Virtue and care ethics & humanism in medical education: a scoping review

Abstract

Purpose This scoping review explores how virtue and care ethics are incorporated into health professions education and how these factors may relate to the development of humanistic patient care. Method Our team identified citations in the literature emphasizing virtue ethics and care ethics (in PubMed, NLM Catalog, WorldCat, EthicsShare, EthxWeb, Globethics.net, Philosopher’s Index, and ProQuest Central) lending themselves to constructs of humanism curricula. Our exclusion criteria consisted of non-English articles, those not addressing virtue and care ethics and humanism in medical pedagogy, and those not addressing aspects of character in health ethics. We examined in a stepwise fashion whether citations: 1) Contained definitions of virtue and care ethics; 2) Implemented virtue and care ethics in health care curricula; and 3) Evidenced patient-directed caregiver humanism. Results Eight hundred eleven citations were identified, 88 intensively reviewed, and the final 25 analyzed in-depth. We identified multiple key themes with relevant metaphors associated with virtue/care ethics, curricula, and humanism education. Conclusions This research sought to better understand how virtue and care ethics can potentially promote humanism and identified themes that facilitate and impede this mission.

Practical wisdom in medicine through the eyes of medical students and physicians

“…practical wisdom in open-ended descriptions, the relevance of practical wisdom to clinical situations requiring individualised care, and the number of person-centred virtues widely endorsed as essential for practical wisdom, such as empathy, honesty, respectfulness, compassion, benevolence, patience, justice, and kindness. These findings also support the need for ethics education in health care that explicitly includes virtue ethics 24,32,46,51,54,74 and recognises its challenges. 46,[75][76][77][78][79] Lastly, the multidimensionality of practical wisdom serves to clarify aspects of clinical judgement by making the relationship between clinical reasoning and ethical grounding explicit, and by highlighting the need for patient care that is individualised, goal-directed, and context-sensitive.…”

“…This was clear not only from a closed‐ended question about the necessity of ethics for practical wisdom, but also from a considerable emphasis on the person‐centred dimension of practical wisdom in open‐ended descriptions, the relevance of practical wisdom to clinical situations requiring individualised care, and the number of person‐centred virtues widely endorsed as essential for practical wisdom, such as empathy, honesty, respectfulness, compassion, benevolence, patience, justice, and kindness. These findings also support the need for ethics education in health care that explicitly includes virtue ethics 24,32,46,51,54,74 and recognises its challenges 46,75–79 …”

“…Second, such engagement in medical education should aim to keep practical wisdom, ethics, and professionalism close together within the physician's formation, 24,[41][42][43][45][46][47][48]72,73 especially regarding the need to maintain a guiding focus on the good of the patient. 72 The responses of our participants suggest they recognised the need for these connections.…”

“…43,44 In these other contexts of discussion, this shared moral content is sometimes articulated explicitly in terms of virtues 41,42 and sometimes implicitly in terms of values. 43,45 Moreover, some authors perceive virtue ethics as the foundation of professionalism, 24,46,47 or at least its oldest framework, 48 and consider practical wisdom to be one of its most important virtues. 24,47 The potential contrast between the 'deliberative' and 'constellation' interpretations of wisdom, as well as broader debates about how practical wisdom is best conceptualised, suggests a degree of heterogeneity in how this virtue is understood.…”

Surprising pandemic experiences: A confrontation between principle‐based and virtue ethics, and a plea for virtue ethics training for medical students and residents. A rudimentary outline of a four‐step model

“…The added value of a virtue ethics training is that it demonstrates that in the end, ethics comes down to acting by persons in a medical relationships. 39 Among the major topics in virtue ethics in medical education, according to a recent scoping review article of Doukas et al, 40 are altruism, development of virtuous traits, care as virtue, role modelling, humanistic behaviour, virtues as principles, the hidden curriculum and physician-patient relationship. Those topics ought to be included in the formal training curriculum.…”