I RECENTLY ATTENDED a BMA Medical Ethics conference in London and was reinforced in my scepticism about the level of integration of medical ethics education in the UK curriculum. Many institutions still seem lost, frustrated and ill at ease with what is happening. Hence the reason for the conference.
Even when there was a workshop on the ‘integration of medical ethics and the humanities’, there was no one in the room who really had any experience of it or even any knowledge of what it meant. Perhaps that was why we were there.
Humanities resources are far better than the philosophical underpinnings of medical ethics which bore and confound students. Good writers of short stories and plays have the ability to get at the heart of the matter of what we call the practice of medicine. In addition, students, particularly those in a preclinical situation, often enjoy and are willing to think and talk about issues which they realise are genuine – even if they are fictional.
However, when I attempted to explain what this meant for me, there was very little interest in exploring or developing what I was saying.
I have been reflecting on this over the past weeks and during this time I received some emails from former students who have passed on to a partner institution for their clinical years. They are frustrated because of the lack of ethics teaching, dialogue or any kind of engagement with humanities, patientphysician relationship, etc. in the curriculum and the institution which they joined after departing St Andrews. I suspected that some of the people who attended the BMA conference must be in charge of their curriculum and realised that this is probably happening at other places as well, though this may be very presumptuous of me.
At this point I have only been able to conclude that there are two main issues which are contributing to this ‘Tower of Babel’ education story.
Firstly, the vast array of backgrounds of the people who have been ‘soldiered’ into teaching medical ethics and anything related to it prevents them from having a meaningful discussion with each other. They are easily ‘shouldered out’ and pushed aside by basic science staff and clinical staff who have their terrain to protect and are much more homogeneous as a group. I mention this because I think students are not aware of the backgrounds and educational expertise of the people who teach them. Hence, behavioural scientists, philosophers and lawyers, not to mention the ethically illequipped doctor/clinician, are only part of the vast array of staff people who cannot agree on how to teach ethics.
The second point is this. There are curricula that are integrated and those which are not. If you have a PBL curriculum (the extreme of integration?), there is no formal teaching prior to the PBL in order to establish how you think about, interpret and analyse ethical dilemmas (and you cannot learn it from a book on medical ethics) – so there is often little point in including ethical issues in the case studies. (A friend at Glasgow tells me that there is some formal teaching of medical ethics alongside the PBL portion of the curriculum.) In addition, some facilitators cannot be bothered with the airy-fairy, woolly stuff because doctors are people of integrity and compassion and advocacy and commitment and don’t need to be taught about it in any case. (Incidentally, this is a good reason to use humanities resources – in order to demonstrate that often they are not any of the above.)
Anyway, because I don’t know any better, I don’t teach ‘medical ethics’ but The Practice of Medicine, which confounds everyone on staff – and they just leave me alone.
Peter Nelson is Deputy Director of Teaching at the University of St Andrews
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