaign the topics they are interested to make patients and or clinicians to be more aware of? 3. Decide among yourselves, after consulting the supervisor, on which topics are more relevant and feasible to do. 4. Discuss and decide on the activities you think should be there in the campaign. 5. Distribute the roles among yourselves (Who should do What When?) 6. Set you plan from preparation to delivery in a Gantt’s chart, or other time management/planning tool (MS Project Manager is a good one) 7. Have your plan approved by the relevant department, including the needed resources 8. Conduct the campaign as decided by the relevant department. 3. Producing short film 1. Meet with your team and supervisor A good quality finished (documentary) on an ethical to choose a topic edited video issue(5 marks) 2. Discuss the possible scenarios - To produce a short video (3-30 3. Discuss and write the script minutes) that presents an ethical issue 4. Distribute the roles among yourselves in a drama or documentary 5. Prepare the technical needs, e.g. video camera, recorder...etc. 6. Set a time for video taping 7. Edit the video, and make it presentable 4. Developing Ethics education 1. Meet with the group, the supervisor and The developed material and material(3 marks) the relevant department in the hospital any other supporting - To develop a new educational 2. Decide on the topics you want to cover material, e.g. photos for material that can be used to educate a 3. Assess your target group’s pervious preparations or meetings. target group on one or more ethical knowledge about the topic(s) issue 4. Discuss and decide on how best to present topic (brochure? poster? snowman in the main hospital’s entrance? BE INNOVATIVE)How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 26 of 30
    • 5. Design and develop printed materials to be used in ethics education for patients, families, and staff 8. Short Play or scene(3 marks) 1. Meet with your group and supervisor to A written Script and a play - The purpose of this activity is to decide on the ethical issue your role play of a short role play (not prepare a short play of one or more will discuss more than 10 minutes) that scenes that presents an ethical issue. 2. Start developing the script, including the presents and discusses an - The main difference between this distribution of roles ethical issue and the activity 3 (short movie) that it 3. Rehearsal is very important. You need to will be done live and not video-taped give enough time to practice. Remember you will play it live! Movie review (3 marks) - Discuss with your team on the movie(s) An individual written movie - This is bit more than watching a that you have access to and talks about review by each member drama movie and cry! one or more ethical issues. with the answers to the - you should watch a movie, if you - These links may give you some guidance: related questions don’t have religious reasons not to do, http://www.cityethics.org/Top10%20Ethic and answer a set of questions that are s%20Films related to ethics: http://faculty.deanza.edu/burkelarry/stori  What are the ethical issues es/storyReader$163 discussed/presented in the movie? - Watch a movie that presents a set of  Who did what wrong, ethically healthcare ethical issues speaking? Explain why you think it is - Write down your reflections on the ethically wrong. movie with the answers for the mentioned  How would have you done, if you questions. were in his/her position? 9. Ethics consultation meeting (2 - Coordinate with your supervisor to Your reflections on each marks/ meeting) attend the next ethics-related meeting. meeting should be written - Almost every clinician faces an - Attend the meeting on time, observe, down and signed by the ethical issue/dilemma as s/he and take notes of what took place in the head of the committee, or practices. Some of these issues need meeting. your supervisor experts opinion to help in resolving - Write down your reflections on what you them. attended (what was the problem? who - The purpose of this activity is to submitted it? What are the ethical issues acquaint yourself to the process taken at stake? How did the experts managed it by ethics experts to help clinicians and what have they recommended?) resolve ethical issues 10. Research ethics review meeting (2 - Coordinate with your supervisor to Your reflections on each marks/ meeting) attend the next ethics-related meeting. meeting should be written - Every research that involves human - Attend the meeting on time, observe, down and signed by the participants should be reviewed and take notes of what took place in the head of the committee, or scientifically and ethically before being meeting. your supervisor conducted. - Write down your reflections on what you - The purpose of this activity is to attended (what were the ethical points acquaint yourself to the process taken identified? How did the experts managed by ethics experts to help researchers it and what have they recommended?) manage the ethical issues in their research before startingHow to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 27 of 30
    • It is the students responsibility to: 1- Register for the intended activity individually (don’t expect that their leader or friend will do it for the students) 2- Make sure that all the activities the students attended are recorded and signed by their supervisor 3- Attach any published works and printed material with the logbook. Final Exam As for the mid-term exam, the final exam will be composed of (about X) MCQs, with one best answer, and (X-Y) short essay questions. These may include short cases with questions to answer, or the students are asked to "discuss" or "list". The weight of each MCQ and short essay will be mentioned in the questions sheet. Answering in either Arabic or English is allowed; however, each question should be answered in only one language. Course evaluation The course will be evaluated through their feedback after each lecture and each test, or exam. Their feedback is crucial to help improving the course for the students and for the batches to come. The items to be evaluated include the students’ satisfaction with: A. Teachers’ ability to… - Deliver the material - Engage the students - Use the teaching aids effectively B. The content’s: - Clarity of learning objectives - Relevance of the presented material to the objectives - Amount in the allocated time - Method of delivery (lecture, case, group work, etc.) suitability to the content C. The Exam’s… - Format (MCQs, short essays, case analysis, etc.)How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 28 of 30
    • - Length - Given time - Relevance to the content - Ratio of questions related to knowledge (vs. logical thinking)How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 29 of 30
    • How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 30 of 30