Medical ethics language doesn’t stick with students

A study finds a gap between learning ethical terms and using them in a clinical setting, which can lead to a lack of shared understanding.

By MARCIA FRELLICK
amednews correspondent — Posted May 15, 2013

Do medical school students remember ethical principles when they start practicing medicine?

Because physicians need shared language and universal terms when they discuss ethical issues with each other and with patients, researchers at the University of Iowa Carver College of Medicine examined how well terms and concepts taught in school were recalled and incorporated in the clinical years. The study asked 109 third-year medical students at the University of Iowa to recall ethics terms learned in the first two years of school.

Results were mixed, according to the study posted online April 14 in AJOB Primary Research. The students were much more likely to name the four ethical principles (beneficence, nonmaleficence, respect for patient autonomy and justice) than the six sources of ethical value or categories for justifying an ethical decision (ethical principles, rights, consequences, comparable cases, professional guidelines and conscientious practice).

Overall, 59.6% of the students remembered all four principles, but the highest number of sources of ethical value recalled was four of the six. Only 10% of students could name three or four of the six sources.

The entire article is here.

Here is the original research abstract.

Background: 
Ethics education is an established part of the medical school curriculum and typically involves preclinical instruction that includes formal ethical terminology. However, it is not clear whether the language of ethics taught in preclinical settings is applied by students during the clinical years of training.

Methods: 
We used a survey and a content analysis of written reflections to determine whether third-year (clinical) medical students were able to recall and apply ethical principles and other sources of ethical value they were taught as second-year (preclinical) students.

Results: 
The majority of clinical students were able to recall the four ethical principles, appreciated the relevance of preclinical ethics education, and had positive self-assessments of their clinical-ethical reasoning abilities. However, they were less able to recall other (nonprinciple) sources of ethical value and infrequently used ethical terms spontaneously in written reflections about ethically or professionally challenging issues.

Conclusions: 
Ethics educators should consider the extent to which preclinical ethics education depends on a formal language of ethics and should develop ways to reinforce that language meaningfully through experience-based learning opportunities during the clinical years of training, with special emphasis on the way clear ethical reasoning and communication demonstrate respect for other persons.

What is the Value of Ethics Education?

Are Universities Successfully Teaching Ethics to Business Students?

By Steven Mintz
Ethics Sage Blog
Originally published on February 12, 2013

Last week I read an article on the failure of ethics education of business students to change the dynamic in the business world where the pursuit of self-interests trumps all else. We certainly have been through a decade or so of glaring unethical business practices at companies such as Enron and WorldCom, Bernie Madoff’s insider-trading scandal, and the financial meltdown of 2008-2010 from which we still have not recovered.

As a professor who teaches ethics I was struck by the reasoning given for the failure of ethics education. Some claim ethics is taught only in a separate course rather than integrated throughout the curriculum creating a perception in the minds of students that ethics is only important tangentially rather than as an integral part of business practice. I agree with this perspective but realize, having been an academic administrator for many years, the problem lies in not being able to get faculty from various business disciplines on board to incorporate ethics into their individual courses. Some feel unequipped to do so; others do not believe we should be “preaching” to college students.

I did some research on how ethics is taught to business students and their perspectives on business responsibilities and found some interesting results. Surveys conducted by the Aspen Institute, a think tank, show that about 60% of new M.B.A. students’ view maximizing shareholder value as the primary responsibility of a company; that number rises to 69% by the time they reach the program's midpoint.

There is nothing wrong with maximizing shareholder value – it is a basic tenet of capitalism. The problem lies when that is the only driver of corporate behavior to the exclusion of broader stakeholder approaches that would include customers, suppliers, and employees in the mix. Though maximizing shareholder returns isn't a bad goal in itself, focusing on that at the expense of societal interests can lead corporate decision-makers down the road of greed. By maximizing shareholder value, bonuses increase and stock options are worth more.

The entire blog is here.

Does an 'A' in Ethics Have Any Value?

B-Schools Step Up Efforts to Tie Moral Principles to Their Business Programs, but Quantifying Those Virtues Is Tough

By MELISSA KORN
The Wall Street Journal
Originally published on February 6, 2013

Business-school professors are making a morality play.

Four years after the scandals of the financial crisis prompted deans and faculty to re-examine how they teach ethics, some academics say they still haven't gotten it right.

Hoping to prevent another Bernard L. Madoff-like scandal or insider-trading debacle, a group of schools, led by University of Colorado's Leeds School of Business in Boulder, is trying to generate support for more ethics teaching in business programs.

"Business schools have been giving students some education in ethics for at least the past 25 or 30 years, and we still have these problems," such as irresponsibly risky bets or manipulation of the London interbank offered rate, says John Delaney, dean of University of Pittsburgh's College of Business Administration and Katz Graduate School of Business.

He joined faculty and administrators from Massachusetts' Babson College, Michigan State University and other schools in Colorado last summer in what he says is an effort to move schools from talk to action. The Colorado consortium is holding conference calls and is exploring another meeting later this year as it exchanges ideas on program design, course content and how to build support among other faculty members.

