Fetal Cardiology Bioethics: An Innovative New Curriculum for Cardiology Trainees.

Decision-making in fetal cardiology is fraught with ethical issues yet education in bioethics for trainees is limited or nonexistent. In this innovation report, we describe the development of a fetal cardiology bioethics curriculum designed to address this gap. The curriculum was developed to supplement the core curriculum for cardiology fellows and fetal cardiology subspecialty trainees. The series combines didactic and interactive teaching modalities and contains 5 key components: (1) introduction to bioethics and its role in fetal cardiology, (2) counseling and pathways for compassionate terminal care, (3) case vignette-based ethical analysis and discussion cases, (4) fetal counseling considerations for shared decision-making and recommendations, (5) facilitated communications role play. The curriculum was refined using session evaluations from end users. This report describes the innovative curriculum as a starting point for further incorporation and study of bioethical education in pediatric cardiology and fetal training programs.

Bioethics curriculum for undergraduate medical students: an evaluation study utilizing mixed methods approach.

BACKGROUND: The undergraduate bioethics curriculum introduced in a private medical college in Pakistan in 1988 and revised in 2009 has evolved over time to incorporate globally relevant innovations, including integration of bioethics spirally within an existing problem-based learning curricular framework. The present evaluation study shares the results of this integrated bioethics curriculum delivered for 10 years across the five-year undergraduate medical curriculum. The study assessed the effectiveness of the curriculum in terms of student achievement, appropriateness of course contents and efficiency of instructional methods. METHODS: The study utilized a mixed method sequential explanatory design. The quantitative method was used in the first phase to gather data by utilizing a structured online questionnaire. This was followed by the second phase of qualitative methods to explain the findings of the first phase and enrich the data gathered. This phase was based on focus group discussions and document review. RESULTS: Student and faculty responses showed the curriculum contents to be relevant, informative, and appropriate as per learning objectives and student achievement. Multi-modal instructional methods used were stated to be effective and engaging; small group teaching and shorter sessions suggested to be preferable for fostering discussion and maintaining student engagement and attention. Large class formats were stated to be less effective. Students affirmed the contribution of bioethics education to their personal and professional development and ethical positioning. The majority of students agreed that the curriculum contributed to their knowledge acquisition (60.3-71.2%), skill development (59.41-60.30%) and demonstration of ethical/professional behavior (62.54-67.65%). The ranges indicate agreement with related sets of questions. Participants suggested that the curriculum could be further strengthened by better integration in clinical years, role modelling and providing opportunities for application in clinical health care settings. Moreover, topics like ethical issues related to the use of social media, public health ethics and ethics and law were suggested as additions to the existing curriculum. These findings have regional and global relevance for the development and assessment of effective bioethics curricula. CONCLUSION: An effective bioethics curriculum for undergraduate medical education should run longitudinally across the 5 year curriculum and be integrated in the modules and clerkships. Basic acquisition of knowledge and skills takes place in Years 1 & 2 with reinforcement and application in Years 3-5. Learning embedded in an integrated curriculum can help students recognize, critically analyze and address ethical dilemmas. Involvement and commitment of the clinical faculty is essential for reinforcing the ethical principles and concepts learnt in the earlier years.

The current status and challenges of bioethics education in undergraduate medical education in Karachi, Pakistan.

BACKGROUND: The importance of including bioethics in the medical curricula has been recognized globally. Certain countries including Pakistan continue to lag behind although some developments have occurred recently. OBJECTIVES: The research aimed to provide a snapshot of bioethics education in undergraduate medical colleges in Karachi, Pakistan. The secondary objectives included identifying factors promoting or inhibiting integration of bioethics into the curriculum. METHODS: A two-pronged strategy was used to collect data including a website review of medical colleges, in existence for more than ten years, recognized by the Pakistan Medical and Dental Council (PMDC), the regulating body for undergraduate medical education in Pakistan. The other arm employed in-depth interviews with medical educationists in colleges fulfilling inclusion criteria. Data from the website was analyzed and presented as frequencies. Qualitative data was analyzed using content analysis method which involved coding of transcripts, multiple readings and arriving at subthemes and themes iteratively. RESULTS: Thirteen medical colleges were included for the website review, of which four were from public sector. Three medical colleges used the word "ethics" in their vision and mission statement and four had provided a detailed curriculum for ethics on their website. Thematic framework included four broad themes: 1) Need for Bioethics Education, 2) Current Status of Bioethics Education 3) Challenges in integration of bioethics in medical curriculum and 4) Recommendations for integration of bioethics in the Curriculum. Participants were in agreement that bioethics was important in development of future physicians. Participants identified various challenges, foremost being shortage of trained faculty, lack of institutional buy-in and overcrowded curriculum. CONCLUSION: The study identified sporadic inclusion of bioethics in undergraduate medical curricula, left to the discretion of individual institutions. Since Karachi is a cosmopolitan city, the findings may reasonably reflect the situation in other parts of the country. While bioethics is recognized as an important field, it will continue to remain an orphan subject in the curricula unless the regulatory and accreditation bodies make it compulsory for institutions to include ethics in their curricula.

