The purpose of this workshop is to enhance teachers' skills for improving students' attitudes towards their learning and work. The workshop is designed for healthcare educators.

1. Improving
Students’ Attitude
by using FORCE
Prof. Muhammad Shahid Shamim
MBBS, FCPS, FRCS, Dip-Bioethics, MHPE, PhD Scholar
Professor of Surgery and Add. Director
Dow Institute of Health Professionals Education, DUHS

2. Introduction
• Name?
• Institute?
• What do you expect from this workshop?
• Why do you do/ want to do Research?

3. Objectives
• Identify the attitudinal characteristics required in healthcare
professionals
• Discuss issues in improving students’ attitudes through educational
intervention
• Develop and enhance educational interventions for attitudinal change
in students, using the FORCE criteria

4. Overview
• What are attitudes?
• What is the role of medical education in attitude development?
• Can attitudes be “taught”?
• Current scenario
• Barriers
• How can teaching and assessment be planned for attitudinal change
in students?
• Using the FORCE criteria for Junior Ethical Doctors Initiative
• How to solve the problem?
• The Workbook approach

5. What are “Attitudes”?
• Dictionary definition
• A way of thinking or feeling about
something
• A position of the body indicating a
particular mental state

6. What are “Attitudes”?
• Psychological definition
• A psychological tendency that is expressed by evaluating a particular entity
with some degree of favor or disfavor
• An attitude refers to a set of emotions, beliefs and behaviours towards a
particular object, person, thing or event.

7. Components
of Attitude
Affective
Feelings or
emotions
Behaviour
Tendency to act in
certain way towards
something
Cognitive
Thoughts, beliefs and
ideas about
something

8. What are the effects of “Attitude” on
healthcare professionals?

9. Types of “Attitudes”
• Positive and Negative
• Conscious ….
• Supportive ….
• Confident …
• Sincere …
• NEUTRAL
• Professional / Unprofessional

10. Factors influencing “Attitudes”
• Upbringing
• Social interactions
• Culture
• Experiences!
• Education!

11. “Attitudes” in
Healthcare
• What are the Attitudinal characteristics
of healthcare professionals?

12. 10 Attitudinal characteristics of
healthcare professionals
1. Compassion
The ability to identify with the suffering of another or to imagine
ourselves in a similar state.
2. Understanding
The ability to think and act with what one knows.
3. Empathy
A social-emotional ability having two distinct components:
one affective: the ability to share the emotions of others, and
one cognitive: the ability to understand the emotions of others.
John Murphy, MDLinx | September 11, 2018. Featured Articles in Internal Medicine. https://www.mdlinx.com/internal-medicine/article/2631

13. 4. Honesty
Truth-telling and professional integrity are the basic requirements.
5. Competence
The ability to manage patients ethically using knowledge and skills,
in collaboration with other healthcare persons.
6. Commitment
Giving meaning and direction to their work, enabling them to resist
the effects of stress in profession.
John Murphy, MDLinx | September 11, 2018. Featured Articles in Internal Medicine. https://www.mdlinx.com/internal-medicine/article/2631
10 Attitudinal characteristics of
healthcare professionals

14. 7. Humanity
To like people genuinely. “Treat the patient, not the disease”.
8. Courage
The voluntary willingness to stand up for and act on one's
ethical beliefs despite barriers. Commitment to act in the best
interest of patients.
9. Respect
Considering the patient as the center of all professional work.
10 Attitudinal characteristics of healthcare
professionals
John Murphy, MDLinx | September 11, 2018. Featured Articles in Internal Medicine. https://www.mdlinx.com/internal-medicine/article/2631

15. 10 Attitudinal characteristics of healthcare
professionals
10. Optimism
Inspire patients with a positive approach towards things.
John Murphy, MDLinx | September 11, 2018. Featured Articles in Internal Medicine. https://www.mdlinx.com/internal-medicine/article/2631

16. Teaching and Learning Educational Environment
“How attitudes can be positively influenced through education
is a matter of debate and is, as yet, undetermined” (Martin, Lloyd, Singh 2002)

17. Teaching for Changing Attitudes
How are you doing it now?
What are the barriers?
Activity

18. How are you doing it?
1. Compassion
2. Understanding
3. Empathy
4. Honesty
5. Competence
6. Commitment
7. Humanity
8. Courage
9. Respect
10. Optimism
What are the barriers?
• Institutional
• Faculty
• Students
Teaching for Changing Attitudes

19. Attitude
Cognitive
Knowledge and Beliefs
Psychomotor
Skills, Behavior
Affective
Feelings, Emotions
How to Change Attitudes?
Teaching and Assessment of What!
Ethics
Professionalism
Communication skills

20. Requirements – before you start!
• Committed institutional leadership
• Recognise the moral and cultural values
• Provide resources and priority
• Formal (‘taught’) and hidden curricula
• Dedicated place and time in curriculum (outcomes and objectives)
• Identify Role-Models among the faculty
• Separate courses in ethics, professionalism & communication skills
• Qualified and trained faculty
• Department of Bioethics and Professionalism!

