Stevens N G, McCormick T R
Department of Family Medicine, University of Washington School of Medicine, Seattle.
J Am Board Fam Pract. 1994 Jan-Feb;7(1):38-43.
Medical ethics has traditionally been taught using dramatic, out-of-the-ordinary cases to illustrate principles. Little attention has been focused on the ethical decisions family physicians make routinely in the course of their practice.
As part of a multidisciplinary course in medical ethics at the University of Washington School of Medicine, one class section was taught by a family physician using cases from her primary care practice. Cases were presented up to the point of decision making. Students were then encouraged to consider what action they would take. Each case was concluded with the family physician sharing the outcome of the case.
Five case examples were presented. A comprehensive, context-sensitive approach to patient problems was modeled. Ethical issues explored included financial constraints, resource utilization, substance abuse, truth telling, confidentiality, and patient autonomy.
Case-based teaching by a family physician was very effective at generating interest and enthusiasm among students and in encouraging their own thinking about ethical decisions. Students also valued the exposure to the family physician's style of practice. This teaching method created an excellent opportunity for learning about ethics and primary care that is applicable to many teaching settings.
传统上，医学伦理学教学采用引人注目的、不同寻常的案例来说明原则。很少有人关注家庭医生在日常诊疗过程中做出的伦理决策。
作为华盛顿大学医学院医学伦理学多学科课程的一部分，一个班级由一位家庭医生授课，使用她在初级保健实践中的案例。案例呈现至决策点。然后鼓励学生思考他们会采取什么行动。每个案例最后由家庭医生分享该案例的结果。
展示了五个案例。对患者问题采用了全面、结合具体情境的方法。探讨的伦理问题包括经济限制、资源利用、药物滥用、告知真相、保密和患者自主权。
家庭医生基于案例的教学在激发学生兴趣和热情以及鼓励他们思考伦理决策方面非常有效。学生也重视接触家庭医生的诊疗方式。这种教学方法为学习伦理学和初级保健创造了一个极好的机会，适用于许多教学环境。