The value of nurse bioethicists.

BACKGROUND: The field of nursing has long been concerned with ethical issues. The history of the nursing profession has a rich legacy of attention to social justice and to societal questions regarding issues of fairness, access, equity, and equality. Some nurses have found that their clinical experiences spur an interest in ethical patient care, and many are now nurse bioethicists, having pursued additional training in bioethics and related fields (e.g., psychology, sociology). PURPOSE: The authors describe how the clinical and research experiences of nurses give them a unique voice in the field of bioethics. RESULTS: Authors present reasons for the relative invisibility of nurse bioethicists, compared with physician, theologian, or philosopher bioethicists, as well as current efforts to increase the visibility of nurse bioethicists. They also describe four specific areas where nurse bioethicists have made and continue to make important contributions: as ethics consultants to colleagues in hospitals and other settings; as bioethics researchers or as advisers to researchers conducting trials with human subjects; as educators of trainees, patients and families, healthcare providers, and the public; and in helping to draft humane and ethical policies for the care of vulnerable patients and underserved populations. CONCLUSION: Nurse bioethicists are central to the future goals of healthcare bringing a unique perspective to the day-to-day ethical challenges of both clinical care and research, as well as to the education of health professionals and the public.

Joining Humanity and Science: Medical Humanities, Compassionate Care, and Bioethics in Medical Education.

Educating medical students to be physicians involves many dimensions. But in an educational culture where science and technology dominate the curriculum, these subjects also too often dominate the academic value system as well. While a firm grasp of scientific knowledge and technical skill is essential, cultivating humanistic virtues is at the core of all good medical care and the full well-being of those within it. This article describes a formative educational process that points towards compassionate flourishing and unfolds through dialogue and reflection on the human aspects of patient care and the student experience, a process coequal in value to scientific development. This educational process has been successfully implemented at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook. When supported by a broader institutional culture through an ongoing reflective group process in residencies and other clinical settings, this process fosters professional flourishing, which leads to deeper meaning and compassionate care of patients.

An exploration of how gender, political affiliation, or religious identity is associated with comfort and perceptions of controversial topics in bioethics.

Bioethics is an important aspect of understanding the relationship between science and society, but studies have not yet examined undergraduate student experiences and comfort in bioethics courses. In this study, we investigated undergraduate bioethics students' support of and comfort when learning three controversial bioethics topics: gene editing, abortion, and physician-assisted suicide (PAS). Furthermore, student identity has been shown to influence how students perceive and learn about controversial topics at the intersection of science and society. So, we explored how students' religious affiliation, gender, or political affiliation was associated with their support of and comfort when learning about gene editing, abortion, and PAS. We found that most students entered bioethics with moderated viewpoints on controversial topics but that there were differences in students' tendency to support each topic based on their gender, religion, and political affiliation. We also saw differences in student comfort levels based on identity: women reported lower comfort than men when learning about gene editing, religious students were less comfortable than nonreligious students when learning about abortion and PAS, and nonliberal students were less comfortable than liberal students when learning about abortion. Students cited that the controversy surrounding these topics and a personal hesitancy to discuss them caused discomfort. These findings indicate that identity impacts comfort and support in a way similar to that previously shown in the public. Thus, it may be important for instructors to consider student identity when teaching bioethics topics to maximize student comfort, ultimately encouraging thoughtful consideration and engagement with these topics.

The outcomes of a mobile just-in-time-learning intervention for teaching bioethics in Pakistan.

