ETHICS IN

MEDICAL EDUCATION

DR. INAYAT ULLAH MEMON

MCPS – HPE (2016 -18)
THIRD CONTACT SESSION

COLLEGE OF PHYSICIANS & SURGEONS PAKISTAN

DEPARTMENT OF MEDICAL EDUCATION

KARACHI: 27TH JULY 2017

 Ground Rules

• Let the presenter talk about the topic (25 min)

• Avoid ask question before the question period
(question period: 5 min)
• If asking question is unavoidable during
presentation, please raise the hand
• Ask the question at the end of presentations
• Avoid repetition of questions
• Comments can me made at the end of the
presentation
• Turn-off mobile phones
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Plan of my lecture
• What are various perspectives of the topic
 Learning Objectives:

 By the end of this lecture, audience will be able to:

To describe and interpret Ethics in Medical
Education.
To have knowledge of different components of
Ethics in Medical Education.
To able to facilitate to form curriculum component
in Ethics education
To able to facilitate to formulate different
modalities of Ethics Education
To be familiar with and help to facilitate mode of
assessment used in Ethics in medical education.
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1. What is Ethics in Medical Education

Various components

?
How ethically the medical education be delivered
(e.g. teachers should not have own interests, be
morally role-models, avoidance of indecent
behavior of medical educators to the vulnerable
students and patients etc.)
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2. What is Ethics in Medical Education

OR

• Is it the ethical to impart medical education to

trainees using patients for the benefit of learners
• Though learners benefit from patients
But
• The patients either no get benefit or harmed by
this practice

(Ref: Jagsi R, Lehmann LA. The ethics of Medical Education. BMJ. 2004; 329:
332-4)
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3. What is Ethics in Medical Education

OR
A. Why, What and How ethics education be
imparted to medical students and trainees
B. How ethical conduct in medical practice and
training be evaluated and strengthened

I, Presume:
Core objective of today’ topic is above perspective
Delivering Ethics Education to students and
trainees
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1. Unethical conduct of medical educators and

physicians: Some harsh facts:

More than 1,000 registered and licensed doctors have

criminal convictions... including possession of indecent
images of children, sexual assault and threats to kill 

By Thomas Burrows for MailOnline

Published: 15:04 BST, 21 January 2017 | Updated: 21:50 BST, 21 January
2017

(Source: http://www.dailymail.co.uk/news/article-4068340/More-1-000-doctors-
criminal-convictions.html)
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Unethical conduct of medical educators

and physicians: Some harsh facts:

23 Jan 2017 New York Post

• A former Mount Sinai doctor who sexually assaulted

four emergency room patients was sentenced Monday
to 2 years in prison - as a victim tearfully recounted
her terrific encounter with the disgraced physician

Source: http://nypost.com/2017/01/23/prison-for-doctor-who-drugged-
sexually-assaulted-patient/
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2. Using ptients for Medical Education

• Does the patient has right to refuse to participate in clinical
teaching?
• Is it really voluntary?
• If NO, the situation is objectionable and Unethical!
• W have to balance:
▫ Potential good to the society
▫ Potential benefit to the patient
▫ Potential harm to the patient
• Unfair distribution of risks and benefits to the patients

(Ref: Jagsi R, Lehmann LA. The ethics of Medical Education. BMJ. 2004; 329: 332-4)
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Using ptients for Medical Education

• Current system of medical education , in which

doctors in training and medical students
participate in medical care, may expose patients
to physical, psychological and economical risks,
often without their full consent.

(Ref: Jagsi R, Lehmann LA. The ethics of Medical Education. BMJ. 2004; 329:
332-4)
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3. Delivering Ethics Education to students and trainees

• Why teaching ethics as part of medical

education: (Objectives)
• What should be taught (Curriculum)
• How it should be taught (Learning / teaching
modalities)
• How the imparted learning (knowledge, conduct
and performance) be evaluated (Assessment)
• How it could / should be strengthened (Post-
assessment evaluation).
(Source: Singer PA. Strengthening the role of ethics in medical education.
CMAJ. April 2003; 168(7): 854-55)
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Princeton University, Monash University,

University of Melbourne
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Abraham Flexner
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Why
teaching ethics as part of medical education?

