Goldie John, Schwartz Lisa, McConnachie Alex, Morrison Jillian
Department of General Practice, Division of Community Based Services, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, Scotland, UK.
Med Educ. 2004 Sep;38(9):942-9. doi: 10.1111/j.1365-2929.2004.01915.x.
To evaluate the impact of a modern medical curriculum on students' proposed behaviour on encountering ethical dilemmas.
Cohort design.
University of Glasgow Medical School.
The first intake of students into Glasgow's new curriculum (n = 238). Main outcome measure Student answers consistent with consensus professional judgement on the ethical dilemmas posed by the vignettes of the Ethics and Health Care Survey Instrument.
The probability of giving a consensus answer was lowest pre-Year 1 and highest post-Year 1. It reduced slightly post-Years 3 and 5, but remained significantly higher than at pre-Year 1. The performance of students undertaking a 1-year intercalated BSc, however, appeared to regress on testing post-Year 4.
While the first year of the curriculum had a positive impact on students, the remainder of the curriculum did not impact to the same extent. These findings support the recommendation that small group teaching, the predominant teaching method in Year 1, should be preferred to lecture and large group teaching, the predominant method of the remaining curricular years. Full integration of ethics and law teaching within the rest of the curriculum is recommended, particularly during the clinical years. This has training implications for all medical teachers involved in the curriculum. The assessment of ethics should be incorporated into all formal examinations. It is recommended that ethics be addressed as part of a wider approach to professionalism in order to promote integration.
评估现代医学课程对学生在遇到伦理困境时所提出行为的影响。
队列设计。
格拉斯哥大学医学院。
格拉斯哥新课程首批入学的学生（n = 238）。主要结局指标 学生对《伦理与医疗调查工具》案例所提出伦理困境的回答与专业共识判断一致。
给出共识性答案的概率在第1年前最低，在第1年后最高。在第3年和第5年后略有下降，但仍显著高于第1年前。然而，攻读为期1年插读理学士学位的学生在第4年后测试中的表现似乎出现了退步。
虽然课程的第一年对学生有积极影响，但课程的其余部分影响程度不同。这些发现支持以下建议：应优先采用第1年的主要教学方法小组教学，而非其余课程年份的主要教学方法讲座和大班教学。建议在课程的其余部分，特别是临床年份，将伦理与法律教学全面整合。这对参与该课程的所有医学教师的培训具有启示意义。伦理评估应纳入所有正式考试。建议将伦理作为更广泛的职业素养方法的一部分来处理，以促进整合。
