Teaching clinical ethics as a professional skill: bridging the gap between knowledge about ethics and its use in clinical practice.

Ethical reasoning and decision-making may be thought of as 'professional skills', and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient's problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical practice. Not surprisingly, many students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making.     

在校医学生医德教育现状调查

通过对我院在校的06、07、08、09级学生的医德认知现状进行抽样调查,了解目前医学生的医德认知状况,结果表明,大学生对开设医学伦理学课必要性认识均率为70．56％,对医德规范的界定认知均率为40．25％,对当前社会医德敏感话题的认知令人担忧,对目前医学院校医德教育过程中存在的主要问题的看法令人深思,并对医学生医德教育的现状、实效与对策进行了思考分析。     

论道德体验在医学生德育课程中的作用

通过分析医学院校德育课程重专业而轻德育,“知”与“行”存在分离,德育目标存在特殊性的现状,指出医学生德育课程中,简单的说教或照本宣科的授课方式往往缺乏能动性,其中的形式主义制约着教学效果.提升医学院校德育教学的效果,需要适时地引入道德体验模式,并通过以下几种教学方式：角色扮演,结合实例进行实际演练,医患纠纷典型案例学习使医学生能从另一个角度审视自己的言行,引起心理过程的变化,重新规范自身的道德行为,从而强化了对医学生德育教育的教学效果.     

Medicine and the Holocaust: a visit to the Nazi death camps as a means of teaching medical ethics in the Israel Defense Forces Medical Corps

A novel method of teaching military medical ethics, medical ethics and military ethics in the Israel Defense Force (IDF) Medical Corps, essential topics for all military medical personnel, is discussed. Very little time is devoted to medical ethics in medical curricula, and even less to military medical ethics. Ninety-five per cent of American students in eight medical schools had less than 1 h of military medical ethics teaching and few knew the basic tenets of the Geneva Convention. Medical ethics differs from military medical ethics: the former deals with the relationship between medical professional and patient, while in the latter military physicians have to balance between military necessity and their traditional priorities to their patients. The underlying principles, however, are the same in both: the right to life, autonomy, dignity and utility. The IDF maintains high moral and ethical standards. This stems from the preciousness of human life in Jewish history, tradition and religious law. Emphasis is placed on these qualities within the Israeli education system; the IDF teaches and enforces moral and ethical standards in all of its training programmes and units. One such programme is 'Witnesses in Uniform' in which the IDF takes groups of officers to visit Holocaust memorial sites and Nazi death camps. During these visits daily discussions touch on intricate medical and military ethical issues, and contemporary ethical dilemmas relevant to IDF officers during active missions.     

Issues in bioethics. Teaching medical ethics to health professionals

New medical technologies, public concern about medical ethics, and the advent of numerous ethical dilemmas in healthcare have led many medical schools to increase their formal teaching of ethics. Ethical issues in healthcare may involve a complex mix of scientific, economic, social, cultural, religious, moral and legal issues. Education in medical ethics will therefore need to be on-going to accommodate changes that periodically occur in healthcare issues, policies, or the changing moral values of the society. This article proposes frameworks within which this process may occur.     

Students'' attitudes to ethics in the medical school curriculum.

A survey of 106 medical students assessing their interest in and attitudes to medical ethics in the curriculum is reported by the authors. Results indicate that 64 per cent of the students rated the importance of medical ethics to good medical care as high or critical and 66 per cent desired to learn more about the topic. However, in reports of patient encounters identifying ethical issues, less than six per cent of the students reported a frequency of more than one such patient encounter per week. The students also demonstrated a greater awareness of more obvious ethical issues than of more subtle, less publicised issues. When asked how medical ethics should be taught, the students clearly affirmed a desire for an integrated exposure to the subject throughout the medical curriculum. Possible implications of these findings for medical education are discussed.     

医学伦理学教育与药理学专业的结合

将医学伦理学理论融入到药理学课程教学中,加强教师自身素质培养,以良好的教师形象增进伦理学教育的灌输;注意医学伦理学信息的收集、整理与更新,保持教学的新鲜感;在不增加本专业学科课时的情况下将两者有机结合;探讨并完善该教学法的有效评价体系.     

Reflecting on senior medical students' ethics reports at the University of Auckland

In January 2010, fifth year medical students in the medical programme at the University of Auckland were asked to write a 1200-word report as part of their ethics assessment. The purpose of the report was to get students to reflect critically on the ethical dimension of a clinical case or situation they had been involved in during the past 2 years. Students were required to identify and discuss the salient ethical issues that arose as they saw them, and consider what they had personally learnt from the situation. The purpose of the following discussion is twofold: first, to outline some of the ethical issues raised by year five medical students in their ethics reports; and second, to reflect on what we, as educators and health professionals can learn from their experiences and insights.     

PBL与医德教育结合的教学模式在大学英语教学中的运用探索

高等医学院校医德教育重医术,轻医德;教育方式单一,缺乏系统性;内容缺乏现实性的问题引出了大学英语教学进行医德教育渗透的必要性。运用PBL教学法与医德教育结合的教学模式在大学英语教学中深入挖掘教材中的德育内涵,讨论典型实例,增强医德意识,创设真实学习情境,激发学生的德育体会。这种全新的教学模式,既帮助医学生掌握课本里的语言知识,还使其体会到良好的医德医风对于医务工作者的重要性。     

浅谈医学高等院校大学英语教学与医学生道德观的培养

围绕道德教育在大学英语课程中的培养问题,叙述了大学英语课程对帮助学生树立正确道德观的重要性以及在教学中如何培养医学生的伦理道德观、职业道德观。此外,作为医学院校的英语教师自身也应加强医学知识,运用教师个人的人格魅力,以身作则,为学生树立良好的榜样。     

Moral dilemmas in surgical training: intent and the case for ethical ambiguity.

