How medical students learn ethics: an online log of their learning experiences

Carolyn Johnston & Jonathan Mok
J Med Ethics doi:10.1136/medethics-2015-102716

Abstract

Medical students experience ethics learning in a wide variety of formats, delivered not just through the taught curriculum. An audit of ethics learning was carried out at a medical school through a secure website over one academic year to determine the quantity and range of medical ethics learning in the undergraduate curriculum and compare this with topics for teaching described by the Institute of Medical Ethics (IME) (2010) and the General Medical Council's (GMC) Tomorrow's Doctors (2009). The online audit captured the participants’ reflections on their learning experiences and the impact on their future practice. Results illustrate the opportunistic nature of ethics learning, especially in the clinical years, and highlight the reality of the hidden curriculum for medical students. Overall, the ethics learning was a helpful and positive experience for the participants and fulfils the GMC and IME curriculum requirements.

The entire article is here.

Moral Distress in Medical Education and Training

by Berger, Jeffrey T
Journal of General Internal Medicine, Volume 29, Issue 2
doi: 10.1007/s11606-013-2665-0

Abstract

Moral distress is the experience of cognitive-emotional dissonance that arises when one feels compelled to act contrary to one’s moral requirements. Moral distress is common, but under-recognized in medical education and training, and this relative inattention may undermine educators’ efforts to promote empathy, ethical practice, and professionalism. Moral distress should be recognized as a feature of the clinical landscape, and addressed in conjunction with the related concerns of negative role modeling and the goals and efficacy of medical ethics curricula.

Introduction

Moral distress is the cognitive-emotional dissonance that arises when one feels compelled to act against one’s moral requirements. Moral distress is common in clinical practice, because caring for the ill is an inherently moral activity. Medical students and junior practitioners may be particularly challenged by morally distressing situations. Their development into attending physicians involves a process that is complex intellectually, sociologically, and culturally, and is no less complex in its moral dimensions.

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Academic health institutions whose leadership presupposes that moral distress affects all of its clinicians will be best positioned to mitigate this stress and to promote moral wellness and professionalism. Programs should expect that their trainees will experience moral distress and trainees should be aware of this expectation.

The entire article is here.

Mental Health: Parity Yes, Providers No

By Ben Hartman
Contributing Writer, MedPage Today
Originally published February 7, 2014

Demand -- for both facilities and providers -- has long outpaced supply in the field of mental health, but recent moves to increase funding for mental health services combined with innovative delivery systems may reverse that trend.

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But money is not the only issue: many PCPs lack the needed psychiatric training, according to Jaseu Han, MD, residency director of the combined family medicine/psychiatry program at the University of California Davis Health System.

"There has to be a behavioral component to all residencies. There is a ton of talk about the value of patient-physician interactions, but the residents are not receiving psychiatric training. If you look at internal medicine, Ob/Gyn, pediatrics, and family medicine, they don't get anything. There is no requirement during residency to get any mental health experience."

The entire story is here.

Editorial note: This article points out another reason psychologists with advanced training and supervision in psychopharmacology can bridge the gap as prescribing psychologists.

Please listen the Psychologists and Prescriptive Authority: Where are we now? podcast

Medical Schools Teaching Little About Gay Health

By CARLA K. JOHNSON, AP Medical Writer

Future doctors aren't learning much about the unique health needs of gays and lesbians, a survey of medical school deans suggests.

On average, the schools devoted five hours in the entire curriculum to teaching content related to lesbian, gay, bisexual and transgender patients, according to the survey results appearing in Wednesday's Journal of the American Medical Association. A third of the schools had none during the years students work with patients.

More than a quarter of the medical school deans said their school's coverage of 16 related topics was "poor" or "very poor." The topics included sex change surgery, mental health issues and HIV-AIDS.

While nearly all medical schools taught students to ask patients if they "have sex with men, women or both" while obtaining a sexual history, the overall curriculum lacked deeper instruction to help "students carry that conversation as far as it needs to go," said lead author Dr. Juno Obedin-Maliver of the University of California, San Francisco.

Without such education, doctors are left guessing and can make faulty assumptions, Obedin-Maliver said. For instance, lesbians need Pap tests, which screens for the sexually spread virus that causes most cervical cancer, as often as heterosexual women do. But some doctors assume they don't need them.

"I'm an ob-gyn and I have had lesbian patients come to me and say I haven't had a Pap test in 20 years because my doctors said I didn't need one," Obedin-Maliver said.

Earlier this year, the Institute of Medicine reported that there's little research to guide doctors in the treatment of lesbians and gays. But some things are known: There are increased risks of depression, suicide attempts, homelessness and being victims of violence for lesbians, gay men and bisexuals. Lesbians and bisexual women may get less preventive care to stay healthy, and have higher rates of obesity and breast cancer.

The Association of American Medical Colleges recommends that medical schools ensure students master "the knowledge, skills and attitudes necessary to provide excellent comprehensive care" for gay, lesbian, bisexual and transgender patients.

The new findings are based on a Web-based survey that drew responses from 85 percent of U.S. and Canadian medical schools.

That's a remarkably high response rate, which shows the deans believe it's an important issue, said Dr. Raymond Curry, vice dean for education at Northwestern University Feinberg School of Medicine in Chicago.

In an accompanying editorial, Curry wrote that the researchers missed the opportunity to find out how many medical schools have gay and lesbian faculty and how many have student groups for gays and lesbians.

"Trying to assess the adequacy of a curriculum in addressing these issues is perhaps not best approached in counting hours of instruction," Curry said.

Original article in JAMA found here.