Postgraduate education in medical ethics in Japan

The objective of this paper was to investigate what kind of postgraduate education in medical ethics medical residents in Japan receive and what they want for ethical education and guidelines. Sixteen teaching hospitals that provide a general internal medicine residency programme in Japan were used (145 medical residents working at the departments of general internal medicine). A total of 114 residents participated in our survey, yielding a response rate of 79%. Of these, 28% received education in medical ethics more than once a month; 24% were offered it only when ethical problems were involved in actual patient care; and 18% answered that opportunities were very rare and sporadic. A full 30% had received no education in medical ethics at all. Many residents (71%) learned medical ethics from individual supervising doctors. A majority of the residents had been taught about informed consent (79%) and doctor–patient relationships (54%); 46% had learned about the appropriateness of truth telling and of ethical decisions regarding withholding and withdrawing a life-sustaining treatment, respectively. A total of 85 residents (75%) wanted to have more comprehensive education in medical ethics, 13% could not decide, and 12% did not want it. Many (66%) thought that both doctors and ethical philosophers should jointly teach medical ethics in postgraduate residency programmes. The results suggest that many residents desire more comprehensive and interdisciplinary education in medical ethics and educators in Japan should aim to develop education programmes to meet these desires.     

The need for medical ethics education in family medicine training

Professional and accreditation organizations have endorsed medical ethics as a fundamental component of education for family medicine trainees. Yet various obstacles combine to work against the continuation of formal medical ethics education beyond medical school and into residency training. This article reviews the current consensus on the scope and objectives of medical ethics education in the context of family medicine training. The need for, and outcomes of, medical ethics teaching are analyzed on the basis of the available evidence. Recent trends in medical education that potentially influence graduate medical ethics training are also discussed (specifically ethics training in medical schools and the priority given to training in professionalism). This review shows a strong evidence-based need to provide medical ethics education for family physicians in training, a need that is apparent on many levels. The current reliance on medical school ethics education and emphasis on professionalism does not answer this need. A well-constructed course in medical ethics for family medicine trainees can teach an array of competencies stipulated by professional and accreditation agencies as important in the practice of family medicine. Educators must strive to overcome barriers and provide formal medical ethics programs to better prepare family physicians for modern professional roles.     

现代医德:医学伦理本性的回归

医德是医学的伦理本性的集中体现。现代社会的发展客观上要求医学不断彰显其伦理本性,而现实中医德正面临着一个失去规范的时代,这使医学越来越偏离其伦理本性。重整现代医德是要使医学回归其伦理本性的根本途径。     

Attitudes of medical students to the teaching of medical ethics

Summary. The teaching of ethics to medical students has recently become a topic of much importance to all concerned with medical education. However, those most involved, the students themselves, have been consulted very little. This paper reports the views of a sample of medical students at Oxford University on what ethics teaching they receive, of how much value they consider it to be and what form of teaching they would like to see included in their curriculum.     

Professionalism in medical education, an American perspective: from evidence to accountability

CONTEXT :Professionalism is central to sustaining the public's trust in the medical profession; it is the essence of the doctor-patient relationship. Evidence exists that public trust is waning and that doctors are facing powerful contemporary threats to their professional values. The role of medical education is paramount in preparing future doctors to recognise and overcome these threats; to do so will require substantial change in the culture and environment of medical education. OBJECTIVES: The aims of this paper are to provide a definition and framework for professionalism in the context of medical education, describe current threats to medical professionalism, and detail the role medical schools and academic medical centres can play in preparing tomorrow's doctors to recognise and resist these threats. Additionally, the paper reviews established and potential methods for measuring professionalism and thus assuring public accountability. Finally, specific recommendations are offered for medical schools and teaching hospitals to nurture and sustain professionalism. DISCUSSION: The progressive intrusion of commercialism into the realm of medicine is threatening to replace the ethics of professionalism with the irreconcilable ethics of the marketplace. Academic medicine must assume greater responsibility and accountability for strengthening the resolve of future doctors to sustain their commitment to the ethics of professionalism. It can do so by improving the medical school admission process, enhancing both formal and experiential teaching of professionalism, and purging the educational environment of unprofessional practices. Ten approaches that academic medicine might adopt to achieve these goals are provided.     

