Medical ethics language doesn’t stick with students

A study finds a gap between learning ethical terms and using them in a clinical setting, which can lead to a lack of shared understanding.

By — Posted May 15, 2013

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Do medical school students remember ethical principles when they start practicing medicine?

Because physicians need shared language and universal terms when they discuss ethical issues with each other and with patients, researchers at the University of Iowa Carver College of Medicine examined how well terms and concepts taught in school were recalled and incorporated in the clinical years. The study asked 109 third-year medical students at the University of Iowa to recall ethics terms learned in the first two years of school.

Results were mixed, according to the study posted online April 14 in AJOB Primary Research. The students were much more likely to name the four ethical principles (beneficence, nonmaleficence, respect for patient autonomy and justice) than the six sources of ethical value or categories for justifying an ethical decision (ethical principles, rights, consequences, comparable cases, professional guidelines and conscientious practice).

Overall, 59.6% of the students remembered all four principles, but the highest number of sources of ethical value recalled was four of the six. Only 10% of students could name three or four of the six sources.

Researchers also found that students were not likely to use the terms they had learned when asked to reflect on ethical situations they had encountered. (link).

Medical schools may need to reinforce the terms in the third and fourth years and place more emphasis on incorporating the formal terms when describing ethical conflicts, said lead study author Lauris Kaldjian, MD, PhD.

“If one is an educator in a medical school where most of the ethics education happens in the preclinical setting, then I would really encourage faculty to think about how to integrate ethical education also into the clinical realm,” said Dr. Kaldjian, director of bioethics and humanities at the University of Iowa Carver College of Medicine.

Real experiences help

The college is addressing that with seminars that ask students to write reflections in years three and four about experiences with patients that involved ethical issues and demonstrate how the principles or sources of ethical value came into play. Some of the reflections are chosen for group discussion.

Recalling these terms based on real experiences, rather than hypothetical ones in a lecture hall, makes the concepts more useful, Dr. Kaldjian said.

“It’s like a booster vaccine. … You need to remind people of these terms,” he added.

Students must not only memorize the terms but also know the tensions among them, Dr. Kaldjian said. “It’s very helpful to have words to identify where the points of tension exist,” he said. “Then we have to decide in a given case what values should have precedence or priority in a given setting.”

Having a common language helps physicians explain the moral reasons for a decision to colleagues and patients so there is shared understanding of what’s at stake, Dr. Kaldjian said.

“If I’m disagreeing with a patient or having a disagreement with a colleague about something, a sign of respect to those individuals is that I give reasons for why I’m disagreeing,” he said.

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