Moral Diversity for Medical Trainees.

While the proliferation of diversity, equity, and inclusion (DEI) initiatives among medical schools and residency training programs has provided important benefits of demographic and experiential diversity among medical trainees, there has not been a similar emphasis upon the importance of moral diversity in medical training. Enhanced attention to the importance of moral diversity and the centrality of conscience to medical practice might allow trainees to better interface with the morally diverse patients they serve, learn important virtues like humility, patience, and tolerance, and deepen their understanding of and appreciation for alternative moral viewpoints among their fellow practitioners.

Promoting professionalism through humanities-based transformation.

INTRODUCTION: In the last two decades, academic medical centers in the United States have faced a new challenge, dealing with breaches of medical professionalism in their staff, house staff, and medical students. Medical education settings have largely directed their professionalism efforts toward responding reactively to negative outliers. DISCUSSION: This paper contends that the warrant of medical education mandates a transformative path forward. While negative behavior must be responded to meaningfully, so, too, must positive role models of professional behavior be publicly lauded for their consequential culture change in their institutions, and promoted as positive role models. Further, the promotion of medical professionalism must be part of this culture by proactively engaging all learners and health care providers with medical ethics and humanities-based knowledge, critical thinking skills, and role modeling. CONCLUSION: Professionalism programs should be vested with the authority to implement an affirmative educational program intended to nurture and promote medical professionalism in each medical student, resident, fellow, and attending and utilize methods to that end employing both virtue and care ethics.

Medical professionalism is the foundational concept grounded upon scientific- and humanities-based knowledge and skills, directed toward the promotion of patient benefit with the rejection of self-interest, delivered with excellence in comportment, and the adherence to a covenant of trust with society.Medical educators who solely emphasize the detection and punishment of negative outliers are missing essential elements in promoting medical professionalism.Medical professionalism should be comprehensively addressed through a systematic addressing of teaching fundamental knowledge, skills, and virtue, promote excellence in role modeling and mentorship, and the redress of those lacking insight in their professional conduct.

Ethical issues and proposed solutions in conducting practical assessment of medical students involving patients.

Practical assessment involving patients plays a vital role in medical education, allowing students to demonstrate their clinical competencies. However, there are significant ethical concerns associated with these assessments that require careful consideration and resolution. The primary ethical concerns include violation of patient autonomy, lack of written informed consent, power dynamics, cultural differences, potential harm to patients, breach of privacy and confidentiality, discomfort to admitted patients, financial loss to patients, impact on other patients' care, and delays in workup/procedures. To address these concerns, measures such as respecting patient autonomy, obtaining written informed consent, ensuring patient safety, exploring alternative methods, providing reimbursement, resource planning, creating a supportive environment, developing cultural competency, putting in place a feedback system, prioritising patient care, and implementing ethical oversight and monitoring are recommended. The formulation of a guideline could be a crucial starting point, and it should be integrated into a broader ethical framework that encompasses education and training, ethical oversight, ongoing monitoring, and a culture that prioritises ethical conduct.

Ethical Considerations and Fundamental Principles of Large Language Models in Medical Education: Viewpoint.

This viewpoint article first explores the ethical challenges associated with the future application of large language models (LLMs) in the context of medical education. These challenges include not only ethical concerns related to the development of LLMs, such as artificial intelligence (AI) hallucinations, information bias, privacy and data risks, and deficiencies in terms of transparency and interpretability but also issues concerning the application of LLMs, including deficiencies in emotional intelligence, educational inequities, problems with academic integrity, and questions of responsibility and copyright ownership. This paper then analyzes existing AI-related legal and ethical frameworks and highlights their limitations with regard to the application of LLMs in the context of medical education. To ensure that LLMs are integrated in a responsible and safe manner, the authors recommend the development of a unified ethical framework that is specifically tailored for LLMs in this field. This framework should be based on 8 fundamental principles: quality control and supervision mechanisms; privacy and data protection; transparency and interpretability; fairness and equal treatment; academic integrity and moral norms; accountability and traceability; protection and respect for intellectual property; and the promotion of educational research and innovation. The authors further discuss specific measures that can be taken to implement these principles, thereby laying a solid foundation for the development of a comprehensive and actionable ethical framework. Such a unified ethical framework based on these 8 fundamental principles can provide clear guidance and support for the application of LLMs in the context of medical education. This approach can help establish a balance between technological advancement and ethical safeguards, thereby ensuring that medical education can progress without compromising the principles of fairness, justice, or patient safety and establishing a more equitable, safer, and more efficient environment for medical education.

A review of the ethical considerations for the use of 3D printed materials in medical and allied health education and a proposed collective path forward.