Virtue in Medical Practice: An Exploratory Study

Virtue ethics has long provided fruitful resources for the study of issues in medical ethics. In particular, study of the moral virtues of the good doctor—like kindness, fairness and good judgement—have provided insights into the nature of medical professionalism and the ethical demands on the medical practitioner as a moral person. Today, a substantial literature exists exploring the virtues in medical practice and many commentators advocate an emphasis on the inculcation of the virtues of good medical practice in medical education and throughout the medical career. However, until very recently, no empirical studies have attempted to investigate which virtues, in particular, medical doctors and medical students tend to have or not to have, nor how these virtues influence how they think about or practise medicine. The question of what virtuous medical practice is, is vast and, as we have written elsewhere, the question of how to study doctors’ moral character is fraught with difficulty. In this paper, we report the results of a first-of-a-kind study that attempted to explore these issues at three medical schools (and associated practice regions) in the United Kingdom. We identify which character traits are important in the good doctor in the opinion of medical students and doctors and identify which virtues they say of themselves they possess and do not possess. Moreover, we identify how thinking about the virtues contributes to doctors’ and medical students’ thinking about common moral dilemmas in medicine. In ending, we remark on the implications for medical education.     

Ethics of clinical genetics: The spirit of the profession and trials of suitability from 1970 to 2000

As research on and applications of human genetics expanded remarkably during the 1990s, claims were increasingly raised that genetics and its applications should also be considered from an ethical viewpoint. Here medical ethics is the subject of sociological analysis. The paper examines how medical ethics gradually became part of the argumentation and practices of genetic counselling and screening during three decades (1970-2000) by analysing screening and counselling projects and physicians' argumentation in Finland. Medical ethics is analysed as part of a network of experts, regulations and mores, and is regarded as an ongoing process embedded in the processes of medicine, the healthcare system and legislation. It appears that there were two main forms of medical ethics. First, there was the medical ethics that refers to the age-old ways of proper practising of medicine and helping the suffering patient, i.e. the spirit inspiring the profession. Second, during recent decades, medical ethics gradually became expressed in more operationalized and formalized forms, examples of which are codes of ethics, the ethics committees governing medical research and the psychosocial questionnaire studies examining clients' satisfaction and approval. The present paper analyses the medically and morally complicated circumstances in which new formulations of ethics as well as the revival of old foundational medical ethics gained ground.     

Flexner's ethical oversight reprised? Contemporary medical education and the health impacts of corporate globalisation

BACKGROUND: Abraham Flexner's famous reports of 1910 and 1912, Medical Education in the United States and Canada and Medical Education in Europe, were written to assist the development of a positive response in university curricula to a revolution in understanding about the scientific foundations of clinical medicine. Flexner pointed out many deficiencies in medical education that retain contemporary resonance. Generally underemphasised in Flexner's reports, however, were recommendations promoting a firm understanding of and commitment to medical ethics as a basis of medical professionalism. Indeed, Flexner's praise for the scholastic basic of German medical education appeared somewhat ironic when the ethical inadequacies of prominent Nazi doctors were revealed at the Nuremberg Trials. CORPORATE GLOBALISATION AND ITS IMPACT ON MEDICAL PROFESSIONALISM: This article suggests that contemporary medical educators, like Flexner, may be at risk of inadequately addressing a major challenge to evolving medical professionalism. Medical ethics, health law and even the international right to health are now increasingly emphasised in medical curricula. The same cannot be said, however, of lobbying principles arising from the structures of corporate globalisation, although these are rapidly becoming an even more dominant force in shaping medical practice around the globe. Conclusion Today it is the normative tension between medical ethics, health law and international human rights on the one hand and the lobbying principles and strategies of corporate globalisation that must urgently become the focus of major recommendations for reshaping the teaching of medical professionalism. Suggestions are made as to how this might practically be achieved.     

