Los principios de la bioética en la docencia: dificultades y propuesta / The principles of bioethics in teaching: difficulties and proposal

Es frecuente que la docencia de la bioética se base en el aprendizaje de los principios de autonomía, be neficencia, no maleficencia y justicia, ampliamente usados hoy. De cara a la práctica ética, estos principios adolecen de una insuficiencia notable, dejando aparte su ambigüedad y otros problemas. Pero de cara a la docencia muestran una especial incongruencia, por varios motivos: a) poca adecuación de los términos a los conceptos que quieren expresarse, b) formalismo que dificulta el acercamiento a la realidad, c) poca adecuación a las necesidades del discente y d) ser términos especializados en un ámbito que debería ser fundamentalmente divulgativo. Se examinan en detalle estas cuatro limitaciones, que aconsejan otro en foque en la docencia de la bioética; se aporta una reflexión final sobre la diferencia entre los principios de la bioética y la ética (AU)

It is common base the teaching of bioethics on the learning of the principles of autonomy, beneficence, non-maleficence and justice, widely used today. In terms of ethical practice, these principles suffer from a notable inadequacy, leaving aside their ambiguity and other problems. Nevertheless, as a teaching meth od, they show a special incongruity, for several reasons: a) little adequacy of the terms to the concepts that want to be expressed, b) formalism that hinders the approach to reality, c) little adaptation to the needs of the student and d) be specialized terms in a field that should be fundamentally informative. These four limitations, which advise another approach in the teaching of bioethics, are examined in detail; a final reflection is provided on the difference between the principles of bioethics and ethics (AU)

Ethics Education in U.S. Allopathic Medical Schools: A National Survey of Medical School Deans and Ethics Course Directors.

AbstractPurpose: to characterize ethics course content, structure, resources, pedagogic methods, and opinions among academic administrators and course directors at U.S. medical schools. METHOD: An online questionnaire addressed to academic deans and ethics course directors identified by medical school websites was emailed to 157 Association of American Medical Colleges member medical schools in two successive waves in early 2022. Descriptive statistics were utilized to summarize responses. RESULTS: Representatives from 61 (39%) schools responded. Thirty-two (52%) respondents were course directors; 26 (43%) were deans of academic affairs, medical education, or curriculum; and 3 with other roles also completed the survey (5%). All 61 schools reported some form of formal ethics education during the first year of medical school, with most (n = 54, 89%) reporting a formal mandatory introductory course during preclinical education. Schools primarily utilized lecture and small-group teaching methods. Knowledge-based examinations, attendance, and participation were most commonly used for assessment. A large majority regarded ethics as equally or more important than other foundational courses, but fewer (n = 37, 60%) provided faculty training for teaching ethics. CONCLUSIONS: Despite a response rate of 39 percent, the authors conclude that medical schools include ethics in their curricula in small-group and lecture formats with heterogeneity regarding content taught. Preclinical curricular redesigns must innovate and implement best practices for ensuring sound delivery of ethics content in future curricula. Additional large-scale research is necessary to determine said best practices.

Love Your Patient as Yourself: On Reviving the Broken Heart of American Medical Ethics.

This article presents a radical claim: American medical ethics is broken, and it needs love to be healed. Due to a unique set of cultural and economic pressures, American medical ethics has adopted a mechanistic mode of ethical reasoning epitomized by the doctrine of principlism. This mode of reasoning divorces clinicians from both their patients and themselves. This results in clinicians who can ace ethics questions on multiple-choice tests but who fail either to recognize a patient's humanity or to navigate the ethical quandaries into which they are frequently thrown. Drawing on personal experience as well as the philosophical work of Augustine of Hippo, Simone Weil, and Iris Murdoch, we propose a novel ethical approach grounded in a conception of neighbor love, specifically, the virtue of love understood as attention to a sufferer's humanity. We conclude with five practical recommendations for reimagining medical ethics education oriented around the virtue of love.

The effectiveness of online team-based learning in introduction to medical ethics education for medical students at a medical college of Nepal: a pilot study.

