Innovative curriculum: Integrating the bio-behavioral and social science principles across the LifeStages in basic science years.

Behavioral and social science integration in clinical practice improves health outcomes across the life stages. The medical school curriculum requires an integration of the behavioral and social science principles in early medical education. We developed and delivered a four-week course entitled "LifeStages" to the first year medical students. The learning objectives of the bio-behavioral and social science principles along with the cultural, economic, political, and ethical parameters were integrated across the lifespan in the curriculum matrix. We focused on the following major domains: Growth and Brain Development; Sexuality, Hormones and Gender; Sleep; Cognitive and Emotional Development; Mobility, Exercise, Injury and Safety; Nutrition, Diet and Lifestyle; Stress and coping skills, Domestic Violence; Substance Use Disorders; Pain, Illness and Suffering; End of Life, Ethics and Death along with Intergenerational issues and Family Dynamics. Collaboration from the clinical and biomedical science departments led to the dynamic delivery of the course learning objectives and content. The faculty developed and led a scholarly discussion, using the case of a multi-racial, multi-generational family during Active Learning Group (ALG) sessions. The assessment in the LifeStages course involved multiple assessment tools: including the holistic assessment by the faculty facilitator inside ALGs, a Team-Based Learning (TBL) exercise, multiple choice questions and Team Work Assessment during which the students had to create a clinical case on a LifeStages domain along with the facilitators guide and learning objectives.

Yesterday's Doctors: The Human Aspects of Medical Education in Britain, 1957-93.

In the wake of the Second World War there was a movement to counterbalance the apparently increasingly technical nature of medical education. These reforms sought a more holistic model of care and to put people - rather than diseases - back at the centre of medical practice and medical education. This article shows that students often drove the early stages of education reform. Their innovations focused on relationships between doctors and their communities, and often took the form of informal discussions about medical ethics and the social dimensions of primary care. Medical schools began to pursue 'humanistic' education more formally from the 1980s onwards, particularly within the context of general practice curricula and with a focus on individual doctor-patient relationships. Overall from the 1950s to the 1990s there was a broad shift in discussions of the human aspects of medical education: from interest in patient communities to individuals; from social concerns to personal characteristics; and from the relatively abstract to the measurable and instrumental. There was no clear shift from 'less' to 'more' humanistic education, but rather a shift in the perceived goals of integrating human aspects of medical education. The human aspects of medicine show the importance of student activism in driving forward community and ethical medicine, and provide an important backdrop to the rise of competencies within general undergraduate education.

Ética, Bioética y método clínico en el tratamiento de pacientes pediátricos aquejados de migraña / Ethics, Bioethics and clinical method in the treatment of pediatric patients suffering from migraine

La migraña es una de las enfermedades que ha acompañado al hombre a lo largo de la vida. Con el objetivo de argumentar, mediante la recopilación de resultados de estudios clínicos de evidencias, la relación existente entre la ética médica y el método clínico en el tratamiento de migrañas en pacientes pediátricos, se realizó revisión de bibliografías sobre migraña, y algunos aspectos del cumplimiento de la ética médica y el método clínico, los que fueron considerados en el desarrollo de las consultas e interconsultas de Neurología del Hospital Pediátrico Universitario William Soler , incluyendo las consultas de Proyección Comunitaria del municipio de Boyeros, en La Habana, en los últimos 10 años. Se accedió a las bases de datos PubMed, Lilacs, Scielo y Google, se restringió la búsqueda por temática y para los últimos 10 años, así como estudios de evidencia, cuyas bases de datos se obtuvieron de las consultas y los resultados fueron publicados en revistas. Se exponen trabajos de evidencia relacionados con el tratamiento de la migraña, en los cuales se aprecia la comunión existente entre la Ética y el método clínico. Las evidencias demostradas en las publicaciones de la autora principal de este estudio sobre el tratamiento de la migraña en Pediatría, demuestran que se puede cumplir con la ética médica y el método clínico, apuntes de Hipócrates antes de nuestra era(AU)