Teaching medical ethics: A review of the literature from North American medical schools with emphasis on education

Efforts to reform medical education have emphasized the need to formalize instruction in medical ethics. However, the discipline of medical ethics education is still searching for an acceptable identity among North American medical schools; in these schools, no real consensus exists on its definition. Medical educators are grappling with not only what to teach (content) in this regard, but also with how to teach (process) ethics to the physicians of tomorrow. A literature review focused on medical ethics education among North American medical schools reveals that instruction in ethics is considered to be vitally important for medical students. Agreement by medical educators on a possible “core curriculum” in ethics should be explored. To develop such a curriculum, “deliberative curriculum inquiry” by means of a targeted Delphi technique may be a useful methodology. However, the literature reveals that medical curricular change is notoriously slow. General implications for medical ethics education as a discipline are discussed. This revised version was published online in July 2006 with corrections to the Cover Date.     

Educating about biomedical research ethics

This article examines the global and worsening problem of research misconduct as it relates to bio-medico-legal education. While research misconduct has serious legal implications, few adequate legal remedies exist to deal with it. With respect to teaching, research ethics education should be mandatory for biomedical students and physicians. Although teaching alone will not prevent misconduct, it promotes integrity, accountability, and responsibility in research. Policies and law enforcement should send a clear message that researchers should adhere to the highest standards of ethics in research. It is vital that researchers and physicians understand basic aspects of law and the legal system in order to develop understanding of the medico-legal issues not just in the legal context, but with a sound grounding in ethics, social and theoretical contexts so that they can practice good medicine. Routine and holistic research ethics education across the curriculum for medical students and resident physicians, and continuing medical education for practicing doctors, are probably the best ways to accomplish this goal.     

Measuring ‘virtue’ in medicine

Virtue-approaches to medical ethics are becoming ever more influential. Virtue theorists advocate redefining right or good action in medicine in terms of the character of the doctor performing the action (rather than adherence to rules or principles). In medical education, too, calls are growing to reconceive medical education as a form of character formation (rather than instruction in rules or principles). Empirical studies of doctors’ ethics from a virtue-perspective, however, are few and far between. In this respect, theoretical and empirical study of medical ethics are out of alignment. In this paper, we survey the empirical study of medical ethics and find that most studies of doctors’ ethics are rules- or principles-based and not virtue-based. We outline the challenges that exist for studying medical ethics empirically from a virtue-based perspective and canvas the runners and riders in the effort to find virtue-based assessments of medical ethics.     

The teaching of legal medicine in British medical schools

In view of recent public anxiety concerning possible inadequacies in the field of legal medicine and ethics, a questionnaire survey was made of medical students, newly qualified housemen, medical school deans, coroners and medical defence and protection organizations. The results indicate that the teaching of legal medicine and ethics is insufficient, and a recommendation is made for an increase in such teaching.     

科研管理促进转化医学的发展

转化医学是近年来国际医学健康领域新出现的一个分支,目的是将基础研究成果迅速转向临床应用。如今医学基础研究与临床实际结合不够紧密已经成为当前医学研究和医学教育亟待解决的重要问题。为解决这一根本矛盾,转化医学应运而生。因此,本文对转化医学本质及现状进行分析,并立足医学科研管理的自身特点,提出加快转化医学发展的对策。     

Ethics education and physician morality.

Medical ethics education remains an important venue of moral education. In spite of the intensity of these efforts, the desired outcomes of medical ethics education remain obscure, undefined and largely untested. In the first part of this study, the goals of medical ethics are operationalized along cognitive, behavioral and attitudinal dimensions. This includes a written moral judgment test, a survey of ethical confidence, competence and interest, attitudinal surveys of physician assisted suicide, and aggressive treatment of newborns and, finally, self-reported behavior about the frequency of pro-bono work and treatment of self-abusive patients. Medical ethics education is operationalized by the type, scope and intensity of ethics education throughout a physician's education and subsequent career. Data were collected by a questionnaire distributed to the staff of a large urban hospital in 1996 (n = 200, response rate = 41%). Causal models measure the effects of medical education. The results suggest that ethics education plays an important but limited role in the attainment of these cognitive, attitudinal and behavioral outcomes. While some outcomes such as moral development, and ethical confidence are unaffected by ethics education, other attitudinal and behavioral objectives, such as ethics interest and pro-bono work are positively associated with formal ethics training as well as with demographic variables such as religious observance and age. Ethics education does not function as an isolated factor but as part of a web of interrelated factors that influence educational outcomes. In addition, it is clear that ethics education resists quantitative analysis to some extent. Rather, it is sometimes viewed as a discipline that is studied for its own sake with the hope that it may contribute to one's all around character in a way that cannot be directly assessed. These implications are explored in the conclusion of the paper.     