BACKGROUND: The effectiveness of online classes is always a concern, and it can be overcome by opting for active learning strategies like team-based learning (TBL). This study was conducted to find out the effectiveness of online TBL as an active learning strategy. We also aimed to explore the satisfaction and perception of students toward TBL. METHODS: This is a mixed-method study conducted among 29 third-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Gandaki Medical College using purposive sampling method in the duration of January to September 2021. Three two hours online TBL sessions were used for teaching introduction to medical ethics. The individual readiness assurance test (IRAT) scores were compared to the group readiness assurance test (GRAT) scores to evaluate the effect of TBL through cooperative learning. Learner reactions and satisfaction of students towards TBL were assessed using a validated questionnaire comprising of a five-point Likert scale. An open-ended question asking the participants to describe their overall experience of the TBL sessions was also included to explore their perceptions towards TBL. The data were collected using Google form and exported to Microsoft Excel and the quantitative data were then analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. To check the normal distribution of the data, Kolmogorov Smirnov and Shapiro-Wilk test were used. Non-parametric tests were used for the non-normally distributed data. P value of < 0.05 was regarded as significant. Thematic analysis was conducted for the qualitative data. RESULTS: The median GRAT scores were significantly higher (p = 0.006 in TBL 1 and 0.001 in TBL 2) than IRAT scores. Learner reactions toward TBL sessions were positive as shown by the mean scores which were in the range of 3.59 to 4.66. Five themes were generated from the codes: "effective learning method", "positive experience", "gained knowledge", "expression of gratitude" and "the way of conduction of the sessions". CONCLUSION: Online TBL in medical ethics was effective as a teaching learning tool in our setting. The students were satisfied with the learning process and rated the learning strategy positively.

Ethics and Well-Being: The Health Professions and the COVID-19 Pandemic.

The COVID-19 pandemic has had a profound impact on health professionals, adding to the moral suffering and burnout that existed prepandemic. The physical, psychological, and moral toll of the pandemic has threatened the well-being and integrity of clinicians. The narrative of self-sacrifice and heroism bolstered people early on but was not sustainable over time. For health professions students, the learning environment changed dramatically, limiting opportunities in direct patient care and raising concerns for meeting training requirements. Learners lost social connections and felt isolated while learning remotely, and they witnessed ethical tensions between patient-centered care and parallel obligations to public health. Worries about transmission of the virus and uncertainty about its management contributed to their moral suffering. Educators adjusted curricula to address the changing ethical landscape. Preparing learners for the realities of their future professional identities requires creation of interprofessional moral communities that provide support and help develop the moral agency and integrity of its members using experiential and relational learning methods. Investing in the well-being and resilience of clinicians, implementing the recommendations of the National Academy of Medicine, and engaging learners and faculty as cocreators of ethical practice have the potential to transform the learning environment. Faculty need to be trained as effective mentors to create safe spaces for exploring challenges and address moral adversity. Ethics education will need to expand to issues related to health systems science, social determinants of health, and public health, and the cultivation of moral sensitivity, character development, professional identity formation, and moral resilience.

Teaching of ethics in medical undergraduate programs / Enseñanza de la ética en programas de pregrado médico / Ensino da ética nos cursos de graduação em medicina

Abstract 19. Literature points to the existent diversity in medical graduate courses' curriculums, reinforcing the need to systematise and deepen more studies in this area with the aim of qualifying the formation of our future professionals. This study aims to understand the methods used in the teaching of Bioethics in medical graduation worldwide. It was characterised as an integrative review and the databases used were Pubmed, Scopus and Web of Science. In total 2993 articles were identified and 72 met the pre-selected criteria and were included in the review. The characteristics of teaching bioethics that stood out the most in the analysis were: teaching still very heterogeneous between different universities, use of various methodologies in the process of teaching/learning, teaching disconnected from the medical practice of students showing the need to integrate the curriculum with clinical practice and challenges of teaching-learning process. Most of the studies in this review lead us to understand that there is still no minimum parameters on the ideal method to teach bioethics, suggesting that it may affect the feeling of unpreparedness felt by students in face of ethical issues in clinical practice, despite the theoretical basis acquired.

