Medical ethics in medical education: finding and keeping a place at the table.

Although almost three decades have passed from the early days of the modern medical ethics movement, both articles discussed here manifest variations of some old concerns. First, an acceptance of ethics is incorporated into general requirements and found in specific programs, but ethics is not given great attention by those who decide who will enter the medical profession. Second, in the clinical setting itself, practitioners are busy and the teaching process is placed amidst a multitude of other concerns. And third, the goals for resident and faculty education are remarkably similar to those proposed for undergraduates (awareness, development of analytical skills, involvement in patient care, and so forth). The evaluation of ethics instruction, which has been a concern since the 1960s, has a new face. Upon entering the medical-education setting, humanists found that there was a need for accountability that they had not generally experienced in their university teaching. Yet, they also knew that ethics was different from other medical courses, and that quantifying its special contribution was difficult. Today's general societal emphasis on cost and outcome as measures of the value of education gives consideration of evaluation a critical role. White and Zaner, and most of the other authors cited here, mention the need for systematic accounting of the results of teaching, as well as the difficulty of evaluation. The evaluation of the effectiveness of ethics instruction will remain problematic, yet it is necessary in the changing health-care market. To the degree to which it is possible to communicate knowledge about ethics, residency and other accrediting bodies can provide means to evaluate the results of teaching.(ABSTRACT TRUNCATED AT 250 WORDS)