Democratization of medical education as a need to teach ethics> A presentation for the International Association for Ethics Education, (USA, 2012)

1. Democratization of Medical
Education as a need to Teach
Medical Ethics: Perspectives from
Developing Countries
Ghaiath Hussein
Abdulaziz Alkaabba
Department of Biomedical Ethics
Faculty of Medicine, King Fahad Medical City
King Saud Bin Abdulaziz University for Health Sciences
Riyadh, Saudi Arabia

2. Nikita: What is the big fuss you
make about the US as the land of
democracy...what is it anyway?
Nixon: For example any American
citizen can stand in front of the
White House, protest against the
American President without being
arrested.
Nikita: So what?!! Now any Soviet
citizen can stand in front of
Kremlin, protest against the
American President without being

3. Outline of the presentation
 Developing Bioethics in the ‘developing world’, how
does it differ?
 Bioethics: what affects teaching bioethics?
 What is democratization of medical education?
 How does it affect teaching bioethics?
 Challenges and Practical steps

4. The developing world.. A closer look
The world map proportional to Human Development
Source: www.worldmapper.org

5. How does that affect Bioethics’
development?
• Sophisticated
services
• Higher expectation
• More Conflicts
• Set of ethical
values and
principles
• Community
agreement
• Free public
debates
• Politicians’ &
practitioners’
accountability
• Free to ask
• The right to have
them answered
• Free press
Freedom of
speech
Democratic
Political
System
Developed
Health
System
Cultural &
Moral
Heritage

6. At the smaller scale… the Medical College
Poor/No
ethics
curriculum
“Sub-ethical doctor”?
Vulnerable
patient
‘Dictator’
professor
Strict
hierarchy
Sub-ethical researcher
Sub-ethical clinician
Sub-ethical teacher
Sub-ethical…etc.
Poor/No
accountability

7. Democratization of ME: Why? What? How?
 Hypothesis: Free informed medical students who
contribute to the educational process without
exploitation will be doctors who will work on making
patients free, informed, and actively involved in
healthcare.
 Ideally, students will practice what they have been
taught as right, whether in classrooms, or at bedside
affected by their community (social, cultural,
religious, etc.)
 Democratization of medical education is about:
 Interactive teaching (listen, ask, answer, e.g. PBL &
COME)
 Participatory decision-making (academic meeting,
management & leadership)
 Make them informed and accountable (informed decision

8.  Political level:
 Overall lack of freedom (people don’t seek their rights)
 Inherited fear of participation
 Academic Level:
 Students don’t get much ‘extra-marks’ for being ethical
 Inherited traditional hierarchical teaching (resistance to
change)
 Institutional affiliations to the Gov. and laws (lack of
academic independence)
 Public & Community Level:
 People do not miss what they do not know.
 Patients who don’t dare (or want) to know & stand for their rights
will not help in making doctors who care to give them.

9. How to manage these challenges?
 Adopt interactive medical education, where students
‘get marks’ for effective communication
 Adopt, develop and empower the ethics curriculum
 Establish ‘safe’ routes and forums for student-
student, student-dean, student-patients
interactions
 Make university/teaching hospitals more patient-
centered in their care.
 Enhance academic transparency and
accountability through regulations and policies.
 Educate the people about their rights (preferably
through students)