Resumen 23. La literatura apunta a la diversidad existente en los currículos de los posgrados de medicina, reforzando la necesidad de sistematizar y profundizar más estudios en esta área, con el fin de capacitar la formación de nuestros futuros profesionales. Este estudio tiene como objetivo comprender los métodos utilizados en la enseñanza de la bioética en la graduación médica en el mundo. Se caracterizó como una revisión integradora y las bases de datos utilizadas fueron Pubmed, Scopus y Web of Science. En total se identificaron 2.993 artículos, 72 cumplieron los criterios preseleccionados y se incluyeron en la revisión. Las características de la enseñanza de la bioética que más se destacaron en el análisis fueron: docencia aún muy heterogénea entre diferentes universidades, uso de diversas metodologías en el proceso de enseñanza/aprendizaje, docencia desconectada de la práctica médica de los estudiantes, mostrando la necesidad de integrar el currículo con la práctica clínica y los desafíos del proceso de enseñanza/aprendizaje. La mayoría de los estudios de esta revisión nos lleva a entender que aún no existen parámetros mínimos sobre el método ideal para enseñar bioética, sugiriendo que puede impactar en la falta de preparación que sienten los estudiantes ante cuestiones éticas en la práctica clínica, a pesar de las teorías base adquiridas.

Resumo: 27. Vários estudos relatam a diversidade existente nos currículos da graduação em medicina, reforçando a necessidade de sistematizar e aprofundar mais estudos nesta área com o objetivo de qualificar a formação dos nossos futuros profissionais. Este estudo tem como objetivo compreender os métodos utilizados no ensino da Bioética na graduação em medicina em todo o mundo. Esse estudo caracterizou-se como revisão integrativa e as bases de dados utilizadas foram Pubmed, Scopus e Web of Science. No total, foram identificados 2.993 artigos e 72 atenderam aos critérios pré-selecionados e foram incluídos na revisão. As características do ensino da bioética que mais se destacaram nas análises foram: ensino ainda muito heterogêneo entre as diferentes universidades, utilização de diversas metodologias no processo de ensino / aprendizagem, ensino desvinculado da prática médica dos alunos evidenciando a necessidade de integração curricular com a prática clínica e os desafios do processo ensino-aprendizagem. A maioria dos estudos desta revisão nos leva a entender que ainda não existem parâmetros mínimos sobre o método ideal de ensino da bioética e traz como um desafio importante o despreparo sentido pelos alunos frente às questões éticas na prática, apesar da fundamentação teórica adquirida.

Teaching Effective Informed Consent Communication Skills in the Virtual Surgical Clerkship.

BACKGROUND: The disruption by the COVID-19 pandemic on undergraduate medical education allowed for assessment of virtual curricular innovations. One of the difficulties encountered in the virtual curriculum is the teaching of clinical competencies that would traditionally require students to undergo in-person simulations and patient encounters. We implemented a novel informed consent activity module, with standardized patients, to improve self-efficacy in communication within our core surgery clerkship. STUDY DESIGN: All medical students who participated in the virtual surgery clerkship were recruited to participate in a retrospective survey study regarding the novel informed consent module. These questions evaluated their perceived competence in 4 domains relating to informed consent: identifying the key elements, describing common challenges, applying the New Mexico Clinical Communication Scale (NMCCS), and documenting. RESULTS: Thirty-four of 90 students participated in the study (38% of the cohort). Respondents to the survey reported that their self-efficacy in communication skills related to informed consent improved as a result of their participation in the activity in each of the 4 domains surveyed (p < 0.01), with the majority of students identifying as satisfactory or above in each domain post-module. Students generally viewed the virtual informed consent activity positively, but noted that it was not the same as an in-person clinical experience. CONCLUSIONS: A virtual module of communication skills training, using standardized patients and faculty, improved students' belief in their self-efficacy in obtaining informed consent. This communication module can be useful in a virtual or mixed curricular structure for both current and future medical students.