3D scanning and printing technologies are quickly evolving and offer great potential for use in gross anatomical education. The use of human body donors to create digital scans and 3D printed models raises ethical concerns about donor informed consent, potential commodification, and access to and storage of potentially identifiable anatomical reproductions. This paper reviews available literature describing ethical implications for the application of these emerging technologies, existing published best practices for managing and sharing 2D imaging, and current adherence to these best practices by academic body donation programs. We conclude that informed consent is paramount for all uses of human donor and human donor-derived materials and that currently there is considerable diversity in adherence to established best practices for the management and sharing of 3D digital content derived from human donors. We propose a new and simplified framework for categorizing donor-derived teaching materials and the corresponding level of consent required for digital sharing. This framework proposes an equivalent minimum level of specific consent for human donor and human donor-derived materials relative to generalized, nonidentical teaching materials (i.e., artificial plastic models). Likewise, we propose that the collective path forward should involve the creation of a centralized, secure repository for digital human donor 3D content as a mechanism for accumulating, regulating, and controlling the distribution of properly consented human donor-derived 3D digital content that will also increase the availability of ethically created human-derived teaching materials while discouraging commodification.

Contribution of ethical reasoning learning sessions on medical training.

INTRODUCTION: Ethical reasoning is an important skill for all physicians who often face complex ethical dilemmas in their daily practice. Therefore, medical training should include methods for learning ethical theories and concepts, as well as how to apply them in practical situations. AIM: Assess the contribution of an Ethical Reasoning Learning session to fifth medical students' training through a comparison of results of the same objective and structured clinical examination (OSCE) in the form of simulated interview before and after sessions. METHODS: Four 45- minutes' sessions of Ethical Reasoning Learning (ERL) were implemented during a psychiatry internship for four groups of 5th-year students of the faculty of medicine of Monastir (Tunisia). Each session was divided into 7 parts: introduction, reading of a clinical vignette, brainstorming concerning the problems posed by this clinical situation, classification of the problems, identification of the principles of medical ethics, construction of the ethical matrix, and a conclusion. RESULTS: Fifty-seven students participated in the study divided into 4 groups. We found a significant difference in the means of the OSCE scores before and after the ERL session and a significant difference between the probability of respecting medical secrecy during pre and post-ethical reasoning learning sessions (p <0.001). We have found an effect of ERL sessions on the acquisition of this ethical competence by medical students. CONCLUSION: We learned that an ERL session has improved medical training in ethics applied to psychiatry. Other sessions dealing with other ethical skills are necessary to confirm these results.

Implications of the Dobbs Decision for Medical Education: Inadequate Training and Moral Distress.

This Viewpoint discusses how states' restrictions on abortion will affect medical students' training in providing reproductive health care and also create moral distress by being forced to provide care that may harm patients.

The impact of medical students' attitudes towards group ethical norms on their academic achievement and classroom deviant behaviour: An empirical study from China / El impacto de las actitudes de los estudiantes de medicina hacia las normas éticas de grupo en su rendimiento académico y el comportamiento desviado en el aula: un estudio empírico de China / O impacto de atitudes de estudantes de medicine em relação a normas éticas grupais em suas conquistas acadêmicas e comportamentos desviantes em sala de aula: um estudo empírico da China

Abstract: In recent years, medical students' absenteeism has been investigated in depth. Classroom deviant behavior is a richer concept than truancy behavior, but there are few researchers on this aspect in China. There are still many issues worth discussing about deviant classroom behavior. In this paper, questionnaires were given to 977 medical students to collect relevant data. After classifying the data, correlation analysis and multilevel linear regression analysis were used to conclude that academic performance and group ethical norms have a negative impact on medical students' deviant behaviors in class. Group ethical norms have a significant positive influence on academic performance, and descriptive ethical norms and imperative ethical norms of group ethical norms have a significant influence on academic performance. The four dimensions of academic performance: academic performance, task performance, interpersonal promotion, and social comparison have a negative influence on medical students' deviant behaviors in class. Descriptive ethical norms have an inverse effect on medical students' deviant behaviors, while imperative ethical norms have no significant effect on deviant behaviors in class. Group ethical norms as a category of ethical norms clearly have significant implications for improving academic performance and reducing their transgressions in class. Reinforcing group ethics in medical students will not only contribute to their professional ethics upon graduation, but also to their academic performance.