• History witnesses regrettable misconduct by

physicians (world war II experiments, Tuskegee
trial on black Americans and many more)
• Advancement in technology raising ethical issues
and dilemmas

(Source: Singer PA. Strengthening the role of ethics in medical education.

CMAJ. April 2003; 168(7): 854-55)
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Must recognize situations as ethical

dilemma:
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What
should be taught in ethics education?
• Foundational principles of medical ethics
• Informed consent
• Privacy and confidentiality
• Disclosure of medical errors
• Breaking the bad news
• Conflict of interests
• Physicians-Patient relationship
• End-0f-life care
• Resource allocation
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What is required to achieve this?

• Admitting students through “Moral Judgment

Interview”
• Provide effective training:
▫ Relevant knowledge norms and laws
▫ Analysis of this knowledge
▫ Demonstrate skill to communicate and negotiate
situations
▫ Moral reasoning
• Performance
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Millers Triangle
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What
should be teaching modalities?

• Small Group Discussion

• Role modelling
• Role play
• PBL sessions
• Videos
• Home assignments
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How ethics learning be evaluated:

• Best way of ethics assessment is evaluate performance,
by:
▫ OSCE
▫ Assessment by peers
▫ Nurses
▫ Patients and their families
▫ In-training evaluation reports
▫ WPBA (Work-Place Based Assessment
But
What about the Reliability and Validity of these
assessment tools.
(Source: Singer PA. Strengthening the role of ethics in medical education.
CMAJ. April 2003; 168(7): 854-55)
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How ethics teaching be strengthened:

• By creating Ethical Learning Climate

• Cultural change
• Role modelling
• Implementing policies and principles to ensure
learning climate
• Guidelines for ethics in clinical teaching
• Habit of mind: Adopting and valuing patient’s
perspectives
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Summary:
• What are various aspects or components of
“Ethics in Medical Education”
• Discussed three components / interpretation of
the topic
• Detailed discussion of imparting ethics training
to medical students and trainees
• Modes of learning
• Modes of evaluation
• Modes of strengthening
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References:
A. Jagsi R, Lehmann LA. The ethics of Medical Education. BMJ. 2004; 329: 332-4
B. Gondal GM. Role of Teaching Ethics in Medical Education.
Foundation University Med J. 2014; 1(1): 47-49
C. Singer PA. Strengthening the role of ethics in medical education.
CMAJ. April 2003; 168(7): 854-55
D. Nicolaides A. The critical role of ethics training in medical education.
African Journal of Hospitality, Tourism and Leisure. 2014; 3(1): 1-12
http://www.ajhtl.com/uploads/7/1/6/3/7163688/article_22_vol.3_1.pdf
E. Chan S, Harden J, Salas S. Ethics and Social Sciences in Medical Education:
A crucial view from Chile. AMEE MedEdPublish
DOI https://doi.org/10.15694/mep.2016.000158
<https://www.mededpublish.org/manuscripts/740/v1
F. McCrary SV. Role of bioethics in Medical Education A Crucial profession
Under Threat. ActionBioscinces. April 2001; 1-4.
http://www.actionbioscience.org/biotechnology/mccrary.htmlJoseph
G. Carrese JA, Malek J, Watson K, Lehman LS, Green M, McCullough LR,
Geller G, Braddock CH, Doukas DJ. The Essentail Role of medical Ethics
Education in Achieving Professionalism: The Romanel Report. Ademic Medicine.
June 2015; 90 (6): 1-9. http://www.academy-professionalism.org/PDF/The_
Essential_Role_of_Medical_Ethics_Education_in_98809.pdf
H. Rameshkumar K. Ethics in medical curriculum; ethics by the teachers for students and
society. Indian J Uro. July-Sept. 2009; 25(3): 337-39
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779957/?report=printable
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Thanks for Patient Listening