Sullivan Brian T, DeFoor Mikalyn T, Hwang Brice, Flowers W Jeffrey, Strong William
Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, USA.
School of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
J Med Educ Curric Dev. 2020 Jan 22;7:2382120519899148. doi: 10.1177/2382120519899148. eCollection 2020 Jan-Dec.
The best pedagogical approach to teaching medical ethics is unknown and widely variable across medical school curricula in the United States. Active learning, reflective practice, informal discourse, and peer-led teaching methods have been widely supported as recent advances in medical education. Using a bottom-up teaching approach builds on medical trainees' own moral thinking and emotion to promote awareness and shared decision-making in navigating everyday ethical considerations confronted in the clinical setting.
Our study objective was to outline our methodology of grassroots efforts in developing an innovative, student-derived longitudinal program to enhance teaching in medical ethics for interested medical students.
Through the development of a 4-year interactive medical ethics curriculum, interested medical students were provided the opportunity to enhance their own moral and ethical identities in the clinical setting through a peer-derived longitudinal curriculum including the following components: lunch-and-learn didactic sessions, peer-facilitated ethics presentations, faculty-student mentorship sessions, student ethics committee discussions, hospital ethics committee and pastoral care shadowing, and an ethics capstone scholarly project. The curriculum places emphasis on small group narrative discussion and collaboration with peers and faculty mentors about ethical considerations in everyday clinical decision-making and provides an intellectual space to self-reflect, explore moral and professional values, and mature one's own professional communication skills.
The Leadership through Ethics (LTE) program is now in its fourth year with 14 faculty-clinician ethics facilitators and 65 active student participants on track for a distinction in medical ethics upon graduation. Early student narrative feedback showed recurrent themes on positive curricular components including (1) clinician mentorship is key, (2) peer discussion and reflection relatable to the wards is effective, and (3) hands-on and interactive clinical training adds value. As a result of the peer-driven initiative, the program has been awarded recognition as a graduate-level certification for sustainable expansion of the grassroots curriculum for trainees in the clinical setting.
Grassroots medical ethics education emphasizes experiential learning and peer-to-peer informal discourse of everyday ethical considerations in the health care setting. Student engagement in curricular development, reflective practice in clinical settings, and peer-assisted learning are strategies to enhance clinical ethics education. The Leadership through Ethics program augments and has the potential to transform traditional teaching methodology in bioethics education for motivated students by offering protected small group discussion time, a safe environment, and guidance from ethics facilitators to reflect on shared experiences in clinical ethics and to gain more robust, hands-on ethics training in the clinical setting.
在美国，医学院课程中教授医学伦理学的最佳教学方法尚不清楚，且差异很大。主动学习、反思性实践、非正式讨论和同伴主导的教学方法作为医学教育的最新进展得到了广泛支持。采用自下而上的教学方法基于医学实习生自身的道德思考和情感，以促进在应对临床环境中日常伦理考量时的意识和共同决策。
我们的研究目的是概述我们在开展一项创新的、由学生主导的纵向项目以加强对有兴趣的医学生进行医学伦理学教学方面的基层工作方法。
通过开发一个为期4年的互动式医学伦理学课程，为有兴趣的医学生提供机会，通过一个由同伴主导的纵向课程在临床环境中增强他们自己的道德和伦理身份，该课程包括以下组成部分：午餐学习讲座、同伴主持的伦理学报告、师生指导课程、学生伦理委员会讨论、医院伦理委员会和牧师关怀见习，以及一个伦理学顶点学术项目。该课程强调小组叙事讨论以及与同伴和教师导师就日常临床决策中的伦理考量进行合作，并提供一个自我反思、探索道德和职业价值观以及培养自身专业沟通技能的智力空间。
“通过伦理学实现领导力”（LTE）项目现已进入第四年，有14名教师临床伦理促进者和65名活跃的学生参与者，有望在毕业时获得医学伦理学方面的优异成绩。早期学生的叙事反馈显示了关于积极课程组成部分的反复出现的主题，包括：（1）临床医生指导是关键；（2）与病房相关的同伴讨论和反思是有效的；（3）实践和互动式临床培训增加了价值。由于同伴驱动的倡议，该项目已获得认可，成为临床环境中实习生基层课程可持续扩展的研究生水平认证。
基层医学伦理学教育强调体验式学习以及在医疗保健环境中对日常伦理考量的同伴间非正式讨论。学生参与课程开发、在临床环境中的反思性实践以及同伴辅助学习是加强临床伦理学教育的策略。“通过伦理学实现领导力”项目通过提供受保护的小组讨论时间、安全的环境以及伦理促进者的指导，以反思临床伦理学中的共同经历并在临床环境中获得更强大的实践伦理学培训，增强并有可能改变针对有积极性的学生的生物伦理学教育中的传统教学方法。