INTRODUCTION: The study aimed to test the effectiveness and the feasibility of a mobile just-in-time-learning (m-JiTL) approach for teaching bioethics at a university in Pakistan. Over four months, a mobile app (EthAKUL) was used to enhance ethical reasoning among practising nurses, trainee physicians, and medical and nursing students utilising the m-JiTL approach. Participants used EthAKUL to access bioethics modules and participate in asynchronous discussions. METHODS: A mixed methods design was adopted. Pre- and post-knowledge tests were used to assess changes in participants' knowledge of bioethics concepts, while pre- and post-surveys were used to assess changes in participants' attitudes towards m-learning. After the intervention, focus group discussions with the participants were held. Analysis of the discussion posts and meeting notes was conducted. RESULTS: The learners had a favourable attitude toward using mobile devices for learning purposes at the start of the intervention, and the score remained positive afterwards. Bioethics knowledge test scores improved at the end of the intervention, with medical students experiencing the greatest improvement. However, because of the high drop-out rate and lack of participation after the initial phase, it is unclear whether the increase in score or positive attitude is the result of the intervention, making it difficult to draw firm conclusions about the intervention's success. CONCLUSIONS: EthAKUL is the first of its kind app for teaching bioethics, and the study has offered important insights into adopting new pedagogies and technologies for bioethics teaching. It has also identified issues with the design of the app and m-JiTL pedagogy that must be addressed before curriculum-wide adoption.

Bioethics curriculum in medical schools in Portuguese-speaking countries.

BACKGROUND: A curriculum is a fundamental tool for educators, and teaching bioethics is fundamental to good medical practice. Studies report a lack of consensus on the teaching of bioethics in undergraduate medicine, and a critical issue is that there remain no minimum curricular parameters. This study performed an analysis between the bioethics curricula of the medical schools of Brazil and Portugal and UNESCO's Core Curriculum, in addition to proposing key criteria for designing a core bioethics curriculum. METHODS: This is a cross-sectional, descriptive study that analyzes the bioethics curricula of the medical schools in Brazil and in Portugal. The design of the study includes a qualitative summative content analysis-based approach and a quantitative analysis by means of descriptive statistics. RESULTS: Bioethics is taught in both Brazil and Portugal in a diversified way. The results showed that 65.5% of the medical schools analyzed provided at least the 30-h minimum workload recommended by the UNESCO Core Curriculum. Furthermore, bioethics sporadically offered at the end of the medical program in the vast majority of schools studied. CONCLUSIONS: The most important points to take away from this study are the diversity of the curricular structure of bioethics courses and the lack of formalization of bioethics in the curricula of medical schools in Brazil and Portugal. Given the value of bioethics in clinical practice, we propose that medical schools in Portugal and Brazil update their curricula to encompass minimum criteria, which should be similar to one another and based on common sources, but which should also be tailored to each culture.

COVID-19 era healthcare ethics education: Cultivating educational and moral resilience.

The COVID-19 pandemic crisis has had profound effects on global health, healthcare, and public health policy. It has also impacted education. Within undergraduate healthcare education of doctors, nurses, and allied professions, rapid shifts to distance learning and pedagogic content creation within new realities, demands of healthcare practice settings, shortened curricula, and/or earlier graduation have also challenged ethics teaching in terms of curriculum allotments or content specification. We propose expanding the notion of resilience to the field of ethics education under the conditions of remote learning. Educational resilience starts in the virtual classroom of ethics teaching, initially constituted as an "unpurposed space" of exchange about the pandemic's challenging impact on students and educators. This continuously transforms into "purposed space" of reflection, discovering ethics as a repertory of orientative knowledge for addressing the pandemic's challenges on personal, professional, societal, and global levels and for discovering (and then addressing) that the health of individuals and populations also has moral determinants. As such, an educational resilience framework with inherent adaptability rises to the challenge of supporting the moral agency of students acting both as professionals and as global citizens. Educational resilience is key in supporting and sustaining professional identify formation and facilitating the development of students' moral resilience and leadership amid moral complexity and potential moral transgression-not only but especially in times of pandemic.

The Advent of the Professional Ethicist: Moral Expertise and Health-Care Ethics Certification.

