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Teaching Bioethics Teaching Bioethics Arnuparp Lekhakula M.D., M.S. Department of Internal Medicine Faculty of Medicine Prince of Songkla University Hat Yai, Songkhla, Thailand

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Teaching Bioethics. Arnuparp Lekhakula M.D., M.S. Department of Internal Medicine Faculty of Medicine Prince of Songkla University Hat Yai, Songkhla, Thailand. Plan of Presentation. Why should we teach? Who should we teach? What should we teach? How should we teach? - PowerPoint PPT Presentation

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  • Teaching BioethicsArnuparp Lekhakula M.D., M.S.Department of Internal MedicineFaculty of MedicinePrince of Songkla UniversityHat Yai, Songkhla, Thailand

  • Plan of PresentationWhy should we teach?Who should we teach?What should we teach?How should we teach?How should we evaluate?

  • Why should we teach?Performance PerformancePerformance

    (and quality)(and moral distress)

  • Why should we teach? Minimizes complaints and ligitation Improves patient satisfaction Improves treatment complicance Improves clinical outcome Lowers cost Builds trust and mutual respect

  • Who should we teach?Medical studentsResidentsFellowsPracticing physiciansHealth care teams

  • What should we teach?Depends on profession level of student specialty

  • What should we teach?Critical issuesFormal vs informal curriculumTheory vs practicePrinciples vs decision tools vs paradigm cases

  • What should we teach?Medical studentsIntegrated curriculumStudent-specific ethical dilemmas (Hicks et al)conflict between medical education and patient careresponsibility beyond one's capabilitiesperceived substandard patient care

  • I should call thestaff back...An intern and clinical clerk are asked to close a surgical wound; staff then leaves the OR. Neither the intern or the clerk has performed this procedure before.

  • Intern attempts to close the incision,appears to be having difficulty.

  • Intern now clearly has difficulty. Patientbeginning to rouse from anesthetic.

  • Clerk decides not to call staff. Internfinishes closing.If I call for help, Ill look incompetent, get less opportunities and it may affect my mark.Wound infection

  • How should we teach?LectureTeachers casesPaperVideoStandardized patientLearners casesBedside encounter

  • Undergraduate Medical Ethics University of Toronto Medical SchoolYear 1Structure & Function Ethics decision-procedure 2 two-hr whole class sessions Care of newborns with 2-hr multidisciplinary myelomeningocele panel Genetic testing & treatment 1-hr whole class sessionMetabolism & Nutrition Truth telling and androgen 1-hr whole class session insensitivity syndrome Ethical Dilemmas of 2-hr small group seminar Truth telling in Medicine

  • Undergraduate Medical Ethics University of Toronto Medical School

    Year 1Brain & Behaviour Brain death 1-hr whole class presentationYear 2Pathobiology HIV and Ethics 2-hr small group, case-based seminarFoundation to Medical Practice Breaking bad news 1-hr whole class session 2-hr small group with SP The end of life 1-hr whole class lecture

  • Undergraduate Medical Ethics University of Toronto Medical School Informed consent 2-hr small group seminar Ethics in Paediatrics 2-hr small group seminar Euthanasia and Physician- assisted death 2-hr small group seminarYear 3-4 (Clerkship) End of life care (Medicine) 1-hr small group seminar Informed consent & substitute decision-making (Surgery) 1-hr small group seminar Ethical problems (Paediatrics)1-hr small group seminar Medical jurisprudence (Yr 4) 4 three-hr whole class

  • Undergraduate Medical EthicsUniversity of Toronto Medical SchoolAdjunct curriculumArt & Science of Clinical Medicine (Yr 1 & 2) Patient-doctor relationship weekly small groupHealth, Illness and the Community (Yr 1 & 2) Social aspects of illness 3.5-hr symposium Social justice 4-hr small group tutorialDeterminants of Health (Yr 3) Ethical issues in research 2-hr seminar Health care expenditure & health economics 1-hr lecture

  • Undergraduate Medical EthicsUniversity of Toronto Medical SchoolAdjunct curriculum Costs and cost-effectiveness of health care 2-hr workshop Clinical practice guideline & quality assurance 1-hr lecture Developing & implementing CPGs 1-hr lecture

  • Teaching Medical Ethicsthe University of Chicago

    Program Concepts (5 Cs) Teaching should be C linically cased Real patient C ases should serve as the teaching focus Teaching should be C ontinuous Ethics teaching should be C oordinated with the students other learning objectives C linicians should be participate actively in the teaching effort both as instructors and as role models

  • Teaching Medical Ethics the University of ChicagoYear 1 & 2Doctor-patient relationship Social and ethical issues in Medicine(Philosophical bioethics, euthanasia, research ethics, health & economics, legal issue) Use of human body, genetic screening, HIV issues, human experimentation Cognitively impaired patients Large group presentation Team-taught lecture Small group discussion Demonstration Seminar Independent study & research