Migraine is a disease that has accompanied man throughout the life. With the objective of substantiating through the collection of results from clinical studies of evidence the relationship between the medical ethics and the clinical method in the treatment of migraine in pediatric patients, a literature review on migraine and on some aspects of the compliance with the medical ethics and the clinical method was made. These aspects had been considered in the medical consultation and interconsultation service of neurology in William Soler university pediatric hospital including the consultation service of the Community Project in Boyeros municipality in Havana in the last ten years. PubMed, Lilacs, Scielo and Goggle databases were accessed; search by topic and restricted to the last ten years was made as well as evidence-based studies whose databases were created from consultations, and the results were published in journals. Evidence papers related to the treatment of migraine were presented, in which the communion between ethics and the clinical method was reflected. The evidence shown in the publications of the main author of this study on the treatment of migraine in pediatrics prove that the medical ethics and the clinical method should be complied with, as Hippocrates said before the CE(AU)

Ética, bioética y método clínico en el tratamiento de pacientes pediátricos aquejados de migraña / Ethics, bioethics and clinical method in the treatment of pediatric patients suffering from migraine

La migraña es una de las enfermedades que ha acompañado al hombre a lo largo de la vida. Con el objetivo de argumentar, mediante la recopilación de resultados de estudios clínicos de evidencias, la relación existente entre la ética médica y el método clínico en el tratamiento de migrañas en pacientes pediátricos, se realizó revisión de bibliografías sobre migraña, y algunos aspectos del cumplimiento de la ética médica y el método clínico, los que fueron considerados en el desarrollo de las consultas e interconsultas de Neurología del Hospital Pediátrico Universitario “William Soler”, incluyendo las consultas de Proyección Comunitaria del municipio de Boyeros, en La Habana, en los últimos 10 años. Se accedió a las bases de datos PubMed, Lilacs, Scielo y Google, se restringió la búsqueda por temática y para los últimos 10 años, así como estudios de evidencia, cuyas bases de datos se obtuvieron de las consultas y los resultados fueron publicados en revistas. Se exponen trabajos de evidencia relacionados con el tratamiento de la migraña, en los cuales se aprecia la comunión existente entre la Ética y el método clínico. Las evidencias demostradas en las publicaciones de la autora principal de este estudio sobre el tratamiento de la migraña en Pediatría, demuestran que se puede cumplir con la ética médica y el método clínico, apuntes de Hipócrates antes de nuestra era.

Migraine is a disease that has accompanied man throughout the life. With the objective of substantiating through the collection of results from clinical studies of evidence the relationship between the medical ethics and the clinical method in the treatment of migraine in pediatric patients, a literature review on migraine and on some aspects of the compliance with the medical ethics and the clinical method was made. These aspects had been considered in the medical consultation and interconsultation service of neurology in “William Soler” university pediatric hospital including the consultation service of the Community Project in Boyeros municipality in Havana in the last ten years. PubMed, Lilacs, Scielo and Goggle databases were accessed; search by topic and restricted to the last ten years was made as well as evidence-based studies whose databases were created from consultations, and the results were published in journals. Evidence papers related to the treatment of migraine were presented, in which the communion between ethics and the clinical method was reflected. The evidence shown in the publications of the main author of this study on the treatment of migraine in pediatrics prove that the medical ethics and the clinical method should be complied with, as Hippocrates said before the CE.

The Tzu Chi Silent Mentor Program: Application of Buddhist Ethics to Teach Student Physicians Empathy, Compassion, and Self-Sacrifice.

The Buddhist Tzu Chi Silent Mentor Program promotes the donation of one's body to science as a selfless act by appealing to the Buddhist ethics of compassion and self-sacrifice. Together, faculty, families, and donors help medical students to learn the technical, spiritual, emotional, and psychological aspects of medicine. Students assigned to each "Silent Mentor" visit the family to learn about the donor's life. They see photos and hear family members' stories. Afterwards, students write a brief biography of the donor which is posted on the program website, in the medical school, and on the dissection table. In this paper, we: (1) summarize the Silent Mentor Program; (2) describe findings from an assessment of medical students who recently completed a new version of the program in Malaysia; and (3) explore how healthcare settings could benefit from this innovative program.

Edmund Pellegrino's philosophy and ethics of medicine: an overview.

