T1 Moral reasoning is both foundational to and surpasses medical ethics. So teaching it must come first in any medical ethics curriculum and will apply well beyond. #MedEd
T1 important to introduce students to concepts like ethics analysis; informed consent; capacity; COI; as well as providing forum for Professional Identity Formation during pre-Clerkship curriculum #MedEd
T1 #MedEd Not sure. I had a medical ethics course in the pre-clinical years and while it was “exciting” at the time, the actual benefit may have been limited except for some broad introductory concepts. Not sure what the kit says about this
T1 When adult learners see the immediate and practical application of a curriculum there is interest. After starting with the skill of moral reasoning, context-specific cases of med ethics are easily appreciated illustrations. #MedEd
Just like any reasoning skill, you identify pre-existing assumptions, deconstruct those assumptions, and then learn how to make logical arguments that support or refute them. #MedEd
T1 #meded pitfall ...we hold up an ideal that is shattered by hidden curriculum - students are left with moral distress & develop cynical view of profession
In reply to
@Alliance4ClinEd, @thartman2u, @MedEdChat
T1 #meded Integrated in PBL/case based learning, realistic situations where possible. It would be very valuable for newly established professionals to share their ethical and moral conflicts through storytelling, first-person accounts.
I think teaching ethics early on is formidable in theory, not sure how practical it is. Perhaps link it as close as possible to the clinical experience to maximize benefit? #MedEd
T1 #meded Which gets back to the big question of how much time should be devoted in pre-clinical curriculum? If it is devoid of clinical experiences, are the #medstudents getting as much out of it as we would like?
Many curriculums have some clinical during pre-Clerkship; students are exposed to ethical dilemmas that they need space/guidance to process #meded#Bioethics
T1 I also think it’s important to teach the skills necessary to reason through ethics because students should be using those skills in their research experiences as well. #MedEd
Many curriculums have some clinical during pre-Clerkship; students are exposed to ethical dilemmas that they need space/guidance to process #meded#Bioethics
T1 not enough - we can and should do more to help them process these complex ethical issues — falls within realm of Professional Identity Formation #meded
T2 #meded This is where the ideal and reality clash. In administering learning environment questionnaires it's quite evident there are serious conflicts with what #medstudents see vs what they were taught.
T2 If you teach students what to think about ethics, they can be taught something different later on, especially within the power dynamics of supervision. If you teach students how to think about ethics, they’ll be prepared to navigate conflicting opinions or behaviors. #MedEd
T2 when clinicians reinforce ethics lessons and described out loud the decision that is in front of them, students have real opportunity for reflection and growth #meded
T2 Hidden Curriculum = Culture. Culture is hardest to see for those in it; takes high degrees of reflection and vigilance to consciously choose one’s actions. These are the skills #medicalstudents need to build. #meded
T2 Hidden curriculum can fully reverse any good that an ethics education can provide, making students feel like ethics isnt real world applicable #meded
I’m working on a study on students’ fundamental life assumptions with a like-minded colleague who teaches ethics at @MCG_AUG, but I’m not familiar with research on the larger questions regarding ethics curriculum design/development. #MedEd
T2 #meded Often times #medstudents identify these cultural issues in course evaluations. How seriously do our faculty take their comments? If we want to change the culture we have to be open to nuggets of truth in their critique. Right?
I think there needs to be open, honest, real discussion with students. Moving away from historical lectures and moving more into applicable discussion of what would they do in certain scenarios. #meded
T2 #meded Are we as instructors willing to let #medstudents be as open and honest as they want in these discussions? I feel sometimes they are saying what's appropriate and not what they feel.