21. Teaching Methods
• Interactive lectures
• Small group discussions
• Reflection
• Portfolios
• Demos
• Role-models, Videos, ..
• Role-plays
• Guided self-study
• Feedback
• Etc.
Alkabba et al., 2013; Ghias et al., 2011; Smith, Fryer-Edwards, Diekema, & Braddock III, 2004; Umran Al-Umran, Al-Shaikh, Al-Awary, Al-Rubaish, & Al-Muhanna, 2006
Attitude
Cognitive
Knowledge and beliefs
Skills
Behaviour
Affective
Feelings and emotions
Ethics
Professionalism
Communication skills

22. Activity
1. Write a learning objective for attitudinal change
2. Suggest teaching methods to achieve your objective

24. Movie series from 1977 to 2019
Fight between the “evil” and the “good”
Jedi use the FORCE to fight the dark side

25. JEDi
Junior Ethical Doctors initiative
A program to develop effective courses in
ethics education with the use of FORCE
criteria …

26. • O – Objective [reflecting actual need to achieve outcomes]
• E – Ethical [addresses specific content in ethical way]
• F – Focused [on students’ motivation for learning]
• R – Regulated [planned, organized and monitored]
• C – Contextual [relevant to socio-cultural needs]
What is the “FORCE”?
Criteria to identify effective methods

27. F – Focused
• Method should be focused on motivating students’ learning
• Student are motivated when
• the learning methods focus on their learning needs
• they are actively engaged in the learning activities
• (Abbot 2014)

28. O – Objective
• Students should be aware of their learning objectives
• Methods should foster students’ progress towards learning
• Alignment strengthens the internal structure of a course
“Teaching methods should be chosen primarily on the basis of the types
of learning objectives because learning objectives vary as to the
conditions necessary for their achievement.”
(Boner 1999)

29. R – Regulated
• Methods should be regulated properly
• Planning
• Approach to learning
• Document outcomes and objectives
• Organizing
• Provide time as per level of students
• Monitoring
• Evaluate outcomes

30. C – Contextual
• Relevant to the context of students
• Within and outside content boundaries
• The context includes:
• Cultural context
• Social context
• Professional context
“Undergraduate ethics education should be comprehensive, multi-
dimensional and woven into the fabric of student’s experience”
(Bush et. al., 2009)

31. E – Ethical
• Ethical and moral correctness
• Proper conduct
• Discourse
• Respectful challenging
(Landon & McCarthy, 2012)
(Catron, 1989)

32. See the Learning Objectives and Teaching Methods
Activity
How do they fit with the FORCE criteria?

33. How do they fit with the FORCE criteria?
• Int. lecture
• Case
discussion
• Reflection
• Role-play
• Video demos
• Pictures
• Feedback
• Focused [on students’ motivation for learning]
• Objectified [reflecting actual need to achieve
outcomes]
• Regulated [planned, organized and monitored]
• Contextual [relevant to socio-cultural needs]
• Ethical [addresses specific content in ethical
way]

34. How can we increase the FORCE for attitudinal
change?

35. Use these methods in combination!
• Case
discussion
• Reflection
• Role-play
• Video demos
• Pictures
• Feedback
• Focused [on students’ motivation for learning]
• Objective [reflecting actual need to achieve
outcomes]
• Regulated [planned, organized and monitored]
• Contextual [relevant to socio-cultural needs]
• Ethical [addresses specific content in ethical
way]

36. Examples
• Case scenario + Discussion +
Reflection
• Pictures + Discussion
• Case
discussion
• Reflection
• Role-play
• Video demos
• Pictures
• Feedback