It might seem ironic that the author in this mini-symposium who knew Edmund Pellegrino the best should be the one whose essay is the least personal,eschewing anecdote and reminiscence and concentrating on the substance of his scholarly contribution. I think, however, that for Ed, an exposition of his ideas would be the most fitting tribute one could offer. Accordingly, I will attempt to outline his main ideas and bring together his disparate writings in a constructive manner. I do this firstly because there really is no other such brief exposition of his main ideas anywhere in the bioethics literature. Moreover, Pellegrino himself made no attempt to provide an explicit synthesis of his various writings on various topics, and so I will attempt to make explicit a number of implicit connections.Lastly, inasmuch as bioethics has developed dramatically as a field over the last 40 years, there may be young scholars who are unfamiliar with Pellegrino's truly seminal work. A brief overview of his body of scholarship might spur them togo to the primary sources. If I succeed in interesting such persons in reading the work of Edmund Pellegrino, or inspire others to look again at that work with fresh eyes, I believe they will be richly rewarded.

Los aforismos médicos de sir William Osler / Medical Aphorisms of Sir William Osler

William Osler es recordado como uno de los médicos más prestigiados de los siglos XIX y XX, no sólo por su capacidad para resolver problemas de índole clínico, sino, principalmente, por los valores éticos y la filosofía con la que se condujo en su vida cotidiana. Osler sigue siendo un ejemplo para los médicos de las generacionesmodernas, ya que el sistema de aprendizaje que instauró entre sus alumnos (basado en la combinación de la teoría con la práctica médica que se desarrolla al pie de la cama del paciente) sigue vigente hasta nuestros días. Los aforismos presentados en este texto son una invitación a regresar a los orígenes de la medicina, y a recordar que esta profesión forma parte indisoluble del humanismo.

William Osler is remembered as one of the most prestigious physicians of thenineteenth and twentieth centuries, not only for its ability to solve clinical cases,but mainly for ethical values and philosophy by he was conducted in their daily live. Osler remains an example for doctors of modern generations, because the learning system established among their students (based on the combination of theory and medical practice that is developed at patient bed) remains in force until today. The aphorisms presented in this text are an invitation to return to the origins of medicine, and remember that this profession is an indissoluble part of humanism.

Los aforismos médicos de sir William Osler / Medical Aphorisms of Sir William Osler

William Osler es recordado como uno de los médicos más prestigiados de los siglos XIX y XX, no sólo por su capacidad para resolver problemas de índole clínico, sino, principalmente, por los valores éticos y la filosofía con la que se condujo en su vida cotidiana. Osler sigue siendo un ejemplo para los médicos de las generacionesmodernas, ya que el sistema de aprendizaje que instauró entre sus alumnos (basado en la combinación de la teoría con la práctica médica que se desarrolla al pie de la cama del paciente) sigue vigente hasta nuestros días. Los aforismos presentados en este texto son una invitación a regresar a los orígenes de la medicina, y a recordar que esta profesión forma parte indisoluble del humanismo. (AU)

William Osler is remembered as one of the most prestigious physicians of thenineteenth and twentieth centuries, not only for its ability to solve clinical cases,but mainly for ethical values and philosophy by he was conducted in their daily live. Osler remains an example for doctors of modern generations, because the learning system established among their students (based on the combination of theory and medical practice that is developed at patient bed) remains in force until today. The aphorisms presented in this text are an invitation to return to the origins of medicine, and remember that this profession is an indissoluble part of humanism.(AU)

The influence of passive and active moral training on medical university on changes of students' moral competence index - results from randomized single blinded trial.

