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| MEDICAL EDUCATION |
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| Year : 2022 | Volume
: 20
| Issue : 3 | Page : 201-204 |
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Ensuring training of medical students in bioethics competencies as an integral part of medical curriculum
Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2
1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
| Date of Submission | 19-May-2022 |
| Date of Decision | 31-May-2022 |
| Date of Acceptance | 04-Jun-2022 |
| Date of Web Publication | 01-Aug-2022 |
Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
MD, FAIMER, PGDHHM, DHRM, FCS, ACME, M.Phil. (HPE). Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/cmi.cmi_52_22
Ethics has been considered an integral and indispensable part of the health-care profession for multiple decades. The term “bioethics” generally refers to the study of ethical issues arising because of the development made in the field of medicine, biology, and technology, which might become a cause of concern for humans or detrimentally affects the association between human and their environment. In order to streamline the training process of medical students in bioethics, there is an indispensable need to define the competencies that need to be covered during the training period. We must understand that teaching bioethics is way more than covers a theoretical topic, rather it requires exposure of medical students to a number of practical and clinically relevant scenarios. In conclusion, training medical students in bioethics have to be acknowledged as an important need, as it will eventually determine the safety and well-being of the current and future generations of people. It is high time that specific steps are taken to define specific bioethics competencies and integrate them with the existing medical curriculum to benefit both medical students and the general population.
Keywords: Bioethics, communication, curriculum, curriculum mapping, ethics, medical education
How to cite this article:
Shrivastava SR, Shrivastava PS. Ensuring training of medical students in bioethics competencies as an integral part of medical curriculum. Curr Med Issues 2022;20:201-4 |
How to cite this URL:
Shrivastava SR, Shrivastava PS. Ensuring training of medical students in bioethics competencies as an integral part of medical curriculum. Curr Med Issues [serial online] 2022 [cited 2023 Jun 6];20:201-4. Available from: https://www.cmijournal.org/text.asp?2022/20/3/201/352981 |
| Introduction | |  |
Ethics has been considered an integral and indispensable part of the health-care profession for multiple decades.[1] This is predominantly because ethical issues are often harder to deal with than clinical problems, can result in tricky situations if not properly dealt with, and consumers of the health care system have become more knowledgeable. Medical ethics deals with the practice of clinical medicine and associated scientific research-related activities and is generally based on a set of principles, to which a health-care professional should refer if facing a dilemma.[1],[2] These principles include giving freedom to a person to make their own decisions, acting in the best interest of patients/subjects, doing no harm to the patient, and dealing with patients or research participants with fairness, equity, and equality.[1],[2] The adherence to these principles ensures that the health-care personnel can work toward a common goal of the welfare of patients.
| Bioethics and Health Care Professional | | |
The term bioethics generally refers to the study of ethical issues arising because of the development made in the field of medicine, biology, and technology, which might become a cause of concern for humans or detrimentally affects the association between human and their environment.[2],[3] In recent years, a sort of rift has been reported between doctors and patients, wherein there is a lack of trust, and this has manifested in terms of repeated episodes of violence against doctors. The time has come when patients no longer want to be passive, rather they wish to be treated as partners in their care, and this will essentially require training of health-care professionals in bioethics.[3],[4] Further, owing to the advancement in medicine, now, we have robotics, cloning has become a possibility, etc., and if we want to keep the process safe, we have to formulate an ethical framework to guide the decisions and behavior of medical doctors.[1],[3]
| Bioethics and Medical Education | | |
The adherence to bioethics in medicine promotes human dignity and sustenance of fundamental human rights. It is very much true that ethics was taught to undergraduate medical students earlier as well, but it lacked framework and often was covered as a part of the hidden curriculum.[5] However, realizing the scope and significance of ethics in the medical profession and research, the regulatory body for medical education in India has recommended for a structured introduction of attitude, ethics, and communication (AETCOM) module, which was earlier only attitude and communication module.[6] Further, it has also been realized that students might ignore the teaching, if we do not assess them, and thus, it has been recommended to include one question in the theory paper targeting AETCOM theme.[6] It is high time that both undergraduate and postgraduate medical students should acquire skills that will aid them in not only identification, but even addressing the ethical issues emerging in their clinical practice and while carrying out research.[4],[6]
| Bioethics Competencies for Medical Students | | |
