Presentation given at the HEA Social Sciences learning and teaching summit 'Teaching ethics: The ethics of teaching' A blog post outlining the issues discussed at the summit is available via http://bit.ly/1lndTnX

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Teaching Medical Ethics
– from theory to practice
Wing May Kong
Vertical Theme Head
Ethics, leadership & professionalism
Imperial College London

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Common themes
• Relatively new discipline
• Engagement of teaching
colleagues and students
• Building a teaching community
• Avoiding silos
• Institutional culture and the
hidden curriculum
Teaching ethics – work in progress

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Medical Ethics Teaching
• Statutory regulatory framework for
practice, education and training
• Vocational degree
• Year intakes of 300-400 students

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1963: The Five As
Adultery
Advertising
Addiction
Abortion
Association (with non
medical practitioners)
1963:
The London
Medical Group
1987: The Pond
Report
1993
1993

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Teaching aims: a consensus statement
• Recognition of ethical issues
• Ethical reasoning and analysis
• Integration of ethical reasoning with clinical
learning
• …to enable better medical practice
G Stirrat et al. MEL for doctors of tomorrow JME 2010

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19% confident
Preston-Shoot et al Readiness for legally
literate medical practice JME 2011
Confidence of final year medical students in
managing the relationship between the law, ethics
and professional guidance
81% not confident

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Preston-Shoot et al Readiness for legally
literate medical practice JME 2011
Not Confident 92%
Confident 8%
Confidence of final year medical students in
applying the law in clinical practice

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The problem?
• Reflects part of wider anxiety about clinical
responsibility as a junior doctor
• Formal law teaching and assessment largely in
first half of medical course 1
• The ‘hidden curriculum’ 2
2 Hafferty and Franks, Academic Medicine 1994
1 Preston-Shoot et al. Prepared for practice? JME 2010

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Should doctors be good?
The good doctor?

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“I remember the time that Shipman gave to my dad. He
would come round at the drop of a hat.”
C. Rudoi quoted in The Shipman Report, P.
Barkham, 2002
“He was a marvellous GP,”
“apart from the fact that he killed
my dad.”

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Vertical and Horizontal Integration
Vertical Integration
• Build on prior learning
• Minimal new knowledge
• Link to other learning
• Develop higher level
cognitive skills
Horizontal integration
• Embed in other teaching
areas
– Explicit
– Teaching and
assessment methods
– institutional culture

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Integration - Clinicians as educators
• Supports clinical teachers as role models for the
importance of ethics and law to clinical practice
• May help combat the hidden curriculum
www.ucl.ac.uk

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Integration - Clinicians as educators
www.ucl.ac.uk
• Teaching in clinical years largely by senior
doctors with no formal training in medical law
or ethics
• Ethical discussion is rarely part of everyday
clinical practice

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Recognising Ethical Issues
• Focus on ‘big’ ethical dilemmas
• Constructed case scenarios designed to bring
out ethical issues

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http://www.herve-tullet.com/fr/boite-30/Blop-films.html
Engagement and
Collaboration

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Integration and clinician
engagement
2009: Year 5 speciality ethics assignments
100
2010: Year 1 anatomy integration
110
2011:BSc module
120
tutors
2007: Year 2 small group teaching
30
Tutor
training
Ownership &
relevance
Student
engagement
Minimise
paperwork &
assessment

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Tutor support
• Ethics lead appointed for tutor support
• Address generic teaching skills as well as ethical
and legal theory
• Use assessment tools from postgraduate
medicine
• Virtual learning objects

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Virtual Learning Objects

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Teaching Virtues- Ways of Knowing
Three types of knowledge:
• Technical
• Practical
• Critical
A. Kumagi et al. Academic Medicine 2014
www.leansytemsinstitute.com

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Critical knowledge
A. Kumagi et al. Academic Medicine 2014
Reflection
Discourse
Imagination

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Clickers

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Year 1 – Ethics session at end of
anatomy introduction week

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How did you feel when the body
was uncovered?
1. Comfortable, I was interested to see what it looked
like (57.1%)
2. A bit nervous, unsure how I would react (29.5%)
3. Uncomfortable, but I felt it was something I
needed to do (7.9%)
4. Uncomfortable, but I didn’t feel confident to say
anything or step back (1.6%)
5. Uncomfortable but I was able to step back (0%)

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How would you feel if parts of your dead body could
be used for research/education without your
permission or your family’s?
1) I wouldn’t mind – I’d be dead (14.4%)
2) It would be ok – it’s for a good cause (14.8%)
3) Unacceptable - It would be contrary to my religious
beliefs (9.2%)
4) Angry/unhappy - it would be distressing for my
family (30%)
5) Angry/unhappy – can’t explain why (8%)
6) Angry/unhappy – it’s my body (22%)

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‘A deep understanding of
human needs’
A. Kumagi et al. Academic Medicine 2014

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“There wasn’t time to think, there
wasn’t time to…be
compassionate, you didn’t have
time to get to know people…”
“…I think you become less human.
And you didn’t see yourself as
human.”
C. Jaye Medical Humanities 2004

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Haiku by Rhys Davies
Year 4 medical student

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Standard procedure
As hollow an excuse as
‘following orders’

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Heart, valves and organs
A free-for-all, pick-and-
mix,
These are my children

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Summary
There are challenges common to teaching
ethics in the social sciences:
–Developing a community of teachers
–Integrating ethics learning
–Nurturing virtue

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Conclusion
• Engage
• Enable
• Enthuse