Client - meeting - _____ - 1 Key findings of the survey into learning, teaching and assessment of...

Client - meeting - _____ - 1

Key findings of the survey Key findings of the survey into into

learning, teaching and learning, teaching and assessment assessment

of medical ethics and lawof medical ethics and law

Dr. Karen Mattick & Prof. John BlighDr. Karen Mattick & Prof. John Bligh

Background to the studyBackground to the study

Pond report (1987) addressed the question of ethics Pond report (1987) addressed the question of ethics in medical education. in medical education.

Tomorrow’s Doctors (1993, 2003) recommended Tomorrow’s Doctors (1993, 2003) recommended that ethics be included in the core medical that ethics be included in the core medical curriculum curriculum

Consensus Statement (1998), model core curriculum Consensus Statement (1998), model core curriculum for teaching medical ethics and law. for teaching medical ethics and law.

More recently, both the BMA and the IME Governing More recently, both the BMA and the IME Governing Body recognised need for more up-to-date Body recognised need for more up-to-date information about the status of undergraduate information about the status of undergraduate ethics teachingethics teaching

Aim of studyAim of study

To determine whether the recommendations of the To determine whether the recommendations of the Consensus Statement published seven years ago Consensus Statement published seven years ago had been implemented. had been implemented.

To characterise UK undergraduate medical ethics To characterise UK undergraduate medical ethics curriculacurricula

To identify opportunities and threats on the horizonTo identify opportunities and threats on the horizon

MethodologyMethodology

Postal questionnaire survey on the undergraduate Postal questionnaire survey on the undergraduate ethics and law curriculum sent to the lead in teaching ethics and law curriculum sent to the lead in teaching and learning at each UK medical schooland learning at each UK medical school

Questions included design, teaching, assessment, Questions included design, teaching, assessment, staffing, and individuals’ hopes and concerns for the staffing, and individuals’ hopes and concerns for the futurefuture

E-mail reminders reinforced the importance of the E-mail reminders reinforced the importance of the studystudy

Descriptive statistics used to describe some Descriptive statistics used to describe some quantitative aspectsquantitative aspects

Thematic analysis of the open-ended responses Thematic analysis of the open-ended responses performed to identify important issuesperformed to identify important issues

Specific identifying information within quotes removedSpecific identifying information within quotes removed

Findings: what to present Findings: what to present today?today?

Aims of the talkAims of the talk to provide information from the survey that is to provide information from the survey that is

complimentary to the two manuscriptscomplimentary to the two manuscripts

to prompt discussions about future to prompt discussions about future developments within the conference developments within the conference

Structure of the talkStructure of the talk overview of key findingsoverview of key findings

focus on areas of concern, presenting more ‘raw focus on areas of concern, presenting more ‘raw data’ than you will see elsewheredata’ than you will see elsewhere

Key findingsKey findings

Overview of key findings (1)Overview of key findings (1)

Completed responses from 22 / 28 schools (79%). Completed responses from 22 / 28 schools (79%). Significant changes identified that could be directly Significant changes identified that could be directly

attributed to the Consensus Statement. attributed to the Consensus Statement. Most schools did cover all 12 recommended topicsMost schools did cover all 12 recommended topics

But only 3 felt they were covered thoroughlyBut only 3 felt they were covered thoroughlyAnd 3 did not cover one or more topics at all And 3 did not cover one or more topics at all

Only 16 schools identified one or more full time Only 16 schools identified one or more full time academic that took direct responsibility for ensuring academic that took direct responsibility for ensuring undergraduate medical students learnt about ethicsundergraduate medical students learnt about ethicsThese were usually at a lecturer grade. These were usually at a lecturer grade.

More information in: Mattick & Bligh 2006. Undergraduate ethics teaching: revisiting the

Consensus Statement. In press, Medical Education


Aims for ethics teaching were successful (17 Aims for ethics teaching were successful (17 respondents, 77%)respondents, 77%)

Ethics should be learnt throughout the course (20, Ethics should be learnt throughout the course (20, 91%)91%)

Ethics teaching and learning should be fully Ethics teaching and learning should be fully integrated horizontally (13, 59%)integrated horizontally (13, 59%)

Variety in assessment was important (20, 91%) and Variety in assessment was important (20, 91%) and 3 tools was the preferred number3 tools was the preferred number