With the Healthcare Ethics Consultant Certification (HEC-C) offered through the American Society for Bioethics and Humanities (ASBH), the practice of clinical ethics has taken a decisive step into professionalization. But without an unambiguous sense of what clinical ethicists can contribute to the clinical environment, it is unclear what the HEC-C ensures clinical ethicists can do. Though the ASBH enumerates a set of core competencies, many disagree over what role those competencies empower ethicists to serve. Two recent publications are notable for advocating conflicting positions on the question of ethicists' competence: "Ethics Expertise: What It Is, How to Get It, and What to Do with It" by Christopher Meyers (2018) and Rethinking Health Care Ethics by Stephen Scher and Kasia Kozlowska (2018). In response to Scher and Kozlowska's argument that the primary role of ethicists is to create space to engage clinician's moral intuitions, this analysis follows Meyers in contending that ethicists can also contribute a kind of moral expertise. However, acquiring moral expertise is no easy task, and it is unlikely to be substantiated by a certification exam. This analysis draws on research from the psychology of expertise to outline the sort of training needed to cultivate and enhance moral expertise.

Bioethics as a Vocation.

This essay offers practical guidance for the activity of bioethics scholarship in the form of maxims or rules of thumb, explicated by the author's work in bioethics research, mentoring, peer review, and journal editing. It is organized into three sections: (1) education, (2) seeking ideas for projects, and (3) writing papers.

Medical Students' Exposure to Ethics Conflicts in Clinical Training: Implications for Timing UME Bioethics Education.

While there is significant consensus that undergraduate medical education (UME) should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate that medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME.

Beyond the hype of big data and artificial intelligence: building foundations for knowledge and wisdom.

Big data, coupled with the use of advanced analytical approaches, such as artificial intelligence (AI), have the potential to improve medical outcomes and population health. Data that are routinely generated from, for example, electronic medical records and smart devices have become progressively easier and cheaper to collect, process, and analyze. In recent decades, this has prompted a substantial increase in biomedical research efforts outside traditional clinical trial settings. Despite the apparent enthusiasm of researchers, funders, and the media, evidence is scarce for successful implementation of products, algorithms, and services arising that make a real difference to clinical care. This article collection provides concrete examples of how "big data" can be used to advance healthcare and discusses some of the limitations and challenges encountered with this type of research. It primarily focuses on real-world data, such as electronic medical records and genomic medicine, considers new developments in AI and digital health, and discusses ethical considerations and issues related to data sharing. Overall, we remain positive that big data studies and associated new technologies will continue to guide novel, exciting research that will ultimately improve healthcare and medicine-but we are also realistic that concerns remain about privacy, equity, security, and benefit to all.

Is UNESCO's Undergraduate Bioethics Integrated Curriculum (Medical) fit for purpose?

In 2017, UNESCO introduced an Undergraduate Bioethics Integrated Curriculum to be taught in Indian medical schools, with an implied suggestion that it could subsequently be rolled out to medical schools in UNESCO's other member states. Its stated aim is to create ethical awareness from an early stage of a doctor's training by infusing ethics instructions throughout the entire undergraduate medical syllabus. There are advantages to a standardised integrated curriculum where none existed. However, the curriculum as presently drafted risks failing to achieve its laudable aims. There are important lessons to be drawn from UNESCO's First Syllabus for Youth Bioethics Education (2018), which is aimed at schoolchildren and teenagers, and represents a creative, effective and culturally sensitive way to teach bioethics.

The Use of Narratives In Graduate Bioethics Education.

The author considers the role of narratives, specifically end-of-life narratives, in medical education. After addressing the role of indexing and other neurological explanations for the validity of narratives in the classroom, she focuses on one recent memoir that explores the medical experience of an ALS patient. The advantages of using narratives, including the understanding of the patients' perspective and the development of empathy, are two important reasons to adopt this approach.

[Assessing bioethics education: Teaching to be virtuous doctors or just doctors with practical ethical skills]. / Evaluando la enseñanza de la bioética: formando «médicos virtuosos¼ o solamente médicos con habilidades éticas prácticas.

OBJECTIVE: In the last decades, bioethics has been incorporated into the academic training of the Medical Schools. Some studies analyze the ethical-moral development of medical students and the effect of ethical education in other countries. This evaluation is done by measuring Kohlberg's moral reasoning (virtuous doctors), or ethical sensitivity to resolve clinical cases (physicians with ethical skills). The following study is proposed to assess the impact of bioethics training on these two variables, in Spanish medical students. DESIGN: Observational cross-sectional study. SITE: Faculty of Medicine, University of Lleida. PARTICIPANTS: 175 students from third year of medicine (78 before bioethics and 97 after bioethics, in different courses) were conducted. INTERVENTION: Bioethics course. MAIN MEASUREMENTS: A socio-demographic questionnaire, the Rest Defining Issue test scale, and Problem Identification Test with clinical vignettes were administered. RESULTS: A consistent and significant correlation has been found between moral reasoning and ethical sensitivity. Women presented greater post-conventional reasoning. There were no changes in Kohlberg's stage of global moral reasoning with ethical training. There were changes in ethical sensitivity with bioethical training, with a significantly and globally improvement. CONCLUSION: In our study, training in bioethics does not improve moral development but rather the ethical problem solving skills. It is asked if this improvement is enough to train doctors prepared for the new challenges.