Resumen: En los últimos años, se ha investigado en profundidad el absentismo de los estudiantes de medicina. El comportamiento desviado en el aula es un concepto más rico que el comportamiento de absentismo escolar, pero hay pocos investigadores sobre este aspecto en China. Todavía hay muchas cuestiones que vale la pena discutir sobre el comportamiento desviado en el aula. En este trabajo, se entregaron cuestionarios a 977 estudiantes de medicina para recoger los datos pertinentes. Tras clasificar los datos, se utilizó el análisis de correlación y de regresión lineal multinivel para llegar a la conclusión de que el rendimiento académico y las normas éticas de grupo tienen un impacto negativo en los comportamientos desviados de los estudiantes de medicina en clase. Las normas éticas de grupo tienen una influencia positiva significativa en el rendimiento académico, y las normas éticas descriptivas y las normas éticas imperativas de las normas éticas de grupo tienen una influencia significativa en el rendimiento académico. Las cuatro dimensiones del rendimiento académico: rendimiento académico, rendimiento de la tarea, promoción interpersonal y comparación social tienen una influencia negativa en los comportamientos desviados de los estudiantes de medicina en clase. Las normas éticas descriptivas tienen un efecto inverso en las conductas desviadas de los estudiantes de medicina, mientras que las normas éticas imperativas no tienen un efecto significativo en las conductas desviadas en clase. Las normas éticas de grupo como categoría de normas éticas tienen claramente implicaciones significativas para mejorar el rendimiento académico y reducir sus transgresiones en clase. Reforzar la ética de grupo en los estudiantes de medicina no sólo contribuirá a su ética profesional al graduarse, sino también a su rendimiento académico.

Resumo: Nos últimos anos, o absenteísmo dos estudantes de medicina tem sido pesquisado em profundidade. O comportamento desviante na sala de aula é um conceito mais rico do que o comportamento de evasão escolar, mas há poucos pesquisadores sobre este aspecto na China. Ainda há muitas questões que vale a pena discutir sobre o comportamento desviante em sala de aula. Neste documento, foram entregues questionários a 977 estudantes de medicina para coletar dados relevantes. Após a classificação dos dados, análise de correlação e análise de regressão linear multinível foram utilizadas para concluir que o desempenho acadêmico e as normas éticas de grupo têm um impacto negativo sobre o comportamento desviante dos estudantes de medicina em sala de aula. Normas éticas de grupo têm uma influência positiva significativa no desempenho acadêmico, e normas éticas descritivas e normas éticas imperativas de normas éticas de grupo têm uma influência significativa no desempenho acadêmico. As quatro dimensões do desempenho acadêmico: desempenho acadêmico, desempenho de tarefas, promoção interpessoal e comparação social têm uma influência negativa sobre os comportamentos desviantes dos estudantes de medicina nas aulas. As normas éticas descritivas têm um efeito inverso sobre os comportamentos desviantes dos estudantes de medicina, enquanto as normas éticas imperativas não têm efeito significativo sobre os comportamentos desviantes nas aulas. Normas éticas de grupo como uma categoria de normas éticas têm claramente implicações significativas para melhorar o desempenho acadêmico e reduzir suas transgressões na classe. O reforço da ética de grupo em estudantes de medicina não só contribuirá para sua ética profissional ao se formarem, mas também para seu desempenho acadêmico.

Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education.

Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.

Addressing Equity in Global Medical Education During the COVID-19 Pandemic: The Global Medical Education Collaborative.

PROBLEM: The COVID-19 pandemic has presented a unique set of challenges to medical education globally. Low- and middle-income countries (LMICs) have faced unique barriers in transitioning to virtual modalities, and many medical students in LMICs experienced dramatically reduced educational time. The authors created the Global Medical Education Collaborative (GMEC) to address this problem by providing free, online, case-based tutorials to medical students in LMICs during the pandemic. APPROACH: The authors developed a needs assessment to gauge students' educational requirements, which informed GMEC's 2 primary goals: to provide free access to interactive online tutorials for students in LMICs and to bridge the physical distance between educators and learners via an online platform. A pilot program in Nigeria (April 26-May 26, 2020) helped inform the current strategy and logistics. Tutors and students were recruited via social media and medical education networks at the authors' home institutions. OUTCOMES: Within the first 2 months (April 26-June 26, 2020), 324 students representing 12 countries and 20+ medical schools joined GMEC. Additionally, 95 physicians and trainees joined as tutors and, collectively, delivered 52 tutorials. Students responded to a needs assessment querying confidence in various clinical domains, interest in covering clinical topics, barriers to virtual learning, and the effect of the pandemic on their education. Tutors held 1-hour, interactive tutorials over Zoom covering a variety of clinical topics. According to surveys, 91% of students (71 of 78) felt more confident in the material related to the tutorial's topic after participating. NEXT STEPS: GMEC will continue to engage students, tutors, and collaborators to facilitate the delivery of innovative, high-quality tutorials to students affected by COVID-19 in LMICs. To ensure that the platform is sustainable and aligned with GMEC's mission to promote equity in global medical education, the collaborative will need to be agile and responsive.