A shortfall in ethics core competencies did not A shortfall in ethics core competencies did not preclude graduation (15, 68%) preclude graduation (15, 68%)


Most successful aspects of courses: their integrated Most successful aspects of courses: their integrated nature (10), the small group teaching (4)nature (10), the small group teaching (4)

Weaknesses: need still greater integration (6), the Weaknesses: need still greater integration (6), the heavily theoretical aspects (5)heavily theoretical aspects (5)

Major concerns for the future: staffing and staff Major concerns for the future: staffing and staff development (12, 55%)development (12, 55%)

More information in: Mattick & Bligh 2006. Teaching and assessing medical ethics: where

are we now? Journal of Medical Ethics 32, 181-185.

Areas of concernAreas of concern

Concern 1: staffingConcern 1: staffing

The concern: Staffing and staff developmentThe concern: Staffing and staff development Generally, a small number of dedicated ethics Generally, a small number of dedicated ethics

teachers (e.g.1-3) plus a much larger number of teachers (e.g.1-3) plus a much larger number of sessional tutors. sessional tutors.

Only 16 schools had at least one full time Only 16 schools had at least one full time academic to provide and coordinate ethics academic to provide and coordinate ethics teaching and learningteaching and learning

Consensus Statement called for this to be a senior Consensus Statement called for this to be a senior academic - predominance of lecturers in this role academic - predominance of lecturers in this role

Training for teachers often provided (10) but Training for teachers often provided (10) but generally optional and in-housegenerally optional and in-house


There does not seem to be a cohort of medical ethicists There does not seem to be a cohort of medical ethicists in waiting to take over the reins in future. Many people in waiting to take over the reins in future. Many people are interested and will help, but to create and sustain a are interested and will help, but to create and sustain a vertical theme that works over 5 years requires vertical theme that works over 5 years requires considerable investment of personal time, energy and considerable investment of personal time, energy and leadership.leadership.

We are so stretched that taking time to review / We are so stretched that taking time to review / evaluate / innovate is very difficult.evaluate / innovate is very difficult.

Lack of clinical academic staff. Lack of time / resources Lack of clinical academic staff. Lack of time / resources to support theme.to support theme.

As numbers of students increase, loss of either As numbers of students increase, loss of either curriculum time, or small group teaching.curriculum time, or small group teaching.

As lectures are cheaper to provide than seminars, there As lectures are cheaper to provide than seminars, there could be pressure to abandon seminarscould be pressure to abandon seminars..


The relevance, depth and vibrancy of the The relevance, depth and vibrancy of the programme could be lost, especially through failure programme could be lost, especially through failure to support and develop both specialist and generic to support and develop both specialist and generic clinical teachers, not least through the many clinical teachers, not least through the many competing pressures on their time and attention.competing pressures on their time and attention.

I think ethics needs a product champion in every I think ethics needs a product champion in every medical school – it is easy for it to become medical school – it is easy for it to become everyone’s – and therefore no-one’s - responsibility.everyone’s – and therefore no-one’s - responsibility.

In 2000 or so everything looked rosy; now we're In 2000 or so everything looked rosy; now we're under great pressure, RAE-obsessed senior staff under great pressure, RAE-obsessed senior staff have put at least one post under threat, and the have put at least one post under threat, and the incentives to teach and to teach well are ever incentives to teach and to teach well are ever weaker.weaker.

Questions for todayQuestions for today

How can we retain and develop How can we retain and develop existing well qualified and existing well qualified and experienced staff?experienced staff? StaffingStaffing


How can we retain and develop How can we retain and develop existing well qualified and existing well qualified and experienced staff?experienced staff?

How do we recruit and groom the How do we recruit and groom the next generation?next generation?

StaffingStaffing




What training is needed for ethics What training is needed for ethics teachers?teachers?

StaffingStaffing




What training is needed for ethics What training is needed for ethics teachers?teachers?

How do we resist threats to staff How do we resist threats to staff time, for example from increased time, for example from increased student numbers and the pressures student numbers and the pressures of clinical or research work?of clinical or research work?

StaffingStaffing

Concern 2: graduating without Concern 2: graduating without ethics competenciesethics competencies

The concern: a shortfall in ethics core The concern: a shortfall in ethics core competencies does not preclude graduationcompetencies does not preclude graduation

15 schools (68%) answered yes to the following 15 schools (68%) answered yes to the following question in the questionnaire: question in the questionnaire:

““Q: Is it possible for a student to graduate if they fail Q: Is it possible for a student to graduate if they fail their ethics assessment?”their ethics assessment?”