Global Bioethics: A Story of Dreams and Doubts from Bengal.

This article is concerned with the practice of bioethics outside of the Euro-American and Anglophone settings in which it was first formulated. In theoretical terms, the article considers the frictions that arise when global-scale projects such as bioethics are introduced into diverse social and cultural settings. Methodologically, the article is constructed around the biography of an Indian medical educator trained in bioethics and working to promote the subdiscipline in the Indian context. The article describes the situated practice of bioethics and highlights the incommensurability of some of its key terms and concepts when practiced outside of the global North.

Novel horizontal and vertical integrated bioethics curriculum for medical courses.

Studies conducted by the University of Haifa, Israel in 2001, evaluating the effectiveness of bioethics being taught in medical colleges, suggested that there was a significant lack of translation in clinical care. Analysis also revealed, ineffectiveness with the teaching methodology used, lack of longitudinal integration of bioethics into the undergraduate medical curriculum, and the limited exposure to the technology in decision making when confronting ethical dilemmas. A modern novel bioethics curriculum and innovative methodology for teaching bioethics for the medical course was developed by the UNESCO Chair in Bioethics, Haifa. The horizontal (subject-wise) curriculum was vertically integrated seamlessly through the entire course. An innovative bioethics teaching methodology was employed to implement the curriculum. This new curriculum was piloted in a few medical colleges in India from 2011 to 2015 and the outcomes were evaluated. The evaluation confirmed gains over the earlier identified translation gap with added high student acceptability and satisfaction. This integrated curriculum is now formally implemented in the Indian program's Health Science Universities which is affiliated with over 200 medical schools in India. This article offers insights from the evaluated novel integrated bioethics curriculum and the innovative bioethics teaching methodology that was used in the pilot program.

The long-term impact of a comprehensive scholarly concentration program in biomedical ethics and medical humanities.

BACKGROUND: There is a strong and growing interest in biomedical ethics and medical humanities (BEMH) within medical education for facilitating key components of medical professionalism and ethics, clinical communication and observational skills, and self-care and reflective practices. Consequently, United States (US) medical institutions have begun to incorporate BEMH through formal Scholarly Concentrations (SCs). This is the first study to examine the impact of a US BEMH SC, from student experience in medical school to post-graduate development, as perceived by graduate physicians. METHODS: Graduated students who participated in the BEMH SC or did extensive BEMH research prior to the BEMH SC's establishment (n = 57) were sampled for maximum variation across graduating years. In telephone surveys and interviews, participants discussed the perceived impact of the BEMH SC on (a.) student experience during medical school and (b.) post-graduate development. Interviews were audiotaped, transcribed, and de-identified. The authors iteratively generated a codebook; two raters coded independently, adjudicated codes, and completed inter-rater reliability (IRR) tests. The authors subsequently conducted a team-based thematic analysis, identifying emergent themes. RESULTS: Nineteen BEMH graduates were interviewed. Results were analyzed according to (a.) student experience and (b.) post-graduate development. Overall, respondents perceived impacts in reinforcing knowledge and skills in clinical ethics; solidifying self-care and reflective practices; refining a sense of professional identity and integrity for ethically challenging situations; and promoting student skills, productivity, and later careers involving BEMH. CONCLUSION: A comprehensive US BEMH SC achieved the purported aims of BEMH in medical education, with graduate physicians perceiving persisting effects into clinical practice. Furthermore, the structure and format of a SC may offer additional advantages in promoting student scholarly skill and productivity, career development, and professional identity formation-core competencies identified across clinical training and ethics programs. Our findings indicate that a BEMH SC is effective in achieving a range of desired immediate and post-graduate effects and represent a particularly promising venue for BEMH in medical education. We believe these findings to be of critical significance to medical educators and administrators when considering how best to incorporate BEMH into SCs and medical curricula.