Ética médica nas Faculdades Integradas do Norte de Minas: percepção do estudante / Medical ethics in Faculdades Integradas do Norte de Minas: student perception / Ética médica en las Facultades Integradas del Norte de Minas: percepción de los estudiantes

Resumo Está cada vez mais evidente que a reflexão sobre ciências humanas e deontologia é necessária para a formação mais abrangente do estudante de medicina, visando preparar não apenas profissionais tecnicamente capacitados, mas também humanizados. Diante disso, e a fim de seguir as diretrizes curriculares nacionais atuais, as Faculdades Integradas do Norte de Minas instituíram módulo no sexto período de medicina chamado "Humanidades, Bioética e Antropologia Médica". Objetivando avaliar a percepção de alunos sobre o ensino de ética nessa instituição, esta pesquisa aplicou questionário a estudantes do sétimo ao décimo períodos do curso de medicina. O instrumento contava com perguntas sobre a estruturação do módulo e o ensino de ética. Os resultados evidenciaram a proposta inovadora do módulo e a importância da ética médica na grade curricular no sentido de contribuir para a formação de médicos mais humanos.

Abstract It is increasingly evident that reflection on humanities and deontology is necessary for a more comprehensive training of medical students, aimed at preparing professionals that are not only technically qualified, but also humanized. For this reason and also to follow the current national curriculum guidelines, Faculdades Integradas do Norte de Minas introduced a new module in the sixth period: "Humanities, Bioethics and Medical Anthropology." Aiming to evaluate student perception about the teaching of ethics in the institution, this research applied a questionnaire to the students (seventh to tenth period) of the medical course. The instrument comprised questions on the module's structure and the teaching of ethics. Results show the importance of including medical ethics in the medical curriculum for a more humanized formation of doctors.

Resumen Cada vez es más evidente que la reflexión sobre humanidades y deontología es necesaria para la formación integral del estudiante de medicina, con el objetivo de preparar no solo profesionales técnicamente calificados, sino también humanizados. Por lo tanto, y con el fin de seguir las actuales directrices curriculares nacionales, las Facultades Integradas del Norte de Minas establecieron un módulo en el sexto período de medicina denominado "Humanidades, Bioética y Antropología Médica". Con el fin de evaluar la percepción de los estudiantes sobre la enseñanza de la ética en esta institución, esta investigación aplicó un cuestionario a estudiantes del séptimo al décimo período de la carrera de medicina. El instrumento tenía preguntas sobre la estructuración del módulo y la enseñanza de la ética. Los resultados mostraron la propuesta innovadora del módulo y la importancia de la ética médica en el plan de estudios para contribuir a la formación de futuros médicos más humanos.

La ciudadela (1938) de King Vidor: luces y sombras en el ejercicio de la profesionalidad / The Citadel (1938) by King Vidor: Lights and shadows in the practice of professionalism

La ciudadela (1938) de King Vidor, es una película que narra la vida profesional del doctor Andrew Manson, desde su entusiasmado inicio como médico recién graduado en un pueblo minero en Gales, donde labora apasionadamente en diferentes casos sin importar las circunstancias, hasta su llegada a Londres donde ve distorsionado su propósito al adentrarse en la élite de la ciudad. Con la ayuda de su esposa Christine, tratará de recobrar el significado de la medicina. A través del filme se exhibe la ligera línea que divide el buen ejercicio de la profesionalidad. Por ello, en el presente trabajo se reflexiona sobre la medicina como profesión, su relación con la sociedad y se destaca la importancia de la educación en humanidades para el fortalecimiento del discernimiento ético en los futuros profesionales en salud. (AU)

The Citadel (1938) by King Vidor, is a film that narrates the professional life of Dr. Andrew Manson, from his enthusiastic start as a recently graduated doctor in a mining town in Wales, where he works passionately in different cases regardless of the circumstances, until his arrival in London where he sees his purpose distorted as he enters the elite of the city. With the help of his wife Christine, he will try to regain the meaning of medicine. Throughout the film the thin line that divides the good exercise of professionalism is exhibited. For this reason, this paper reflects on medicine as a profession, its relationship with society, and highlights the importance of education in the humanities for strengthening ethical discernment in future health professionals. (AU)

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.