In order to streamline the training process of medical students in bioethics, there is an indispensable need to define the competencies that need to be covered during the training period.[5] The idea should be to cover the identified topics spread throughout the training period in a sequential manner and assess them periodically to understand the progress of students. The training on these specified aspects will lay down the seeds for the making of ethical medical healthcare professional.[7] The topics to be covered in the medical curriculum include sensitization about what is moral behavior and ethics, the importance and scope of ethics, the progress of medical ethics, the significance of bioethics, and principles of ethics in clinical practice and research.[2],[4] In addition, students should be exposed to the need to respect cultural diversity, treat humans with dignity and safeguard their rights, without discriminating or stigmatizing any population section.[1],[2]
Further, students have to be trained about consent in medical practice and research, its significance, and how to obtain consent from people who lack the capacity to give consent.[5] In addition, students should be also oriented about doctor–patient communication, the necessity to maintain privacy and confidentiality, and the protection of privileged information.[2],[4] Moreover, students should be also exposed to specific/exceptional scenarios (viz., transplantation, emergency surgery, euthanasia, medical genetics, genetic counseling, palliative care, and patients with psychiatric illnesses), which they are expected to encounter in their clinical practice, and how to respond to these situations.[5],[7] Furthermore, students have to be explained about research ethics, sharing the benefit of research with the participants, and maintaining confidentiality. Finally, medical students have to understand and acknowledge their social responsibilities and the need to safeguard the health and well-being of people in future generations.[4],[5],[7]
| Training Opportunities and Curriculum Mapping | | |
The training of medical students in bioethics competencies has to begin right at the start of the course, and the best opportunity is at the time of the foundation course. The students can be sensitized about the basic topics during this foundation course that runs for 1 month in medical colleges across India. In the second and third professional years, the training of medical students in bioethics competencies can continue either in classroom settings through case vignettes or AETCOM module training or in clinical settings through role modeling. In addition, elective modules can be designed for covering the other intricacies in bioethics and to provide in-depth information to the students and inculcating bioethics skills among them. However, to streamline the overall curriculum, we have to do a thorough curriculum planning, wherein it is predefined and mapped which of the bioethics competencies will be covered in which specific phase of the training of medical students, using which teaching–learning method, and will be assessed using which assessment tool. All this has to be defined well in advance to ensure that we can keep a track of the competencies covered and even plan for the overall evaluation in the due course.
| Teaching Bioethics to Medical Students: Issues and Solutions | | |
We must understand that teaching bioethics are way more than covers a theoretical topic, rather it requires exposure of medical students to a number of practical and clinically relevant scenarios.[4] However, the question that arises is whether we have clearly defined bioethics competencies? Are teachers familiar/competent in teaching bioethics or their awareness of cultural diversity? Whether the teaching-learning methods we have been using effective or do we need a more innovative approach? In order to prepare teachers for their role in training AETCOM to medical students, they are sensitized about the AETCOM module as a part of the Revised Basic Course Workshop, which is a mandatory training program for all the medical teachers.[6]
In addition, the Medical Education Unit of the institution can carry out a separate half or one-day workshop to train the faculty members in a phase-wise manner for the planning and implementation of the AETCOM module. The Medical Education Unit of Shri Sathya Sai Medical College and Research Institute, a constituent unit of the Sri Balaji Vidyapeeth, Deemed to be University, Puducherry, has organized separate phase-wise workshops for faculty members to effectively implement the AETCOM module teaching [Annexure 1 – AETCOM Training Program for Faculty Members of Phase I]. In order to bring about reforms in the teaching–learning method, it has been advocated to discuss a wide range of case scenarios to prepare students to make informed decisions in situations of ethical dilemma, and through implementation of problem-based learning sessions.
| Conclusion | | |
Training medical students in bioethics have to be acknowledged as an important need, as it will eventually determine the safety and well-being of the current and future generations of people. It is high time that specific steps are taken to define specific bioethics competencies and integrate them with the existing medical curriculum to benefit both medical students and the general population.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Shrivastava and Shrivastava: Bioethics and medical curriculum
| References | | |
| 1. | Rose A, Jacob KS. Teaching bioethics in India. Natl Med J India 2015;28:61-3.  |
| 2. | Mele V, Binetti P. Bioethics, bridge to medical education. J Biol Regul Homeost Agents 2005;19:49-53. |
| 3. | Alkaabba A, Hussein GM. Democratization of medical education is needed to effective teaching of bioethics. J Med Liban 2011;59:33-6. |
| 4. | Howard F, McKneally MF, Levin AV. Integrating bioethics into postgraduate medical education: The university of Toronto model. Acad Med 2010;85:1035-40. |
| 5. | Deshpande SN. The UNESCO movement for bioethics in medical education and the Indian scenario. Indian J Psychiatry 2016;58:359-62. [ PUBMED] [Full text] |
| 6. | Medical Council of India. Graduate Medical Education Regulations – 2019. New Delhi: MCI Press; 2019. p. 65-85. |
| 7. | Mijaljica G. Medical ethics, bioethics and research ethics education perspectives in South East Europe in graduate medical education. Sci Eng Ethics 2014;20:237-47. |
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