37. Conflict of interest
Course learning outcomes
• Demonstrate awareness of ethical
standards in dealing with
pharmaceutical industry
Topics
• Conflict of interest in healthcare
• Ways to avoid potential or actual
conflict of interest situations
Case scenario
• A doctor is invited to deliver a
one hour talk in a conference
organized by a drug company at
a resort in Dubai. The doctor is
provided family air-tickets along
with two-day stay at the resort
by the company.
Case scenario + Discussion
+ Reflection

38. Does it apply the FORCE?
Focused [on
students’
motivation for
learning]
Objective
[reflecting actual
need to achieve
outcomes]
Regulated
[planned,
organized and
monitored]
Contextual
[relevant to socio-
cultural needs]
Ethics oriented
[addresses specific
content in ethical
way]

39. Pictures + Discussion
for professionalism & ethics

40. Examples
• Case scenario + Discussion +
Reflection
• Pictures + Discussion
• Role-play + Discussion + Reflection
• Video + Reflective writing
• Case
discussion
• Reflection
• Role-play
• Video demos
• Pictures
• Feedback

41. Combination of video demonstration and reflective
writing used as teaching strategy
Course learning
outcome
Analyse ethical issues
commonly
encountered in clinical
practice
Topic
Informed
consent
Topic learning
outcome
Discuss possible
ethical issues in
consent taking
Video + Reflective writing

43. Does it apply the FORCE?
Focused
[on students’
motivation for
learning]
Objective
[reflecting actual
need to achieve
outcomes]
Regulated
[planned, organized
and monitored]
Contextual
[relevant to socio-
cultural needs]
Ethical
[addresses specific
content in ethical
way]

44. Let’s play a game!
See the short video
1
Make a plan to use this in
ethics education by writing
down:
• Course learning outcome
• Topics
2
Make sure the plan
is according to the
FORCE criteria
3

45. Task
Give a title to the video
clip
Write learning
outcome that can be
achieved from this
video clip
Write content topic/s
for the video clip
Relate the above to the
FORCE criteria

48. Conclusion on how to do it?
• Overcome the common barriers
• Institutional factors
• Student factors
• Faculty factors
• Make it a formal part of curriculum
• Use appropriate methods for teaching
• Enhance the FORCE by using the teaching
methods in combination
Ethics
Professionalism
Communication skills

49. Questions & Comments?

50. References
• Abbot. Hidden curriculum (2014, August 26). In S. Abbott (Ed.), The glossary of education reform.
Retrieved from http://edglossary.org/hidden-curriculum
• Alkabba, A. F., Hussein, G. M., Kasule, O. H., Jarallah, J., Alrukban, M., & Alrashid, A. (2013). Teaching
and evaluation methods of medical ethics in the Saudi public medical colleges: cross-sectional
questionnaire study. BMC Med Educ, 13, 122. doi:10.1186/1472-6920-13-122
• Bonner, Sarah E. "Choosing teaching methods based on learning objectives: An integrative
framework." Issues in Accounting Education 14.1 (1999): 11-15.
• Bush, H. Francis, Karen Gutermuth, and Clifford West. "Teaching Ethics to Undergraduates: An
Examination of Contextual Approaches." Contemporary Issues in Education Research 2.4 (2009): 29-40.
• Catron, Bayard L. "Teaching ethics, teaching ethically." Review of Policy Research 8.4 (1989): 865-870.
• Eckles, R. E., Meslin, E. M., Gaffney, M., & Helft, P. R. (2005). Medical ethics education: where are we?
Where should we be going? A review. Academic Medicine, 80(12), 1143-1152.
• Ghias, K., Ali, S. K., Khan, K. S., Khan, R., Khan, M. M., Farooqui, A., & Nayani, P. (2011). How we
developed a bioethics theme in an undergraduate medical curriculum. Medical teacher, 33(12), 974-
977.
• Passi, V., Doug, M., Peile, J. T., & Johnson, N. (2010). Developing medical professionalism in future
doctors: a systematic review. International Journal of Medical Education, 1, 19.
• Smith, S., Fryer-Edwards, K., Diekema, D. S., & Braddock III, C. H. (2004). Finding effective strategies for
teaching ethics: a comparison trial of two interventions. Academic Medicine, 79(3), 265-271.
• Umran Al-Umran, K., Al-Shaikh, B. A., Al-Awary, B. H., Al-Rubaish, A. M., & Al-Muhanna, F. A. (2006).
Medical ethics and tomorrow's physicians: an aspect of coverage in the formal curriculum. Medical
teacher, 28(2), 182-184.

51. Thank you
doctsaab@gmail.com