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Brewin TB (Lancet 1993) "How much ethics is needed to make a good doctor?"

Bioethics Education in Medical School. Brewin TB (Lancet 1993) "How much ethics is needed to make a good doctor?" 3 qualities of a good doctor; motivation: "put yourself in the patient's place" judgment: sound judgment

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Brewin TB (Lancet 1993) "How much ethics is needed to make a good doctor?"

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  1. Bioethics Education in Medical School Brewin TB (Lancet 1993) "How much ethics is needed to make a good doctor?" 3 qualities of a good doctor; motivation: "put yourself in the patient's place" judgment: sound judgment rapport: all aspects of communication Can we teach these qualities to students? "Yes, through thorough discussion of the pros and cons of difficult dilemmas " (not through academic ethics)

  2. Medical Ethics Course in HCM Compulsory for first-year students Term: 14 to 15 school hours Content: group discussion & lectures Clinical cases: truth disclosure and Jehovah’s witnesses Whole-class session after group discussion Evaluation: ethical test, reports submitted after group discussions, the course attendance rate The aim of this paper: to introduce our 3 year-experience in bioethics education though teachers’, students’ and tutors’ eyes

  3. Backgrounds of Students (continuous variables: average)

  4. Ethical Tests on the First and Last Day Maximum 10 points

  5. Ethical Tests on the First and Last Day mean (95% confidence interval), statistically significant between the first and final test (*P<0.01, ** P<0.001)

  6. Evaluation of Students’ Reports Counting number of key words in their reports e.g. patient’s right → 1, informed consent → 1 patient’s right based on Lisbon Declaration → 2 informed consent based on patient’s right → 2 * In-depth description can attain higher scores ! Example mean (95% confidence interval), *p<0.050

  7. Factors Contributing to Evaluation of Students (2000)

  8. Summary of Evaluation by Teacher (2000) 1 Clinical case-based discussion is possible in first-year students. 2 Group discussion is functioning. 3 Report score correlated with the last ethical test, but not with the first test. 4 The last test was a contributing factor to the acceptance level. 5 Conclusion: the ethics course was useful for the students to increase reflectiveness regarding ethical thinking.

  9. Questionnaire regarding Course by Students (2000&2001)

  10. Response of Students (2000&2001) Originally a five-point Likert scale. Summarized to 3 point, negative/middle/positive answer by percentages.

  11. Summary of Students’ Response (2000&2001) • Medical ethics course • 2000: group size 10 students 2001: group size 7 to 8 students, tutorial method • 2 A majority showed positive attitudes to the course • 3 2001 students showed more affirmative answers in morethan half of evaluated items than the 2000 students • 4 The difference appears to stem from more lively discussion by the introduction of tutorial system and reducing the number of students in discussion groups in the latter-year course.

  12. Questionnaire on Students’ Performance (2001&2002) Answer 2001: a 5-point Likert scale2002: 5 degrees

  13. Correlation of Students’ Performance in Discussion (2001) More lively discussion correlated with more active participation of students to discussion by tutors’ eyes.

  14. Correlation of Students’ Performance with Evaluation (2002) correlation coefficient (p value)

  15. Students’ Performance and Tutors’ Intervention Odds ratio (95%CI) of regression analysis. As students started and discussed PBL without tutors’ order or intervention, odds ratios would increase. *Statistically significant. NC: not calculated.

  16. Students’ Comments on the Course • Most answers were affirmative to this bioethics course • e.g., discussed subjects never thought about knowing different opinion is fruitful • difficult to discuss problems without right answer • personal growth, changed my view toward themes • 2 Some students wanted to learn knowledge of ethics • A few students claimed discussion not based on proper • answer is useless or non-sense.

  17. Bioethics Education in Medical School • 1 Clinical case-based group discussion is functioning well. • 2 The ethics course was useful for the students to increase reflectiveness regarding ethical thinking. • 3 To enhance discussion, tutorial system is useful. • 4 There were some students who wanted more knowledge. • Tutors rated flexibility in response to other opinions as an important factor in discussion. • Need to establish reasonable assessment method.

  18. Bioethics Education in Medical School Bioethics Education vs Medical Ethics Education Bioethics education = more patient-centered Medical ethics education = more clinically centered (Miles SH et al, Acad Med 1989) Question: when doctors’ awareness on ethics are improved, then will doctors become more ethical? Answer: ? Clues to the answer The current medicine: based on belief in limitless advanceReality: life expectancy cannot be extended any longer bymedical science. Example: Japan has sent sophisticated incubators to improveneonatology in Afghanistan.

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