But some efforts are at risk of stalling at the discussion stage, since teaching business ethics faces roadblocks from faculty and recruiters alike. Some professors see ethics as separate from their own subjects, such as accounting or marketing, and companies have their own training programs for new hires.

The entire story is here.

The only religion that my patients see me practice is medicine

By Jennifer Gunter
KevinMD.com - Social Media's Leading Physician Voice
Originally published November 1, 2012


When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion.

So I spoke with her. I explained that over the course of her career she would undoubtedly see people from all walks of life with a myriad of religious and or personal practices. I explained that medical care is not about fulfilling any personal need beyond the need to help.

I gave the example of a doctor who is a Jehovah’s Witness. Refusing to order a blood transfusion would be both unethical and malpractice.

I had an OB/GYN who practiced the same religion discuss how he felt that he could prescribe contraception and still honor his Church.

None of this mattered. In her eyes prescribing contraception was an affront to her religion.

“What if you don’t council a patient about condoms and she gets HIV?” I asked.

No answer.

“Do you think it’s ethical for a woman to take time out of her day to come for a well-woman exam and not leave with the contraception that she wants and needs?”

Silence.

The entire blog post is here.

Thanks to Ed Zuckerman for this information.

Self-Reflection in Ethical Choice Making

Balancing Values Through the Looking Glass
By Allison Bashe
The Ethical Professor Blog
Originally published October 21, 2012

Self-reflection may be the most critical ingredient to making good ethical choices.  As professors, we need to highlight the importance of self-reflection in our undergraduate and graduate ethics courses.  We can do this through assignments that encourage self-reflection and emphasize to students the importance of self-reflection throughout their professional careers.  More importantly, we can highlight the importance of self-reflection by engaging in it on a regular basis and modeling this practice to our students.

At the 17th Annual Ethics Educators Conference in Harrisburg, PA, professionals reflected on their core values and then discussed how these values might be compatible with or might conflict with the profession of psychology.  Although generally the professionals in the room could appreciate the value of self-reflection, one person acknowledged that he initially felt oppositional toward an exercise that required him to consider how his values might conflict with our profession.  He commented that if our values conflict with our profession, it might indicate that we have not worked hard enough yet.  And that’s exactly the point:  Self-reflection helps us sharpen our focus to make better decisions.

The entire blog post is here.

The video can be found here.

How to Train Graduate Students in Research Ethics: Lessons From 6 Universities

By Beth Mole

The Chronicle of Higher Education

Originally published August 14, 2012

What do graduate students consider ethical research conduct? It depends on their adviser, says a new report from the Council of Graduate Schools.

According to the report, which is being released today, graduate students overly rely on their advisers, rather than university resources, for guidance on thorny issues such as spotting self-plagiarism, identifying research misconduct, or understanding conflicts of interest.

The findings come three years after the National Science Foundation said that it's up to universities to make sure researchers receive ethics training required by the federal government.

Graduate students who were surveyed as part of the council's Project for Scholarly Integrity felt they had a good grasp of research ethics, said Daniel Denecke, associate vice president for programs and best practices at the Council of Graduate Schools. But "when we really drill down," he said, "we see a real need on the part of students to know how to handle perceived misconduct."

The report, "Research and Scholarly Integrity in Graduate Education: A Comprehensive Approach," outlines the findings from the project, which began in 2008 and is financed by the federal Office of Research Integrity.

The entire story is here.

Integrating Integrity

By Kaustuv Basu
Inside Higher Ed
Originally published August 14, 2012

Graduate schools need to do a better job teaching their students about responsible and ethical research, according to a report being released today by the Council on Graduate Schools.

If they do, they will have more success preventing research misconduct, the report states.
The report, Research and Scholarly Integrity in Graduate Education: A Comprehensive Approach, suggests that university administrators should work with faculty members and graduate students across disciplines to boost research integrity. For example, a successful workshop offered in one discipline can be adapted for another discipline or a course in research ethics taught intermittently by one professor could be taught by other faculty members.

The entire article is here.

Avoiding Ethical Missteps

By Alan C. Tjeltveit and Michael Gottlieb
The Monitor on Psychology
April 2012, Vol 43, No. 4, page 68

Psychologists want to contribute to human welfare — and the vast majority of them do. But despite their best intentions, they may find themselves in situations where they unwittingly slip into unethical behaviors.

Most psychologists try to prevent such lapses by, for example, learning the APA Ethics Code and attending risk management workshops to better understand ethical risks. Yet research has shown that such efforts are not enough to keep psychologists from ethical blunders.

How then can psychologists prevent such missteps? We suggest that psychologists at all developmental stages — from student to seasoned professional — are wise to examine and better understand their personal feelings and values and how they can lead to ethical problems. Doing so not only reduces the risk of psychologists drifting into ethical trouble, but also helps move the quality of professional practice from merely adequate to optimal.

The problem and efforts at solutions

Psychology training programs accredited by APA are required to provide ethics education to their students. This helps students and colleagues understand where the “floor” in ethical behavior lies and how the standard of care is commonly interpreted. That usually includes learning the APA Ethics Code, as well as state rules and regulations, relevant state and federal statutes and court decisions, and mastering a particular ethical decisionmaking model.