How to achieve quality assurance, shared ethics and efficient teambuilding? Lessons learned from interprofessional collaboration during the COVID-19 pandemic.

Objective: Against the background of the current pandemic crisis, this case report presents the experiences made from interprofessional teamwork with group members from different medical qualification levels. Our objectives were to identify areas of shared knowledge regarding efficient collaboration; to improve effective teamwork based on mutual respect; to develop innovative teaching methods tailored to the needs of COVID-19 interprofessional response teams. Methods: Field notes from numerous team discussions and improvised internal training sessions were compiled into a checklist. Each author edited and revised the checklist and a consensus has been reached after an in-person discussion. Feedback from an academic expert in emergency services has been incorporated into the final version of the checklist. Results: Three main topics were identified: the need for quality-assured professional training, the clarification of role expectations including assigned responsibilities, opportunities to contribute and participate in the team building process, and the development of area-related ethical competence in the sense of shared moral public health literacy. Hence, we developed the following ad - hoc teaching methods: use of online teaching videos, practical exercises on intubation models and the collective development of an annotated, detailed checklist for all relevant work processes of the mobile corona unit based on everyday debriefings. Summary: The need for interprofessional team building in the context of the current health crisis provides a beneficial learning environment for all participants. We propose to conceptually refine this approach into a cross-professional, innovative method of teaching.

Teaching Professional Formation in Response to the COVID-19 Pandemic.

In response to the COVID-19 pandemic, the Association of American Medical Colleges has called for a temporary suspension of clinical teaching activities for medical students. Planning for the continued involvement of learners in patient care during this pandemic should include teaching learners professional formation. The authors provide an ethical framework to guide such teaching, based on the ethical principle of beneficence and the professional virtues of courage and self-sacrifice from professional ethics in medicine. The authors show that these concepts support the conclusion that learners are ethically obligated to accept reasonable, but not unreasonable, risk. Based on this ethical framework, the authors provide an account of the process of teaching professional formation that medical educators and academic leaders should implement. Medical educators and academic leaders should embrace the opportunity that the COVID-19 pandemic presents for teaching professional formation. Learners should acquire the conceptual vocabulary of professional formation. Learners should recognize that risk of infection from patients is unavoidable. Learners should become aware of established ethical standards for professional responsibility during epidemics from the history of medicine. Learners should master understandable fear. Medical educators and academic leaders should ensure that didactic teaching of professional formation continues when it becomes justified to end learners' participation in the processes of patient care; topics should include the professionally responsible management of scarce medical resources. The COVID-19 pandemic will not be the last major infectious disease that puts learners at risk. Professional ethics in medicine provides powerful conceptual tools that can be used as an ethical framework to guide medical educators to teach learners, who will bear leadership responsibilities in responses to future pandemics, professional formation.

Teaching ethics and professionalism in rehabilitation: an empirical research on active learning with university rehabilitation students.

BACKGROUND: Teaching ethics in university courses may benefit from different didactic approaches; nonetheless, it still seems unclear whether ethics teaching can be best offered in stand-alone courses or integrated into other courses, or perhaps both. OBJECTIVE: We describe the experience derived from a structured teaching activity in the field of medical ethics, conducted during a lesson for the students of a rehabilitation university second-cycle degree course. METHODS: The participating students were healthcare professionals with different graduate training in rehabilitation. The aim of the lesson was to discuss the essentials of the relationship between patients and rehabilitation healthcare providers, from an inter-professional viewpoint, focused on the principles of trust, mutual respect, power and personal closeness, which are essential components of the therapeutic relationship between patients and physical therapists. RESULT: Shared moral norms guiding the professional conduct of healthcare professionals are a fundamental characteristic of these professions, promoting the public trust in these professions, tearing down barriers to inter-professional collaboration and communication. CONCLUSION: The results are remarkable, and there has been very positive feedback from the students concerning the production of the oath and its contents, as well as about the proposed teaching method, resulting in great interest in clinical ethics.