It is often assumed that the central problem in a medical ethics issue is determining which course of action is morally correct. There are some aspects of ethical issues that will yield to such analysis. However, at the core of important medical moral problems is an irreducible dilemma in which all possible courses of action, including inaction, seem ethically unsatisfactory. When facing these issues ethical behaviour depends upon an individual's understanding and acceptance of this painful dilemma without recourse to external moral authority.     

Relevance and utility of courses in medical ethics. A survey of physicians' perceptions

In the last decade the teaching of medical ethics has become almost universal in American medical schools. Its effectiveness is, however, just beginning to be evaluated. A stratified random sample of 3,000 practicing physicians who were graduated between 1974 and 1978 was surveyed to evaluate their perceptions of the utility and relevance of medical ethics teaching. Those who had courses in medical ethics perceived it to be of substantial benefit in confronting the actual ethical issues they encountered in daily practice. They favored the continuation and expansion of the teaching of medical ethics and had suggestions for its improvement. Data were also obtained on the relative frequency of specific ethical issues in practices and on the relative influence of home, personal values, medical education, medical practice, and ethics courses on respondents' approaches to ethical issues.     

影响医患关系的医方语言的伦理对策分析--基于B市五家医院的实地调查研究

通过对医务职场语言所处的道德环境及凸显的伦理问题的分析,积极探索关于构建医患良好道德关系的伦理对策：一是从道德教育层面,关注道德的品塑功能,建立个体性与共性相结合的道德教育体系。包括树立“人性丰满”的教育,注重“医学人文”的教育,秉持“职业终身”的教育;二是从道德习惯的培养上,医院应关注道德的表达功能,注重“习惯成自然”的职场道德语言的养成。三是从舆论评价上,媒体应为医患交往营造“善”的氛同,促使医患双方建立尊重与信任。     

医学生医德情感教育探析

情感教育坚持以人为本的理念，关注人的心灵和情感世界，尊重人的情感发展规律和教育发展规律，充分发挥情感的特殊效应。以情育人。在医学模式转换的今天，医学生的医德情感教育在医学教育中具有重要的现实意义，应大力加强情感教育，培养医德情感，增强医德教育的实效。     

医学伦理学教学模式探讨

医学伦理学是医学科学和伦理学科学交叉的边缘科学 ,是医学道德的科学 ,是一般伦理学原理在医学实践中的具体运用。培养合格医学生 ,不仅要注重医学知识的教育 ,而且要重视医学伦理道德的引导和培养。本文从教育的目的、原则、内容及教学方法等方面探讨医学伦理学的教学模式 ,旨在从理论到实践提高医学生的医德修养     

Student-directed teaching of medical ethics at a Canadian medical school

The medical faculty at Queen's University, Kingston, Ontario, Canada, in 1982 decided to omit the formal teaching of medical ethics from its curriculum. This decision led both students and faculty members to review the role of ethics in medical education. The outcome was the establishment of a minicourse of four three-hour sessions devoted to the examination and debate of selected ethical issues. The course was directed by students, who chose four general topics for discussion and three subtopics to be the focus in each session. They organized debates between faculty and community members from the fields of medicine, law, philosophy, and theology to be the core of instruction. The course resulted in a high level of satisfaction among the students, who felt that the issues chosen had been appropriately explored. The course, therefore, was continued in the same form by the following medical class.     

The medical student and the suicidal patient.

Today''s medical students are being confronted with ethical situations of far greater complexity than were their predecessors and yet the medical education system does little to prepare students for the ethical dilemmas which they inevitably face when entering the hospital environment. The following article addresses the issues surrounding a case where a patient has told a student in confidence of his plans to commit suicide. What should the student do? The only way for the student to prevent death is by breaking confidentiality because the student has insufficient clinical experience to provide adequate guidance. However, this requires ignoring the patient''s right to autonomy, a right enshrined in both case law and medical ethics. Clearly the student''s ethical, moral and legal position must be carefully evaluated.     

医德与医学人文教育关系探微

通过厘清医德与医学人文教育的关系,从学理上阐释了二者的本末关系,医德具有更核心、更内在的本质,是医学生和医务工作者正确从事医疗活动的根本动机和指南。恰当把握二者关系,合理调整医学生教育的课程结构。做到医德教育以医学人文教育为佐证和补充,增强医德教育的全面性、实证性和趣味性;医学人文教育以医德教育为宗旨和要义,彰显医学人文教育的伦理性、深刻性和目的性。为医学生的医德培养提供有益参考。     

Is it possible to assess the "ethics" of medical school applicants?

Questions surrounding the assessment of medical school applicants' morality are difficult but they are nevertheless important for medical schools to consider. It is probably inappropriate to attempt to assess medical school applicants' ethical knowledge, moral reasoning, or beliefs about ethical issues as these all may be developed during the process of education. Attitudes towards ethical issues and ethical sensitivity, however, might be tested in the context of testing for personality attributes. Before any "ethics" testing is introduced as part of screening for admission to medical school it would require validation. We suggest a number of ways in which this might be achieved.     

Professional ethics in health care: an introduction

Discussions about issues in medical ethics are often frustrated by the failure to distinguish other concerns: legal and institutional rules, personal values, and personal moralities. Progress can be made if the medical profession reaches a prior agreement on its core values--what the good physician ought to care about--and a consensus on how these values are to be respected by physicians facing ethical dilemmas.