康复医学教学中的医德教育

康复医学是一门新兴的综合性学科，近年来发展较快。由于多种原因，这一学科的工作在我国尚未引起各方面的足够重视。但因康复工作的服务对象是残疾人、老年人、慢性病的功能障碍者，他们的情况与一般病人不同，所以，应加强康复医学中的医德教育，使从事康复医学的医护工作人员，在为康复患者服务过程中遵循康复道德的神圣、平等、严谨、完善、协作５原则，更好地为康复患者提供优质服务。     

加强医学生人文教育的思考

医学是一门自然科学,又是一门社会科学。随着教育本质的回归、医学模式的转变和社会的需要,民众认识到加强医学生人文教育有利于培养高素质医学人才,有助于提高医疗服务质量,有助于防止医德滑坡和减少医疗纠纷。为此,在学校教育阶段主要通过提高师生认识、改革课程设置、提升校园文化、参与社会实践、完善评价体系等环节加强医学生人文教育;在医院教育阶段主要通过院前教育、入科教育、病房教育、手术室教育、与患者及家属沟通教育等环节加强医学生人文教育。     

Practice-based learning and improvement

Workplace learning is becoming increasingly important in all fields. While workplace learning in medicine, also called practice-based learning and improvement (PBLI) is not new, understanding how it works and how it fits with an individual physician's continuing professional development is new. In this article, we describe seven issues associated with PBLI and then pose questions for reflections, as continuing medical education (CME) planners consider working with PBLI.     

The medical school as a social organization: the sources of resistance to change

Medical schools vary by nation and by culture but, for students, the experience appears to be very similar. Also, despite a half-century of radical changes in medical practice, education as a process of socialization for the profession is relatively unchanged. At the same time, medical educators have frequently instituted curricular reforms. To analyse this history of reform without change, this paper first establishes what the content and structure of medical education is, and how it came to be that way; second it traces a process whereby the scientific mission of academic medicine has crowded out its social responsibility to train for society's most basic health-care delivery needs. The main argument is that medical education's manifest humanistic mission is little more than a screen for the research mission that is the major thrust of the institution's social structure.     

Medical ethics contributes to clinical management: teaching medical students to engage patients as moral agents

Objectives  In order to teach medical students to engage more fully with patients, we offer ethics education as a tool to assist in the management of patient health issues.
Methods  We propose that many dilemmas in clinical medicine would benefit by having the doctor embark on an iterative reasoning process with the patient. Such a process acknowledges and engages the patient as a moral agent. We recommend employing Kant's ethic of respect and a more inclusive definition of patient autonomy drawn from philosophy and clinical medicine, rather than simply presenting dichotomous choices to patients, which represents a common, but often suboptimal, means of approaching both medical and moral concerns.
Discussion  We describe how more nuanced teaching about the ethics of the doctor–patient relationship might fit into the medical curriculum and offer practical suggestions for implementing a more respectful, morally engaged relationship with patients that should assist them to achieve meaningful health goals.     

基于中医药文化构建中医药院校德育体系

中医药文化是中国传统文化的重要组成部分,蕴藏着丰富的医德教育、人文教育、美育教育等德育教育资源。该文提出充分挖掘中医药文化中的德育资源,通过建立中医药文化德育资源库、编写中医药文化德育教材并开设相关课程、提高德育教育工作者中医药文化素养、营造中医药文化氛围等途径构建中医药院校德育体系对中医学子的专业提升以及德育教育均有重要意义。