INTRODUCTION AND OBJECTIVES: Human's life as well as medical professions consist of many moral dilemmas. The aim of our study was to evaluate moral competences of midwifery students during their whole university education (3 year course) based on their moral competences C-index. MATERIAL AND METHOD: We performed randomized single blinded 3-year follow-up trial of 72 midwifery students. Standard Moral Judgment Test (MJT) By Georg Lind was used accompanied by own questionnaire. Moral competences were calculated (C-index) according to Lind's methodology. Subjects were also divided into active and passive ethics training to search for differences. RESULTS: C-index varied during studies insignificant (p=0.14). Randomized groups were equal at the beginning point, no significant differences were noticed. Active ethics teaching did not increase C-index compared to controls in all measuring points (P1-P4, respectively p=0,41 and p=0,38). CONCLUSIONS: During 3 year studies at medical university moral competences measured by C-index varied insignificantly, but simultaneously the change in C-index was dependent on its value at the beginning of the trial. There was not statistically significant influence of active ethic's teaching compared to controls. Among social factors parents have strongest influence on students' morality, but growing role of Medical University in this hierarchy raises hopes for improvement in effectiveness of training in ethics.

Julgamento simulado como estratégia de ensino da ética médica / Mock trial as a strategy of the teaching of medical ethics

Este trabalho buscou identificar a percepção dos alunos sobre a importância do julgamento simulado como estratégia de ensino da ética médica em uma escola de medicina. Durante o julgamento simulado do segundo semestre de 2010 compareceram 211 alunos, que responderam um questionário contendo itens escalonados de Likert, no qual foram incluídas três questões específicas sobre a utilização da estratégia: contribuição para a aquisição de conhecimentos sobre ética médica, relevância para a formação profissional e se recomenda a continuidade da atividade na instituição. Os alunos que responderam (definitivamente sim) ou (provavelmente sim) para as três questões escalonadas alcançaram, respectivamente, um total de 96,2 por cento, 93,9 por cento e 92,5 por cento. Este resultado permitiu concluir que, com base na percepção favorável dos estudantes pesquisados, é recomendável a continuidade do julgamento simulado como uma das estratégias de ensino da ética médica na instituição.

This study aimed to identify students’ perceptions about the importance of the mock trial as a strategy for teaching medical ethics in a medical school. During the mock trial of the second term of 2010, students answered a questionnaire with Likert scaled items that in which were included three specific questions about theuse of the strategy: contribution to learn about medical ethics, relevance to the training and if recommendsthe continuation of the activity at the Institution. Two hundred eleven students attended and all respondedto the survey. Students who answered “definitely yes” or “probably yes” to three questions scaled reached,respectively, a total of 96.2%, 93.9% and 92.5%. This result led to conclude that, based on the favorable perception of the students surveyed; it is recommended the continuation of the mock trial as a strategy for theteaching of Medical Ethics at the Institution.

Use of role play in undergraduate teaching of ethics - an experience.

Lecture is the traditional way of teaching adopted in our routine. Learning about medical ethics used to be done by lecture. All of us felt that learning some aspects of ethics requires a deeper understanding of the topics especially those areas involving feelings and emotions. So the role play method was chosen. We taught the topics consent and euthanasia by both the didactic method and by role play to the students of second year MBBS during the period June-July 2012 and then we compared the results. We have tried to evaluate role play vis-a vis lecture by analyzing the feedback from the students. The affective component analysis requires a different method of teaching and assessment as shown by our experience.

Deliberation at the hub of medical education: beyond virtue ethics and codes of practice.

Although both codes of practice and virtue ethics are integral to the ethos and history of "medical professionalism", the two trends appear mutually incompatible. Hence, in the first part of the paper we explore and explicate this apparent conflict and seek a direction for medical education. The theoretical and empirical literature indicates that moral deliberation may transcend the incompatibilities between the formal and the virtuous, may enhance moral and other aspects of personal sensitivity, may help design and improve other parts of the curricula, and may foster self-awareness and clarification of the professional role. Not only are these goals essential for good and conscientious doctoring, but they may also reduce physicians' "burn-out". We argue that medical education should focus on the ubiquitous practice of deliberation in contemporary medicine, and especially the practice of moral deliberation.

Ethics education in chiropractic colleges: a North American survey.

