Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
BMC Med Educ. 2021 Jun 9;21(1):338. doi: 10.1186/s12909-021-02644-5.
Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum.
With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review.
The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF).
Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.
培养能够将伦理原则应用于实践的熟练临床医生是一项具有挑战性的任务，这一任务因研究生阶段伦理教学和评估的广泛差异而变得更加复杂。尽管存在这些差异，但伦理培训计划应认识到，从医学生向医疗保健专业人员的过渡是一个纵向过程，随着临床经验的增加，伦理知识、技能和身份会持续建立和深化。本研究旨在通过系统综述分析同行评议文献中研究生医学伦理培训和评估计划，为制定当地医生培训课程提供指导。
本系统综述采用建构主义视角和相对主义视角，运用系统循证方法（SEBA）进行研究生医学伦理培训和评估，以创建透明且可重复的审查。
第一次涉及伦理教学的搜索产生了 7669 条摘要，评估了 573 篇全文文章，纳入了 66 篇文章。第二次涉及伦理评估的搜索产生了 9919 条摘要，评估了 333 篇全文文章，纳入了 29 篇文章。这两次搜索确定的主题包括教学伦理的目标、内容、教学法、教学的促成和限制因素以及使用的评估方式。尽管伦理培训计划存在内在差异，但它们为学习者提供了应用知识的平台，将知识转化为技能，最终成为学习者身份的一部分。螺旋式课程生动地展示了伦理培训的纵向性质，它将医学院获得的普遍伦理知识与专业实践中新兴的专业、临床和研究特定内容无缝地整合和强化。本研究还使用了各种评估方法，特别提到了档案袋作为一种纵向评估方式，展示了伦理培训对专业身份形成（PIF）发展的影响。
本系统综述总结了研究生阶段伦理教学和评估的关键学习点。然而，仍需要进一步研究建立伦理领域的可委托专业活动（EPA），进一步探索档案袋的使用以及影响其设计、实施和评估 PIF 和伦理实践中小额认证的关键因素。