T2 when it comes to bridging the gap, my question is why do we let that gap continue? Why do we let the hidden curriculum continue? If we know that it's going on, isn't it our responsibility to address those clinicians who are reinforcing the exact attitude we oppose #meded
Totally. Students aren’t fully acculturated yet, so they see things others don’t. Remember that we faculty are in the culture too. “Be the change”: To change culture is to pay attention to one’s own transformation. #meded
T2 Course/program evaluation is part of systemic problems in #meded & #highered — are we assessing quality of curriculum or student satisfaction? Very difficult to incorporate feedback when opposing views expressed by students
T2 #meded This is true, but that's why it takes careful reading of the evaluations....particularly the critiques and not the praise to get to the issues.
T2: at one medical school, the GQ shows students report disrespect of colleagues by clinical faculty as one of the reasons for disillusionment and a major contributor to a toxic learning environment. Faculty must act as role models of professionalism and ethical behavior.
It is common in medical school that you are taught to give the 'right answer,' students may not even realize that with ethics we are not looking for black and white 'read the attendings mind' response #meded
T3 #meded This is where I think deliberately identify key faculty to work with #medstudents might be a solution. Not sure how to best implement, but would be worth investigating. @Kind4Kids
In reply to
@Alliance4ClinEd, @COMSEPediatrics, @Surg_Education, @STFM_FM, @CDEMfaculty, @AAIMOnline, @apgonews, @Kind4Kids
This could explain some of our #meded QRP data. Though I will say: with strong leadership and good mentors, this situation can be avoided! 'Professors eat their own young': how competition can stifle good science https://t.co/g9hgoTw0Du
T3: I talk to #medstudents about practical ethics situations in outpatient peds, & I will comment on if relevant to a patient we see, such as teen privacy laws for sexual health & mental health. #meded 1/
T3: we found that role modeling alone is not enough: students often miss what is role modeled. Have to actively debrief and reflect with students in the role modeled behaviors. https://t.co/Mdhsxt84X7#meded
T3: we found that role modeling alone is not enough: students often miss what is role modeled. Have to actively debrief and reflect with students in the role modeled behaviors. https://t.co/Mdhsxt84X7#meded
Agree: the hidden curriculum will influence what we ask and what students answer, unless we are strategic about changing the conversation by asking different questions. #meded
T2 Course/program evaluation is part of systemic problems in #meded & #highered — are we assessing quality of curriculum or student satisfaction? Very difficult to incorporate feedback when opposing views expressed by students
T3 Just as it’s sometimes hard to ensure case exposure, it can be hard to ensure ethics exposure. Because the stakes are high, controlled but authentic experiences could be a solution (e.g., simulation, case debates, etc). #MedEd
It’s not necessarily something extra; rather it can be a different way of talking about what you were already going to talk about with the students. #meded
T3 #MedEd in #obgyn, there are frequently opportunities to discuss patient-centered decision making, #socialjustice, etc. As faculty, simply acknowledging these topics come into my own patient care is enough to "give permission" to learners to discuss and debate.
Not everything in clinical med is black & white, so I want them to understand the thought process behind how I make a choice and the data I use to arrive at that conclusion. Sometimes will review how a permutation in the situation will yield a different response. 2/ #meded
T3 Just as it’s sometimes hard to ensure case exposure, it can be hard to ensure ethics exposure. Because the stakes are high, controlled but authentic experiences could be a solution (e.g., simulation, case debates, etc). #MedEd
I love that I can call my hospital's lawyer with any questions & advice. I should share with them all the situations that ultimately led up to those calls! #meded
Right, so both case and ethics discussions will resonate more deeply with clinical experience. We do a mid-clerkship simulation for this reason too. #MedEd
T3 I never really understood how somebody could fail Ethics sections of exams and still graduate to be a physician. It always seemed to me like that should be a hard stop. #meded
T3 #meded Do discussions on ethics take place in your practices in real life? Asking, since in my profession we discuss ethics daily (sometimes it seems like hourly), with all colleagues.
Final thought: culture is not some big monolith that needs to be toppled. Rather, it is created and recreated in each little moment. If u want to change culture, you need to change the way you move through those little moments. #meded
