Relevance of the rationalist–intuitionist debate for ethics and professionalism in medical education

Abstract

Despite widespread pedagogical efforts to modify discrete behaviors in developing physicians, the professionalism movement has generally shied away from essential questions such as what virtues characterize the good physician, and how are those virtues formed? Although there is widespread adoption of medical ethics curricula, there is still no consensus about the primary goals of ethics education. Two prevailing perspectives dominate the literature, constituting what is sometimes referred to as the "virtue/skill dichotomy". The first perspective argues that teaching ethics is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. The second perspective suggests that teaching ethics is a means of creating virtuous physicians. The authors argue that this debate about medical ethics education mirrors the Rationalist-Intuitionist debate in contemporary moral psychology. In the following essay, the authors sketch the relevance of the Rationalist-Intuitionist debate to medical ethics and professionalism. They then outline a moral intuitionist model of virtuous caring that derives from but also extends the "social intuitionist model" of moral action and virtue. This moral intuitionist model suggests several practical implications specifically for medical character education but also for health science education in general. This approach proposes that character development is best accomplished by tuning-up (activating) moral intuitions, amplifying (intensifying) moral emotions related to intuitions, and strengthening (expanding) intuition-expressive, emotion-related moral virtues, more than by "learning" explicit ethical rules or principles.

Role Models' Influence on Specialty Choice for Residency Training: A National Longitudinal Study

“…15 Formative experiences of moral elevation may explain the subtle, and at least somewhat subconscious, impact that influential role models appear to have on students' decision making. 2 In our study, the majority of students identified their attending physicians or supervisors as role models.…”

“…Collectively, these findings suggest that program directors who seek to train the next generation of resident physicians should intentionally facilitate trainees' exposure to clinical role models. 2 Sustained interactions with those role models may facilitate the experience of moral elevation during residency training and may even nurture resilience and reduce burnout in ways that positively shape the long-term trajectory of residents' professional identities as physicians. Indeed, our study findings may lend preliminary empirical support to the Accreditation Council for Graduate Medical Education's recently proposed revisions to the Common Program Requirements.…”

“…There is a growing recognition that formative experiences during medical training play an influential role in career decisions, 1 professional identity formation, 2 and overall well-being of physicians in training. [3][4][5] These experiences can include interactions with positive role models who, through their personal enthusiasm, professional satisfaction, and strong sense of calling for their work, attract trainees toward their specialty.…”

Volume 13 Issue 10 Complete Issue

“…In the university campus, the cultivation of university students' healthy social emotion will help university students better integrate into society and seek sustainable development (Hong, Yang, Song, 2016). Start of university life means that students are no longer a simple "natural person", but a "social person" stepping into society, then simple, ideal emotional world will become extraordinary (Leffel, Mueller, Curlin, et al 2015).…”

“Can Virtue Be Taught?”: A Content Analysis of Medical Students’ Opinions of the Professional and Ethical Challenges to their Professional Identity Formation

“…Therefore, in this present investigation, we made use of a 2011 national medical student dataset (10,11) to test whether the Kaldjian taxonomy could be applied to a variety of ethical or professional issues faced by students across multiple institutions who were completing their clinical years. Moreover, given the emerging virtues-based approach to ethics and professionalism education (12)(13)(14), we further attempted to develop a virtues-based taxonomy of the students' reported ethical or professional issues by re-coding the same data based on whether certain virtues were present or absent in the clinical situations that students described.…”