Unfortunately, research suggests that cognitive strategies alone are not sufficient. Although many psychologists and trainees can accurately describe their ethical responsibilities, they report that they might, in certain situations, act otherwise.

The entire story is here.

Alan Tjeltveit will be The Pennsylvania Psychological Association's Ethics Educator of the Year for 2012.  Nice article and great work over the years educating psychologists in Pennsylvania and across the country.

Oh, and Mike Gottlieb is a great guy too.

Richard F. Small: PPA's 2011 Ethics Educator of the Year

Richard F. Small, PhD ABPP

Ethics Educator of the Year

Pennsylvania is fortunate to have Dr. Richard F. Small as a practicing psychologist and ethics educator.

A survey by Ken Pope showed that psychologists were more often likely to turn to peers as a source of ethical information than published articles, ethics codes, or other sources. Here at PPA, we are pleased that the ethics educators’ award not only goes to academic psychologists but also goes to practicing psychologists (such as Don Jennings, Don McAleer, and Eve Orlowe) who have a substantial impact and credibility in supporting their professional colleagues.

Part of Dr. Small’s success as a thinker or presenter on ethical issues stems from  real life experience, as a psychotherapist, a marriage therapist, a practice owner, a supervisor, an evaluator, and a teacher.  This wide ranging experience gives him credibility and familiarity with the ethical issues that psychologists face on an average, everyday basis.

In everything he does, whether as a practicing psychologist, a consultant on insurance and practice issues, or a volunteer for PPA, Rick is guided by overarching ethical principles. For example, his writings on insurance and practice management always kept patient well-being at the forefront. He gave special attention to multiculturalism and diversity while PPA President, and, through the Pennsylvania Psychological Foundation, he has focused on developing book awards for graduate students in psychology.

Dr. Small presented on ethics for a number of organizations, including the American Psychological Association, the Pennsylvania Psychological Association, various private organizations (such as The American Health Care Institute), and non-profits.  In fact, Rick and Sam Knapp first used the term “positive ethics” in a workshop they gave 15 years ago entitled, “Ethics is more than a code.”  Dr. Small has also authored or co-authored a number of articles for The Pennsylvania Psychologist.  He has been a member of our Ethics Committee for years.  He remains committed to multiculturalism and diversity as well.

As you will see this afternoon, Rick is an excellent presenter.  Using the Acculturation model as a guide, Dr. Small balances the legal aspects of ethics with the personal values and emotional qualities of a seasoned psychologist to provide a truly integrated approach to teaching ethics.

For all his work with ethics education at the state and national level, I am pleased to present Dr. Richard F. Small as this year’s the Ethics Educator of the Year.

Vignette 4: A Psychologist in Turmoil

Vignette 4

A psychologist is treating a client who is involved in a legal proceeding.  The client presents the psychologist with information about a well-known, local psychologist who released confidential information to an attorney without a signed release or court order.  After the psychologist reviews the information presented, it is clear to the treating psychologist that other psychologist breached confidentiality.

The treating psychologist knows the local psychologist who released the information, but does not have a strong relationship with him.  The treating psychologist is questioning what to do.  The treating psychologist believes the options are:

1. Address the matter with the other psychologist directly.

2. Refer the matter to the State Board of Psychology.

3. Encourage the client to file a complaint with the State Board of Psychology.


Are there any other options?

What are the possible emotional reactions to this situation?  And, how would you, as the treating psychologist, deal with those emotions?

What is a likely course of action?

Blogging from the Convention

John Gavazzi & Rick Small

Today, Rick Small and John Gavazzi presented an advanced ethics workshop on ethical decision-making.  The workshop addressed relational ethics: a blend of positive ethics, psychological culture, and patient-focused care.  They used the Acculturation Model (Gottlieb, Handelsman, and Knapp) as a means to introduce how relationships with the community of psychologists is an important factor in understanding the ethical culture of psychology.  Bridging from that model, they highlighted how ethical decisions can be understood within that framework. 

Rick and John also described the differences between remedial ethics and positive ethics.  They also touched upon principle-based ethics as a means to identify competing ethical principles that are sometimes found in ethical conflicts.  Since there is no ethical decision-making strategy within APA's Code, they explained how knowledge of ethics, emotional factors, cognitive biases and situational factors combine to make the best decision possible.  Simultaneously, the outcomes of these decisions are ambiguous at the time the decisions are made, which can lead to anxiety and uncertainty.

Relational ethics accentuates that ethical decisions play out within the psychologist's relationship to the patient.  Relational ethics includes a commitment to both the relationship and high quality of care.  Relational ethics combines psychologist factors with the clinical features of the patient.

Rick and John finished the lecture portion of the presentation with quality enhancing strategies related to documentation and redundant protections.

Finally, Rick and John provided participants with several ethical dilemmas.  The workshop participants discussed the vignettes, focusing on the following questions.

What factors make the dilemma difficult for the psychologist?

What would his/her emotional reactions be to the content of the scenario?

What types of redundant protections and documentation issues would be helpful for the dilemma?

Feedback from workshop participants was uniformly positive.

For a copy of the slides, please email John.