teaching medical ethics: from theory to practice - wing may kong

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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

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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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Page 1: Teaching medical ethics: from theory to practice - Wing May Kong

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Powerpoint Templates

Teaching Medical Ethics – from theory to practice Wing May Kong

Vertical Theme Head

Ethics, leadership & professionalism

Imperial College London

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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

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Medical Ethics Teaching

• Statutory regulatory framework for

practice, education and training

• Vocational degree

• Year intakes of 300-400 students

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1963: The Five As

Adultery

Advertising

Addiction

Abortion

Association (with non

medical practitioners)

1963:

The London

Medical Group

1987: The Pond

Report

1993

1993

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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

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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

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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

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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

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Should doctors be good?

The good doctor?

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“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.”

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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

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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

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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

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Recognising Ethical Issues

• Focus on ‘big’ ethical dilemmas

• Constructed case scenarios designed to bring

out ethical issues

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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

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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

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Virtual Learning Objects

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Teaching Virtues- Ways of Knowing

Three types of knowledge:

• Technical

• Practical

• Critical

A. Kumagi et al. Academic Medicine 2014

www.leansytemsinstitute.com

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Critical knowledge

A. Kumagi et al. Academic Medicine 2014

Reflection

Discourse

Imagination

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Clickers

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Year 1 – Ethics session at end of

anatomy introduction week

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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%)

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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%)

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‘A deep understanding of human needs’

A. Kumagi et al. Academic Medicine 2014

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“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

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Haiku by Rhys Davies

Year 4 medical student

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Standard procedure

As hollow an excuse as

‘following orders’

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Heart, valves and organs

A free-for-all, pick-and-

mix,

These are my children

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Summary

There are challenges common to teaching

ethics in the social sciences:

– Developing a community of teachers

– Integrating ethics learning

– Nurturing virtue

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Conclusion

• Engage

• Enable

• Enthuse