Hafferty F W, Franks R
Department of Behavioral Sciences, University of Minnesota, Duluth School of Medicine 55812-2487.
Acad Med. 1994 Nov;69(11):861-71. doi: 10.1097/00001888-199411000-00001.
The authors raise questions regarding the wide-spread calls emanating from lay and medical audiences alike to intensify the formal teaching of ethics within the medical school curriculum. In particular, they challenge a prevailing belief within the culture of medicine that while it may be possible to teach information about ethics (e.g., skills in recognizing the presence of common ethical problems, skills in ethical reasoning, or improved understanding of the language and concepts of ethics), course material or even an entire curriculum can in no way decisively influence a student's personality or ensure ethical conduct. To this end, several issues are explored, including whether medical ethics is best framed as a body of knowledge and skills or as part of one's professional identity. The authors argue that most of the critical determinants of physician identity operate not within the formal curriculum but in a more subtle, less officially recognized "hidden curriculum." The overall process of medical education is presented as a form of moral training of which formal instruction in ethics constitutes only one small piece. Finally, the authors maintain that any attempt to develop a comprehensive ethics curriculum must acknowledge the broader cultural milieu within which that curriculum must function. In conclusion, they offer recommendations on how an ethics curriculum might be more fruitfully structured to become a seamless part of the training process.
作者们对来自普通大众和医学界人士的广泛呼声提出了质疑，这些呼声要求在医学院课程中加强伦理学的正规教学。特别是，他们对医学文化中的一种普遍观念提出了挑战，即虽然传授伦理学信息（例如，识别常见伦理问题的技能、伦理推理技能或对伦理学语言和概念的更好理解）是可能的，但课程材料甚至整个课程都无法决定性地影响学生的个性或确保其道德行为。为此，探讨了几个问题，包括医学伦理学最好是被构建为一套知识和技能体系，还是作为个人职业身份的一部分。作者们认为，医生身份的大多数关键决定因素并非在正规课程中起作用，而是在一个更微妙、官方认可度较低的“隐性课程”中。医学教育的整体过程被视为一种道德训练形式其中伦理学的正规教学只是其中一小部分。最后，作者们坚持认为，任何开发全面伦理学课程的尝试都必须承认该课程必须在其中发挥作用的更广泛文化环境。总之，他们就如何更有效地构建伦理学课程以使其成为培训过程中无缝衔接的一部分提出了建议。
