Center for Biomedical Ethics

ETHICS INSTRUCTION IN THE THIRD YEAR CLERKSHIPS

Topics (and objectives) for Clerkship Sessions:

14 sessions total

Medicine
Pediatrics
Ob/Gyn
Surgery
Psychiatry
Community Health
Family Medicine


Introduction:

The medical ethics sessions provide an opportunity for the medical students individually and as a group to better understand and explore the ethical dimensions of common clinical situations.  Frequently, students, (and house officers and practicing physicians) are placed in ethically difficult situations.  These lively and interactive sessions will help give the participants tools to better understand the underlying ethical and professional issues.


Overall Objectives

  1. The student will know basic facts underpinning common ethical dilemmas.
  2. The student will be able to recognize the ethical dimension inherent in all medical interactions, and specifically to recognize ethical conflict.
  3. The student will develop a practice style that incorporates “preventive ethics” by recognizing and responding to potential ethical conflicts before they become explicit. 
  4. The student will appreciate the risk to patients of his or her silence in the setting of ethical conflict (“Primum non tacere.” {First, be not silent}) and appreciate the role that an Ethics Consultation may play in the approach to complicated ethical dilemmas.

Medicine (6 sessions per 12 weeks)

1. Informed Decision-making  (“Informed Consent”)

At the end of this session, the student will:

  • Understand the concept of informed consent and be able to identify its elements and moral basis
  • Be able to participate in informed decision-making (obtain informed consent) from a simulated patient in a role play
  • Know the basic elements necessary for decision-making capacity
  • Be able to assess decision-making capacity in a simulated patient

2. Advance Directives

At the end of this session, the student will:

  • Understand the ethical basis and practical value of advance directives
  • Appreciate the different kinds of advance directives, and the important differences between them
  • Understand the ethical and legal implications of the use of advance directives
  • Be able to discuss and participate in the formulation of advance directives with hospital patients

3. Medical Error

At the end of this session, the student will

  • Know how to define medical error
  • Understand the importance of disclosure of medical error
  • Know how to approach medical error in your day to day practice

4. Session with residents
5. Session with residents
6. Session with residents

Pediatrics (2 sessions per 6 weeks)

1. Small sick newborn

At the end of this session, the student will:

  • Be able to identify the ethical issues involved in caring for newborns at the limits of viability
  • Gain insight into the concept of "selective non-treatment" using quality of life assessments from the perspective of infants and their families.
2. Medical decision-making with adolescents (consent/assent with minors)

At the end of this session, the student will:

  • Understand the concept of assent in informed decision-making with minors, as distinguished from consent with adults
  • Be able to demonstrate an approach to medical decision-making when the patient lacks full decision-making capacity

Ob/Gyn (2 sessions per 6 weeks)

1. Issues related to training and hierarchy

  • Exam under anesthesia (e.g. “It will be OK, she won’t know she was examined by you…”)
  • Patient refusing examination by male provider
  • First procedure as student (e.g. “Don’t tell her you’re a student…”)

At the end of this session, the student will:

  • Be aware of the resources within the medical school when confronted with situations that result in moral unease.
  • Be able to discuss the nature of their role as trainees with patients

  • Appreciate the role of one’s “moral compass” in professionalization

2. Maternal fetal conflict

At the end of this session, the student will:

  • Be aware of a framework in which to address the dilemma that arises when a pregnant woman refuses care that is “medically necessary” and thereby places a fetus in jeopardy
  • Be able to outline the moral and political/practical issues raised by situations that involve conflict between mother and fetus
  • Gain an understanding of the impact of one’s choice of model of ethical deliberation on the outcome of that deliberation

Surgery (1 session per 8 weeks)

1.  Informed decision-making (“Informed consent”)

At the end of this session, the student will:

  • Understand the requirements of informed decision making in the surgical arena
  • Be able to identify the information necessary to specific patients for informed participation in medical decision-making
  • Value patient autonomy in medical decision making

2.   Ethical issues related to new procedures

  • Innovative techniques
  • Issues related to training
    • Student level
    • Practicing physician level

At the end of this session, the student will:

  • Be aware of the ethical issues related to training, and to the introduction of new technologies
  • Be able to identify situations in which respectful patient care requires disclosure of such information
  • Be able to disclose issues relating to training and new technologies to patients

Psychiatry (1 session per 6 weeks)

1. Involuntary treatment

At the end of this session, the student will:

  • Be aware of situations in which patients may be legally required to undergo treatment
  • Be able to elucidate the ethical issues involved in involuntary treatment in psychiatric and other medical settings

Community Health (1 session per 6 weeks)

1.  Universal Health Care in U.S.

At the end of this session, the student will:

  • Know the statistics of current health care coverage in the United States
  • Be able to discuss the ethical aspects of various health insurance systems
  • Appreciate the duties the profession of medicine may have to society with regards to the public’s welfare, specifically with regard to health insurance coverage

Family Medicine (1 session per 6 weeks)

1. Ethical issues in genetic counseling

At the end of this session, the student will:

  • Appreciate the ethical and social issues in genetic testing
  • Appreciate concerns about genetic testing related to past eugenics movements
  • Understand the potential benefits and risks (including psychologic and social) risks inherent in genetic testing
  • Be cognizant of the effects of genetic testing on non-consenting individuals (i.e. family members of those tested)