Concern 2: graduating without Concern 2: graduating without ethics competenciesethics competencies

Technically yes- but it is unlikely to occur, as there Technically yes- but it is unlikely to occur, as there is sufficient ethics in the exam to require a very high is sufficient ethics in the exam to require a very high mark in all other components to offset a fail.mark in all other components to offset a fail.

Yes, but many students leave the course if they fail Yes, but many students leave the course if they fail an assessment in year 1 or 2, and it is possible for a an assessment in year 1 or 2, and it is possible for a student not to graduate if they fail an essential part student not to graduate if they fail an essential part of finals - so on principle a student could fail if they of finals - so on principle a student could fail if they do something 'unethical' in finals.do something 'unethical' in finals.

Until recently this was not the case. It now is so. Until recently this was not the case. It now is so. This is one area of our work that could improve.This is one area of our work that could improve.


Is this a real issue? In practice, do Is this a real issue? In practice, do students graduate having failed students graduate having failed ethics competencies?ethics competencies? Graduating Graduating

without ethics without ethics competenciescompetencies


Is this a real issue? In practice, do Is this a real issue? In practice, do students graduate having failed students graduate having failed ethics competencies?ethics competencies?

If so, do we think this is If so, do we think this is acceptable?acceptable?

Graduating Graduating without ethics without ethics competenciescompetencies



If so, do we think this is If so, do we think this is acceptable?acceptable?

If not, how can we ensure that a If not, how can we ensure that a lack of ethics competencies is a lack of ethics competencies is a barrier to progression?barrier to progression?




If so, do we think this is acceptable?If so, do we think this is acceptable?

If not, how can we ensure that a If not, how can we ensure that a lack of ethics competencies is a lack of ethics competencies is a barrier to progression?barrier to progression?

Is this a particular problem for Is this a particular problem for schools that use integrated schools that use integrated assessment?assessment?


Concern 3: greater integrationConcern 3: greater integration

The concern: need still greater integrationThe concern: need still greater integration Years ago we used to teach one isolated ethics Years ago we used to teach one isolated ethics

session in an afternoon, which let the students to session in an afternoon, which let the students to see ethics as something external to medicine, which see ethics as something external to medicine, which they could chose to ignore.they could chose to ignore.

Integration of ethics teaching has not occurred, no Integration of ethics teaching has not occurred, no one person taking responsibility in planning.one person taking responsibility in planning.


How can we continue the good How can we continue the good start that has been made start that has been made integrating ethics into the integrating ethics into the undergraduate curriculum?undergraduate curriculum?

Greater Greater integrationintegration


How can we continue the good How can we continue the good start that has been made start that has been made integrating ethics into the integrating ethics into the undergraduate curriculum?undergraduate curriculum?

Is this a real issue or a ‘teacher’s Is this a real issue or a ‘teacher’s eye’ view?eye’ view?

Greater Greater integrationintegration

Concern 4: curriculum topicsConcern 4: curriculum topics

The concern: key topics outlined in the Consensus The concern: key topics outlined in the Consensus Statement not covered or covered sub-optimallyStatement not covered or covered sub-optimally

Four topics not well covered (in yellow)Four topics not well covered (in yellow)

1.1. Informed consent and refusal of treatmentInformed consent and refusal of treatment2.2. Clinical relationship, truthfulness, trust and good communicationClinical relationship, truthfulness, trust and good communication3.3. Confidentiality and good clinical practiceConfidentiality and good clinical practice4.4. Medical researchMedical research5.5. Human reproductionHuman reproduction6.6. The ‘new genetics’The ‘new genetics’7.7. ChildrenChildren8.8. Mental disorders and disabilityMental disorders and disability9.9. Life, death, dying and killingLife, death, dying and killing10.10. Vulnerabilities created by the duties of doctors and medical studentsVulnerabilities created by the duties of doctors and medical students11.11. Resource allocationResource allocation12.12. RightsRights


Are the 12 topics in the Consensus Are the 12 topics in the Consensus Statement important?Statement important? Curriculum Curriculum

topicstopics


Are the 12 topics in the Consensus Are the 12 topics in the Consensus Statement important?Statement important?

