Medical Ethics Education

Last week I attended American Society for Bioethics and Humanities Annual Conference in Washington, D.C.  One of the themes running through the event was ethics education.  There was, for example, much discussion of when to get ethics into the curriculum for those going into medicine. Often such education consists of a few lectures in medical school and perhaps a lecture or two in residency.

At the Ethics Center, we have been trying to start even earlier by offering a Health Care Ethics Internship to junior and senior undergraduates. This yearlong course focuses on experiential learning coupled with ethics lectures and discussion. Our hope is that we can instill in our students a sense of ethics before they go out into the world.  But we also know that their learning may not be sustained through all of the other things they encounter in their medical education. 

I attended at least one session where the focus was on trying to include ethics throughout the medical school curriculum. A number of new medical schools are arising, in part to meet the growing need for physicians.  Many of these new schools are taking the opportunity to rethink how ethics might be integrated at various stages. They have been reevaluating the classic texts and case-based discussion that they might want to include amongst the many other courses first- and second-year medical students attend, as well as how to make ethics part of the core curriculum, rather than just an add-on or fill-in lecture. 

At another session, one new medical school discussed how they integrated ethical issues into their simulation work. One example was a simulation in which medical students practiced having an informed consent discussion with a standardized patient (someone trained to play the part of a patient with a particular ailment) in preparation for dialysis. Unbeknownst to the student, the standardized patient was instructed to act as if he or she lacked decision-making capacity. Instead of simply practicing discussing the risks, benefits, and other potential treatments for dialysis, the medical student also needed to recognize that the patient was not able to consent and make a plan for how to proceed. 

It was really exciting to see these schools integrating ethics into everyday curriculum and simulations. As we think more critically and creatively about when and how to expose students and clinicians to ethics, hopefully ethics education will become a more integral part of medical education.

Ryan Holmes is assistant director of health care ethics at the Markkula Center for Applied Ethics.