There is evidence that medical students do not develop their moral competence as expected for university students and that medical training, via formal and hidden curricula, somehow contributes to the scenario known as dehumanization of medicine. Education in Bioethics may be an interesting strategy to change this scenario. We investigated the impact of a course in Bioethics and a method of dilemma discussion (the Konstanz Method of Dilemma Discussion, or KMDD) on medical students' moral competence. We conducted an observational controlled study at a public Brazilian medical school. The extended version of the Moral Competence Test (MCT-xt) was applied at first and last days of a course on Bioethics in two consecutive years. These two courses were perfectly similar, except that with the second group two discussions according to the KMDD complemented the course. 165 undergraduate students participated in this research. Competence score (c score) slightly decreased in
A formação ética e humanística dos estudantes de Medicina vem sendo bastante valorizada e questionada na atualidade. A discussão dos conflitos éticos que surgem durante o exercício da medicina é uma das estratégias de maior impacto para o desenvolvimento da competência moral dos estudantes. Com o objetivo de conhecer e analisar as situações de conflito consideradas mais relevantes para a discussão com os futuros médicos, pedimos a profissionais que exercem atividades de ensino com estudantes de Medicina na Unifesp-EPM que mencionassem até três situações importantes para discussão. Participaram da pesquisa 237 sujeitos. As respostas, registradas por itens e categorizadas por temas, foram comparadas aos assuntos abordados em cursos formais de ética das escolas médicas brasileiras e analisadas à luz da literatura especializada. Os temas que emergiram desta pesquisa podem ser explorados por diferentes estratégias de ensino-aprendizagem. Cabe às escolas médicas estimular as diversas disciplinas a abrir espaços formais para as discussões e investir na conscientização e no preparo docente para esta tarefa.
The purpose of this paper is to present Bioethics, particularly its educational aspect, as a way to promote moral and democratic competencies, thus improving a personal capacity to face not only bioethical issues but also broader ethical, moral and even political problems. We believe that we should invest educative efforts on the affective and cognitive aspects of moral behavior if we want to promote the capacity to make moral judgments and act according to them. In pluralistic democratic societies, it is necessary to also promote the capacity to speak up and listen to arguments as a means to deal with moral problems. Any Bioethics which does not also include an educational action is prone to lose most of its significance. We propose that Bioethics should be led to an educational turn, focusing on the construction of an educative toolbox composed of interventional and evaluative instruments.
O artigo apresenta as mais freqüentes críticas articuladas nas teorias bioéticas brasileiras contra a importação de teorias estrangeiras, quase sempre dirigidas ao “Paradigma Principialista”. Busca mostrar o Principialismo não como paradigma da Bioética, mas descrevê-lo como ferramenta educativa, analisando aspectos positivos e negativos de sua utilização. Discute o Principialismo, apontando que não é um paradigma, nem sequer uma teoria moral geral, mas uma ferramenta que fornece estrutura para identificar e refletir sobre problemas morais. Aponta que dificuldade do Principialismo com os problemas de saúde pública advém da complexidade na especificação do princípio da Justiça e da abordagem, antes política que ética, que o enfrentamento de tais problemas exige. Considera que a ferramenta principialista utiliza conceitos cuja apreensão é relativamente simples, sendo apropriada para a discussão de casos reais, especialmente quando conduzida por não especialistas.
Introduction: Transgender people are subject to discrimination and illness due to social marginalization and lack of access to basic rights, especially health care. They suffer from the inadequacy of care directed to basic health demands, high incidence of diseases and non-fulfillment of specific demands. The vulnerability of these people reaches a disturbing level due to disrespectful attitudes that lead trans people to avoid seeking help. Understanding that medical education geared to the needs of marginalized populations is the basis for universal access and adequate care, it is essential that medical schools define contents and pedagogical strategies for vulnerable groups. The aim of this study was to investigate and discuss how (and if) the topic of transgender people healthcare is contemplated in the undergraduate curriculum of medical schools in the state of São Paulo. Method: Exploratory, descriptive-analytical study based on data collected from medical schools in São Paulo, conducted in two stages: 1st, documentary research on the inclusion of the topic of trans people health in the undergraduate curricula; 2nd, research with teachers of the Bioethics courses, where a questionnaire was applied to evaluate how and if the topic is approached as a programmatic content. The data obtained in the 1st stage were analyzed quantitatively and are presented as relative frequencies of the evaluated characteristics, while those of the 2nd stage were analyzed through the descriptive statistical method (closed questions) and content analysis (open questions). Results: We identified references to the trans topic in the formal curricula of only 2 of the 32 surveyed medical schools, with a total of 5 citations on the topic. Analyzing the questionnaires applied to teachers in the area of bioethics, we found reports of discussions on this topic in 5/12 (42%) schools. Although all participants consider the topic to be important, only 7/12 (58%) consider themselves prepared to address it. Conclusion: It is postulated that the evident lack of content aimed at trans health in medical schools can make it difficult to reduce transphobia and develop more dignified services within the healthcare network for these people. Based on the subsidies found in the Bioethics of Protection theoretical framework, we believe the medical curricula and Bioethics courses should create spaces to address this issue, using different and effectively transformative pedagogical practices, and respecting gender identity in all environments.
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