  • Teaching Medical Ethics the University of ChicagoYear 3 & 4Medicine (14-20 hr) Care of terminal illness, consent, truth-telling, HIV issues, health care economics, confidentiality, legal issues, student rolesSurgery (8-16 hr) Consent, HIV issues, ethical issues in breast surgery, trauma surgery, poor outcome Case presentation Case discussion Reading Lecture

  • Teaching Medical Ethics the University of ChicagoYear 3 & 4Obstetrics-Gynecology (2-6 hr) Reproductive ethics, terminal illness, treatment of minors, socioeconomic issues in health care, HIV issuesPediatrics (4-6 hr) Care of infants and children, reproductive ethics, socio- economic issues in health care, legal issues Elective Case presentation Case discussion Reading Lecture

  • Teaching Medical Ethics the University of NewcastleYear 1 : 6 seminars (9 hr) Theories of moral reasoning Information disclosure Patient competence Truth-telling Refusal of treatment Doctor-patient relationshipYear 2 : 4 seminars (6 hr) Killing and letting die Acts and omission Active and passive euthanasia Doctrine of double effects Withholding and withdrawal Tutor inputs including lawyer Clinician-led case study analyses Selected reading Small group discussion Class debate

  • Teaching Medical Ethics the University of NewcastleYear 3 : 3 seminars (4.5 hr) Obligatory beneficence Paternalism Autonomy vs beneficence conflicts Contractual and role obligations Tutor inputs including lawyer Clinician-led case study analyses Selected reading Small group discussion Class debate

  • Teaching Medical Ethics the University of NewcastleYear 4 : 9 seminars (13.5 hr) Medical negligence Reproductive technologies Selective non-treatment of newborns Terminating medical care Allocation of health resources Justice as fairness Rights and duties Medical and social utility Cost containment Beneficence vs justice conflicts Tutor inputs including lawyer Ward rounds Patient care team Clinician-led case study analyses Selected reading Small group discussion Class debate

  • Teaching Medical Ethics the University of NewcastleYear 5 : 7 seminars (10.5 hr) Medico-legal issues Risk management Solicitors letters and courts Negligence Human experimentation Termination of medical care Transplantation Drug use and abuse AIDS Genetics Tutor inputs including lawyer Ward rounds Patient care team Clinician-led case study analyses Selected reading Small group discussion Class debate

  • Teaching Bioethics Faculty of Medicine, PSUYear 1 : General PhilosophyYear 2 : 13.5 hours Foundation to Clinical Practice and Medical Ethics IIntroduction to EthicsMeta-ethicsEthical reasoning I Foundation to Clinical Practice and Medical Ethics IIDoctor-patient relationshipEthical reasoning IIEthical reasoning III

  • Teaching Bioethics Faculty of Medicine, PSUYear 3 : 18 hours Foundation to Clinical Practice and Medical Ethics IIIPrinciples of BioethicsAutonomyBeneficence and Non-maleficence Foundation to Clinical Practice and Medical Ethics IVDifficult patientsJustice and resource allocationBreaking bad newsDifficult of life and deathMedical codes of ethics

  • Teaching Bioethics Faculty of Medicine, PSUYear 4 : 12 hours Health and Diseases of Adults and ElderlyConsentConfidentialitySubstitute decision-makingDoctor-patient relationship Preoperative to Postoperative CareConsentTruth telling and withholding informationConflict of interest (student issue) Family and Community MedicinePublic health ethics

  • Teaching Bioethics Faculty of Medicine, PSUYear 5 : 15 hours Health and Diseases of Adults and ElderlyQuality end-of-life care Preoperative to Postoperative CareRefusal of treatment Medical negligence Health and Diseases from Conception to AdolescenceInvolving children in decision makingResource allocation Health and Diseases of WomenMaternal-fetal dilemmaMedical futilityReproductive technology

  • RCPSC Bioethics RequirementsThe academic program must provide opportunities for residents to gain an understanding of the basic principles of biomedical ethics as it relates to the specialty That the Royal College extend evaluation of bioethics in all of its current methods of evaluation of programs and residents

  • RCPSC Bioethics ProjectGoalsTo integrate bioethical knowledge and skills into the clinical practice of residents To assist Canadian post-graduate program directors to teach bioethicsTo develop model curricula in medicine, surgery, OBGYN, and psychiatryTo develop evaluation strategies

  • RCPSC Bioethics ProjectMedicine Curriculum Topicstruth tellingconsentcapacitysubstitute decision makingconfidentialityconflict of interestappropriate use of life-sustaining treatmenteuthanasia / assisted suicideresource allocationresearch ethics

  • How shall we evaluate?Knowledge Mutliple choice, true / falseAnalysis Essay questionPerformanceChart reviewOSCEIn-training evaluation

    TOPIC 1- INTRODUCTION TO BIOETHICS, 11 JAN 2001*****