The fundamental role of storytelling and practical wisdom in facilitating the ethics education of junior doctors

Abstract

Practical wisdom is a key concept in the field of virtue ethics, and it has played a significant role in the thinking of those who make use of virtue when theorising medical practice and ethics. In this article, we examine how storytelling and practical wisdom play integral roles in the medical ethics education of junior doctors. Using a qualitative approach, we conducted 46 interviews with a cohort of junior doctors to explore the role doctors feel phronesis has in their medical ethics practice and how they acquire practical wisdom through storytelling as an essential part of their medical ethics education. Through thematic analysis of the interviews, we discuss the key role storytelling about moral exemplars and role models plays in developing medical ethics education, and how telling stories about role models is considered to be one of the most useful ways to learn medical ethics. We finish by developing an argument for why practical wisdom should be an important part of medical ethics training, focusing on the important role that phronesis narratives should have in teaching medical ethics.

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

“…Finally, it is essential to create conditions for psychological safety and confidence in ethics education, or, in other words, to enable opportunities to express opinions or make blunders without this leading to consequences for the participants [ 41 ]. Instead, trust between the participants should be emphasised and acknowledged in discussions about ethical problems in clinical practice [ 40 , 42 , 43 ]. Simultaneously, there is a risk that high staff turnover and frequent changes in management may limit opportunities for building trust through conversation [ 44 ].…”

“…Skills can be practiced through workshops [ 49 ], case studies and problem-solving sessions [ 37 , 43 , 47 , 48 , 50 – 53 ]. Understanding one’s own values and attitudes can be facilitated through, for example, role-play or simulation activities [ 54 – 56 ], narratives [ 40 , 57 , 58 ], storytelling [ 42 ] and discussions in small groups [ 38 , 43 – 45 , 47 , 59 – 62 ]. Small group discussions are appropriate when healthcare professionals or students are unwilling to stand out by asking questions or giving individual opinions in learning situations in which many people participate [ 63 ].…”

“…The sharing of narratives in the classroom, followed by discussion, can help to add different perspectives, and encourage both the narrator and the class to learn more about a scenario Very poor Parker et al [ 38 ], Australia Qualitative To pilot an ethics teaching programme, with a focus on ethical issues that students are likely to encounter in their clinical education 47 medical students Questionnaires Analytical and descriptive statistics Students feel a lack of experience and confidence in clinical ethics. Students liked the ‘real-life’ curriculum and the learning that comes from discussion of cases and personal experiences Fair Paton et al [ 42 ], United Kingdom Qualitative To examine how storytelling and practical wisdom play integral roles in the medical ethics education of junior doctors 46 junior doctors Interviews Thematic analysis Three major themes: (1) Learning medical ethics through storytelling, (2) Developing phronesis through storytelling and ‘story-listening’ and (3) Passing on/teaching phronesis through ‘phronesis narrative’ Fair Sánchez-Izquierdo et al [ 75 ], Spain Quantitative To develop a behavioural intervention to decrease paternalistic behaviours in formal caregivers and to increase care behaviours 118 health care professionals Questionnaires Analytical and descriptive statistics Compared with the control group, caregivers in the behavioural intervention group displayed significantly lower paternalistic appraisals at the post-test and follow-up. Regarding the intervention group, caregivers at the post-test and follow-up showed a significantly greater occurrence of autonomist behaviours being promoted and lower paternalistic appraisal Good Savitha et al [ 72 ], India Mixed methods To introduce an interactive and integrated ethics programme into the physiology course for first year medical students and to evaluate their perceptions 60 medical students Questionnaires Focus group discussions Observer feedback Descriptive statistics Content analysis …”

Fairness, Ethnicity, and COVID-19 Ethics

“…Existing ethical and clinical guidelines for care during the pandemic are largely unfair. They actively 6 One I will not engage in here, as empirical bioethics and the role of sociology in bioethics has been firmly established in the field by Haimes (2002), Scully (2010), and most recently Paton (2017Paton ( , 2018aPaton ( , 2018bPaton ( , 2019 discriminate against people from ethnic minority backgrounds. When the context within which guidelines will be used are not considered and mitigated by the guidelines themselves, we know more people from ethnic minority backgrounds die for no other reason than a refusal to include evidence from the social sciences during development.…”

“…Additionally, generalizability, in the form of universality, rarely works well when bioethics is put into practice (Paton 2017). Previous work using sociological research has shown that ethical theory developed without empirical data on the context within which it will be used and understood is considered unhelpful by patients and staff in supporting ethical medical practice (Padela et al 2015;Paton 2017;Paton 2019;Paton and Kotzee 2019). This is not just another shot fired in the empirical versus theoretical debate that rages in bioethics literature 6 but an important point about ensuring relevancy in the advice that bioethics is supposed to provide.…”