Why aren’t they covered? Are they Why aren’t they covered? Are they still relevant?still relevant?

Curriculum Curriculum topicstopics


Are the 12 topics in the Consensus Are the 12 topics in the Consensus Statement important?Statement important?

Why aren’t they covered? Are they Why aren’t they covered? Are they still relevant?still relevant?

If they are important, how can we If they are important, how can we ensure they are covered?ensure they are covered?

Curriculum Curriculum topicstopics

Concern 5: theoretical aspectsConcern 5: theoretical aspects

The concern: heavily theoretical aspects of ethics are The concern: heavily theoretical aspects of ethics are unpopular with studentsunpopular with students

Most respondents agreed that both critical and Most respondents agreed that both critical and normative medical ethics needed to be present in the normative medical ethics needed to be present in the curriculum but difficult to make some aspects curriculum but difficult to make some aspects appealing to students.appealing to students.

““Q: What is the balance between critical medical ethics Q: What is the balance between critical medical ethics (e.g. ethical theory, analysis, argument) and (e.g. ethical theory, analysis, argument) and normative medical ethics (e.g. expected behaviour in normative medical ethics (e.g. expected behaviour in given situations, including professional and legal given situations, including professional and legal obligations) at your medical school?”obligations) at your medical school?”


Previously, there was greater emphasis on ethical Previously, there was greater emphasis on ethical theory, but students found this confusing and ‘dry’ theory, but students found this confusing and ‘dry’ according to their evaluations. Integrating theory into according to their evaluations. Integrating theory into resolving dilemmas has resulted in greater student resolving dilemmas has resulted in greater student enjoyment without diluting the teaching of the theory.enjoyment without diluting the teaching of the theory.

I often use the analogy of engineering maths, a I often use the analogy of engineering maths, a subject that can be frustrating for a pure subject that can be frustrating for a pure mathematician to teach, as engineers only want to mathematician to teach, as engineers only want to know what they need to know. In the field of medical know what they need to know. In the field of medical ethics, such a balance can frustrate a pure ethics, such a balance can frustrate a pure philosopher, but I think we need to be realistic.philosopher, but I think we need to be realistic.


Few medical students seem to have a bent for Few medical students seem to have a bent for philosophical scholarship. Perhaps this is why they go philosophical scholarship. Perhaps this is why they go into medicine!into medicine!

Students disliked ethical theory as they felt it was Students disliked ethical theory as they felt it was boring.boring.

We have improved things by trying to make learning We have improved things by trying to make learning practical and relevant. However, I suspect that this has practical and relevant. However, I suspect that this has been at the expense of depth of theoretical learning. been at the expense of depth of theoretical learning. Medical students seem mostly very action-oriented and Medical students seem mostly very action-oriented and rather against thoughtful but incisive reflection.rather against thoughtful but incisive reflection.

Students should always be able to ask – at any stage – Students should always be able to ask – at any stage – and receive a coherent answer to question: “What is the and receive a coherent answer to question: “What is the clinical relevance of what you (the lecturer) are clinical relevance of what you (the lecturer) are saying?”saying?”


How much critical medical ethics is How much critical medical ethics is appropriate to include within appropriate to include within undergraduate courses?undergraduate courses?

Theoretical Theoretical aspectsaspects


How much critical medical ethics is How much critical medical ethics is appropriate to include within appropriate to include within undergraduate courses?undergraduate courses?

How can it be learnt by students in How can it be learnt by students in a way they will find interesting and a way they will find interesting and relevant?relevant?

Theoretical Theoretical aspectsaspects

SummarySummary

Undergraduate ethics learning, teaching and Undergraduate ethics learning, teaching and assessment has come a long way in the last assessment has come a long way in the last decade – but there is still much to be done!decade – but there is still much to be done!

We hope that during the course of the day, you We hope that during the course of the day, you will:will:

Refer back to the study findingsRefer back to the study findings

Discuss them, particularly the areas of concernDiscuss them, particularly the areas of concern

Make recommendations for future directions via Make recommendations for future directions via the workshopsthe workshops

And finally, thank you once again And finally, thank you once again

to those individuals that spent time to those individuals that spent time

completing the questionnaire.completing the questionnaire.

[email protected]@pms.ac.uk

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