OBJECTIVE: The purposes of this study were to survey Council on Chiropractic Education-accredited chiropractic colleges in North America and to describe curricular details on the teaching of bioethics. METHODS: A custom-designed survey was sent to chiropractic colleges. Total number of contact hours, whether the ethics was a stand-alone course or integrated elsewhere, type of instructor, and if there was a required or recommended course text were queried. RESULTS: Of 19 surveys sent by mail, 15 surveys were returned. The average time in ethics instruction was 18.7 hours including lecture format, small group tutorial, and self-study. Chiropractic ethics education includes 8 areas of content (boundaries, law and jurisprudence, professionalism, basic ethic tenets/principles, ethical codes of conduct, prevention of financial and of sexual abuse, and resolving an ethical dilemma). Some colleges include content taught to students under the domain of law and jurisprudence. CONCLUSION: The results of this survey indicate that there are opportunities to further develop the educational ethics program at Council on Chiropractic Education-accredited colleges. All colleges currently offer bioethics teaching. An expanded role for this content is recommended so as to offer optimal benefit for students and practitioners.

Use of standardized patients to teach medical students about living organ donation.

Educators routinely use standardized patients to teach medical students a variety of clinical concepts. Standardized patients have also been used to teach students about medical ethics and deceased organ donation. Not reported before, however, is the use of standardized patients to educate medical students about the ethical issues in living organ donation. It seems important to fill this gap because in the United States, roughly 45% of organ donors are living donors, and these patients will visit physicians throughout their lifespan, not just with the occurrence of donation. This article reports an experience teaching concepts in living donation and transplant ethics to second-year osteopathic medicine students using a standardized patient and supplementary instructional materials (eg, film, panel discussion, reading list). Specifically, a transplant ethics module was created that included an actor portraying a living donor candidate who had a number of case variables pertaining to medical and psychosocial matters. Instructional themes included informed consent, altruism, patient selection criteria, organ vending, and post-donation support systems.

An explorative study of experiences of healthcare providers posing as simulated care receivers in a 'care-ethical' lab.

In recent approaches to ethics, the personal involvement of health care providers and their empathy are perceived as important elements of an overall ethical ability. Experiential working methods are used in ethics education to foster, inter alia, empathy. In 2008, the care-ethics lab 'sTimul' was founded in Flanders, Belgium, to provide training that focuses on improving care providers' ethical abilities through experiential working simulations. The curriculum of sTimul focuses on empathy sessions, aimed at care providers' empathic skills. The present study provides better insight into how experiential learning specifically targets the empathic abilities of care providers. Providing contrasting experiences that affect the care providers' self-reflection seems a crucial element in this study. Further research is needed to provide more insight into how empathy leads to long-term changes in behaviour.

[Ethics and teaching medicine. A principles declaration]. / Declaración de principios éticos del educador en medicina.

Medicine is an old profession, having existed for twenty-four centuries. The ethical principles assumed since the beginning and have been enriched through time, culture and tradition. The stone corner of the moral commitment of physicians with the patient and medical students has deteriorated due to a values crisis. This is due to a lack of personalized and humanized care in "altars of progress," characterized by fragmentation of medical care, excessive use of the technology and merchandizing of medicine, where profits is a priority over human need. The effects are unconsciousness and a lack of professional values, which are expressed as disloyalty, deficient solidarity, diminution of confidence, inequality and lack of honesty, affecting the patients and the whole medical relation. The problem also extends to medical education, when the students follow the same way to practice of physicians. To be a real educating physician in medicine implies an indissoluble educational symbiosis (teacher-student). When there is an ethical deterioration the immediate task is to propose alternative ethical and morals rules in medical education, which feed on values and traditional medicine principles.

Teaching ethics in the operating theatre by small group teaching.

BACKGROUND: Ethics is an important topic for theatre staff. They work in a multidisciplinary team usually with an unconscious patient. Ethical dilemmas can often arise during elective and emergency surgery. CONTEXT: The teaching of ethics for this arena is often neglected in favour of covering other surgical skills. There is some evidence from studies of surgical specialties that doctors do not feel confident in applying their training in ethics in the clinical environment. INNOVATION: This paper suggests a format and describes teaching tools for conducting classroom small group teaching sessions on ethics suitable for the whole theatre team. It outlines some strategies that can be used to stimulate debate, and suggested ground rules to run the session smoothly. IMPLICATIONS: Teaching of ethics at undergraduate level can be reinforced by such small group sessions during clinical placements. A short time spent in the classroom discussing such issues is of great benefit to medical staff and patients in this often forgotten, but vitally important topic.