Teaching ethics that honor the patient’s and the provider’s voice: The role of clinical integrity

Abstract

Medical ethics training is as variable as it is widespread. Previous research has indicated that medical learners find systematic approaches to ethical dilemmas to be helpful. This article describes a bioethics educational module. It includes an overview of common bioethical principles and presents a tool for organizing health-care providers' thinking and discussions about challenging ethical dilemmas. We discuss an area of bioethics that is often neglected, clinical integrity, and the role that a health-care provider's clinical integrity plays in ethical decision-making. We provide several hypothetical ethical vignettes for practice and discussion using the clinical integrity tool. The article also describes how this module has been implemented in one medical education setting and provides suggestions for educators.

Ethics education to support ethical competence learning in healthcare: an integrative systematic review

“…However, the perception of what is relevant is influenced by healthcare professionals’ and students’ previous experiences of ethical problems in their everyday healthcare work. Limited experience entails a risk that the education will not be perceived as relevant, and that the educational content may be difficult to absorb [ 39 ].…”

“…Developing an ethical identity and creating meaning in discussions about ethical problems in everyday healthcare work takes time [ 37 , 40 ]. Simultaneously, it might be difficult to predict how long, for example, group discussions may take to shed light on the various aspects of ethical problems [ 39 ]. There is thus a risk that the time will be too short and insufficient to finish the discussion, or that there may be too much time, thus causing the discussions to be perceived as less engaged [ 37 ].…”

“…Interprofessional group participation strengthened both professions’ performance better through the learning process Fair Gallagher et al [ 55 ], United Kingdom Qualitative To describe experiences from an immersive 24-h simulation 18 nursing students Focus groups interviews Thematic analysis Simulation is a way to promote ethics and to change participants’ perspective on caregiving and care-recipients Fair Gillam et al [ 40 ], Australia Qualitative To introduce ethics educators to a narrative ethics approach in teaching Part I: 12 educators Part II: 44 educators Part I: Interviews Part II: Notes from small-group discussion, comments, and written feedback Part I: Thematic analysis Part II: Unknown Part I: Ethics educators should teach students about rational thinking. Part II: Ethics educators should teach students about how to manage emotions and handle unexpected and unwanted potential emotions Poor Grace et al [ 39 ], USA Case study To describe a bioethics educational module Medical residents, number of unknown participants Unknown Unknown The five-box technique for bioethical decision-making included beneficence, nonmaleficence, autonomy, justice, and clinical integrity. Challenges have often been time based and related to the difficulty of predicting how long it will take to work through a case Very poor Harasym et al [ 48 ], Taiwan Theoretical paper To discuss problem-based learning as an instructional strategy for teaching ethics Not applicable Not applicable Not applicable Problem-based learning is an effective instructional method for developing student ethical behaviours Very poor Hem et al [ 43 ], Norway Qualitative To evaluate the signif...…”

Postgraduate ethics training programs: a systematic scoping review

“… Overall, improve patient care and clinical decision making and adherence to ethical guidelines as part of research [ 50 , 60 , 66 , 67 ]. Change Attitudes and Professional Identity Develop appropriate attitudes, values that facilitate ethical conduct [ 68 ] [ 57 , 58 ]. Maintain high level of professionalism and ethical practice [ 49 , 54 ].…”

“…Believing that new learners often “do not appreciate the practical side of ethical conflicts as they have had limited exposure to clinical medicine or have not yet fully formed a professional identity with its associated values,” Grace and Kirkpatrick [ 68 ] piloted ethical vignettes and ethical reasoning technique to acculturate ethical thinking into practice. Howard, McKneally [ 84 ]’s study of surgical resident’s attitudes towards ethics teaching revealed a general sense of being poorly prepared and relatively inexperienced for case discussions and practical application of ethical issues.…”