Teaching medical ethics: from theory to practice - Wing May Kong

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Presentation given at the HEA Social Sciences learning and teaching summit 'Teaching ethics: The ethics of teaching'

A blog post outlining the issues discussed at the summit is available via http://bit.ly/1lndTnX

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Teaching medical ethics: from theory to practice - Wing May Kong

  1. 1. Powerpoint Templates Page 1 Powerpoint Templates Teaching Medical Ethics – from theory to practice Wing May Kong Vertical Theme Head Ethics, leadership & professionalism Imperial College London
  2. 2. Powerpoint Templates Page 2 Common themes • Relatively new discipline • Engagement of teaching colleagues and students • Building a teaching community • Avoiding silos • Institutional culture and the hidden curriculum Teaching ethics – work in progress
  3. 3. Powerpoint Templates Page 3 Medical Ethics Teaching • Statutory regulatory framework for practice, education and training • Vocational degree • Year intakes of 300-400 students
  4. 4. Powerpoint Templates Page 4 1963: The Five As Adultery Advertising Addiction Abortion Association (with non medical practitioners) 1963: The London Medical Group 1987: The Pond Report 1993 1993
  5. 5. Powerpoint Templates Page 5 Teaching aims: a consensus statement • Recognition of ethical issues • Ethical reasoning and analysis • Integration of ethical reasoning with clinical learning • …to enable better medical practice G Stirrat et al. MEL for doctors of tomorrow JME 2010
  6. 6. Powerpoint Templates Page 6
  7. 7. Powerpoint Templates Page 7 19% confident Preston-Shoot et al Readiness for legally literate medical practice JME 2011 Confidence of final year medical students in managing the relationship between the law, ethics and professional guidance 81% not confident
  8. 8. Powerpoint Templates Page 8 Preston-Shoot et al Readiness for legally literate medical practice JME 2011 Not Confident 92% Confident 8% Confidence of final year medical students in applying the law in clinical practice
  9. 9. Powerpoint Templates Page 9 The problem? • Reflects part of wider anxiety about clinical responsibility as a junior doctor • Formal law teaching and assessment largely in first half of medical course 1 • The ‘hidden curriculum’ 2 2 Hafferty and Franks, Academic Medicine 1994 1 Preston-Shoot et al. Prepared for practice? JME 2010
  10. 10. Powerpoint Templates Page 10 Should doctors be good? The good doctor?
  11. 11. Powerpoint Templates Page 11 “I remember the time that Shipman gave to my dad. He would come round at the drop of a hat.” C. Rudoi quoted in The Shipman Report, P. Barkham, 2002 “He was a marvellous GP,” “apart from the fact that he killed my dad.”
  12. 12. Powerpoint Templates Page 12 Vertical and Horizontal Integration Vertical Integration • Build on prior learning • Minimal new knowledge • Link to other learning • Develop higher level cognitive skills Horizontal integration • Embed in other teaching areas – Explicit – Teaching and assessment methods – institutional culture
  13. 13. Powerpoint Templates Page 13 Integration - Clinicians as educators • Supports clinical teachers as role models for the importance of ethics and law to clinical practice • May help combat the hidden curriculum www.ucl.ac.uk
  14. 14. Powerpoint Templates Page 14 Integration - Clinicians as educators www.ucl.ac.uk • Teaching in clinical years largely by senior doctors with no formal training in medical law or ethics • Ethical discussion is rarely part of everyday clinical practice
  15. 15. Powerpoint Templates Page 15 Recognising Ethical Issues • Focus on ‘big’ ethical dilemmas • Constructed case scenarios designed to bring out ethical issues
  16. 16. Powerpoint Templates Page 16 http://www.herve-tullet.com/fr/boite-30/Blop-films.html Engagement and Collaboration
  17. 17. Powerpoint Templates Page 17 Integration and clinician engagement 2009: Year 5 speciality ethics assignments 100 2010: Year 1 anatomy integration 110 2011:BSc module 120 tutors 2007: Year 2 small group teaching 30 Tutor training Ownership & relevance Student engagement Minimise paperwork & assessment
  18. 18. Powerpoint Templates Page 18 Tutor support • Ethics lead appointed for tutor support • Address generic teaching skills as well as ethical and legal theory • Use assessment tools from postgraduate medicine • Virtual learning objects
  19. 19. Powerpoint Templates Page 19 Virtual Learning Objects
  20. 20. Powerpoint Templates Page 20 Teaching Virtues- Ways of Knowing Three types of knowledge: • Technical • Practical • Critical A. Kumagi et al. Academic Medicine 2014 www.leansytemsinstitute.com
  21. 21. Powerpoint Templates Page 21 Critical knowledge A. Kumagi et al. Academic Medicine 2014 Reflection Discourse Imagination
  22. 22. Powerpoint Templates Page 22
  23. 23. Powerpoint Templates Page 23 Clickers
  24. 24. Powerpoint Templates Page 24 Year 1 – Ethics session at end of anatomy introduction week
  25. 25. Powerpoint Templates Page 25 How did you feel when the body was uncovered? 1. Comfortable, I was interested to see what it looked like (57.1%) 2. A bit nervous, unsure how I would react (29.5%) 3. Uncomfortable, but I felt it was something I needed to do (7.9%) 4. Uncomfortable, but I didn’t feel confident to say anything or step back (1.6%) 5. Uncomfortable but I was able to step back (0%)
  26. 26. Powerpoint Templates Page 26 How would you feel if parts of your dead body could be used for research/education without your permission or your family’s? 1) I wouldn’t mind – I’d be dead (14.4%) 2) It would be ok – it’s for a good cause (14.8%) 3) Unacceptable - It would be contrary to my religious beliefs (9.2%) 4) Angry/unhappy - it would be distressing for my family (30%) 5) Angry/unhappy – can’t explain why (8%) 6) Angry/unhappy – it’s my body (22%)
  27. 27. Powerpoint Templates Page 27 ‘A deep understanding of human needs’ A. Kumagi et al. Academic Medicine 2014
  28. 28. Powerpoint Templates Page 28 “There wasn’t time to think, there wasn’t time to…be compassionate, you didn’t have time to get to know people…” “…I think you become less human. And you didn’t see yourself as human.” C. Jaye Medical Humanities 2004
  29. 29. Powerpoint Templates Page 29 Haiku by Rhys Davies Year 4 medical student
  30. 30. Powerpoint Templates Page 30
  31. 31. Powerpoint Templates Page 31 Standard procedure As hollow an excuse as ‘following orders’
  32. 32. Powerpoint Templates Page 32 Heart, valves and organs A free-for-all, pick-and- mix, These are my children
  33. 33. Powerpoint Templates Page 33 Summary There are challenges common to teaching ethics in the social sciences: –Developing a community of teachers –Integrating ethics learning –Nurturing virtue
  34. 34. Powerpoint Templates Page 34 Conclusion • Engage • Enable • Enthuse

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