Education, Ethics, and History: The Peer Review Process in the US.

Despite the near-universal acceptance of the benefits of a sound peer review process (PRP), the topic of peer review remains a source of controversy among surgeons. The current PRP is plagued by heterogeneity across different hospital and institutional systems. These inconsistencies, combined with a perceived lack of fairness inherent to the PRP in some institutions, led to concerns among practicing surgeons. In this review of the relevant literature on the PRP, we attempted to provide some context and insight into the history of the PRP, its role, its shortcomings, its potential abuses, and some key requirements for its successful execution.

The Clarion Call of the COVID-19 Pandemic: How Medical Education Can Mitigate Racial and Ethnic Disparities.

Public health crises palpably demonstrate how social determinants of health have led to disparate health outcomes. The staggering mortality rates among African Americans, Native Americans, and Latinx Americans during the COVID-19 pandemic have revealed how recalcitrant structural inequities can exacerbate disparities and render not just individuals but whole communities acutely vulnerable. While medical curricula that educate students about disparities are vital in rousing awareness, it is experience that is most likely to instill passion for change. The authors first consider the roots of health care disparities in relation to the current pandemic. Then, they examine the importance of salient learning experiences that may inspire a commitment to championing social justice. Experiences in diverse communities can imbue medical students with a desire for lifelong learning and advocacy. The authors introduce a 3-pillar framework that consists of trust building, structural competency, and cultural humility. They discuss how these pillars should underpin educational efforts to improve social determinants of health. Effecting systemic change requires passion and resolve; therefore, perseverance in such efforts is predicated on learners caring about the structural inequities in housing, education, economic stability, and neighborhoods-all of which influence the health of individuals and communities.

Desafios bioéticos na formação médica: uma perspectiva teleológica e axiológica / Bioethical challenges in medical schools: a teleological and axiological perspective

Resumo: Introdução: Os valores humanos e as virtudes éticas que norteiam a ação médica na sociedade contemporânea são um tema deveras importante, contudo pouco tematizado e enfatizado no processo de formação dos futuros médicos. Objetivo: Dada a suma complexidade do assunto para a formação profissional integral, haja vista a medicina ser uma ciência sobretudo humana que alia técnica e conhecimento ao bem-estar das pessoas, faz-se necessário problematizar quais os principais desafios bioéticos na formação médica sob uma perspectiva teleológica e axiológica. Métodos: Por meio de um artigo de reflexão, far-se-á uma análise sistemático-crítica conceitual das principais virtudes e dos principais valores debatidos e refletidos na tradição ética ocidental mediante cotejamento bibliográfico à luz do atual estado da arte do processo formativo médico. Resultado: A preocupação didático-pedagógica com valores e virtudes ético-morais, tais como caráter, amor, liberdade, respeito, responsabilidade, compaixão, paciência, humildade, fortaleza, prudência, justiça e coragem, entre outros, não está sendo privilegiada no ensino médico. Há um déficit nessa dimensão, dificultando o amadurecimento e a aprendizagem de práticas ético-morais indispensáveis em nosso tempo. Conclusão: O atual estágio do exercício da profissão médica, imersa num paradigma tecnicista, requer, cada vez mais, profissionais com uma formação humanista e não apenas tecnopragmática. Os desafios advindos de uma sociedade multifacetada, em constante evolução, exigem que as universidades e faculdades médicas enfoquem, precipuamente, as dimensões axiológicas e ético-morais na formação.

Abstract: Introduction: Although the human values and ethical virtues that guide medical action in contemporary society constitute a very important theme, they are given little emphasis in medical training. Objective: Given the complexity of this issue in relation to comprehensive professional training, and since medicine is - an above all human - science, that combines technique and knowledge with people's well-being, it is necessary to question the main bioethical challenges in medical training from a teleological and axiological perspective. Methods: In a reflection paper, a systematic-critical conceptual analysis of the main virtues and values debated and reflected in the Western ethical tradition is conducted by means of bibliographic comparison in light of the current state of the art of the medical training process. Results: A didactic-pedagogical concern with ethical-moral values and virtues such as character, love, freedom, respect, responsibility, compassion, patience, humility, fortitude, prudence, justice and courage, is not being prioritised in medical education. There is a deficit in this dimension, making it difficult for students to mature and learn the ethical-moral practices that are indispensable in our time. Conclusion: The current stage in the exercise of the medical profession immersed in a technicalist paradigm increasingly requires professionals with a humanist and not just techno-pragmatic background. The challenges that emerge from a constantly changing and multifaceted society require universities and medical faculties to focus, above all, on the axiological and ethical-moral dimensions of training.