September 19, 2013 | Posted By Wayne Shelton, PhD

When ethics and humanities were first introduced into the first few medical curricula in the early 1970’s, there was considerable optimism about how the exposure to ethics and humanities could “humanize” young physicians and positively affect their practice habits. Learning about the humanistic areas of medicine from trained experts, sometimes referred to as “humanists”, was perhaps naively assumed to be somewhat of an antidote to the effects of the growing medical industrial complex that had become evident to many. Although we take for granted the place of ethics and humanities in most medical school curricula today, those of us who teach in these areas forget that the1970’s were not that long ago and that we are still learning the ropes of how to integrate our efforts into the medical culture. The field has matured as evidenced in the transition from the early naivety regarding the potential impact of knowledge and ideas presented in the abstract versus the realization of how knowledge and ideas are learned, and indeed embodied, in clinical practice; this growing understanding of the factors at work in medical education also parallels the growth and development of educators in ethics and humanities, who by the 1990’s had become entrenched in the mainstream of U.S. medical centers. Many of these same ethics and humanities faculty had made a huge transition from being isolated in an academic area like philosophy to being deeply involved in the hospital clinical setting.

Today most educators in ethics and humanities must grapple with the following challenge: How will ethics and humanities faculty do their part to nurture a medical culture that will support the stated humanistic learning objectives of medical education such as embodying qualities like being altruism, compassion, effective communication and problem solving and other qualities associated with good doctoring? We understand that the time we spend with medical students talking about ethical issues and reflecting on the broader concerns of healthcare illustrated in literature, history and social science may have some impact but it will not alone have the force to shape the future practice habits of physicians and make them become well-rounded physicians. We have grown only too familiar with the powerful influences that have a significant impact on the personal and professional lives of young physicians during their clinical training.

For example, medical trainees face considerable pressure to conform to the expectations of clinical mentors who are responsible for student evaluations in the clerkships and rotations. I can only imagine how this pressure motivates young, enthusiastic, aspiring professionals to do everything possible they can to try to receive a highly favorable evaluation since so much is at stake, such as opportunities for residencies and specialization. I can see how trainees might over time lose sight of the many of the lessons learned during the classroom days with medical educators in ethics and humanities. We realize all too well that our impact can easily be rendered moot by a culture that molds and forms learners in its own image. However, as sad as this realization may be, it is progress that medical educators have come to realize and understand many of the crucial factors within the healthcare system that shape medical education. My hope is that this growing understanding of the broader structural factors that shape learners in medicine will be used as a basis to help medical educators in ethics and humanities and all other educators be more proactive as change agents.

If this cultural change is to occur, it will be a result of realizing that the broader humanistic goals and objectives are the responsibility of all areas of medical education—from basic science teaching to clinical mentoring. Most of all, visionary leaders in medical centers must hold all faculty accountable so that desired educational objectives, from the classroom to the bedside, are coherently put into practice as new physicians learn the habits of good doctoring. Thus the work of ethics and humanities educators today should focus as much on working with our colleagues from other disciplines to work co-operatively so as to ensure that the totality of our educational efforts is coherent and mutually supportive. We have arrived at the point where our work must imaginatively consider ways to ensure what we teach goes beyond the classrooms and has an impact on future practice habits of new physicians. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

2 comments | Topics: Education , Medical Education


Richard R. Pesce, MD,MS,FCCP

Richard R. Pesce, MD,MS,FCCP wrote on 09/20/13 4:54 PM

All good points made here. But I would point out that character development begins much earlier and that selection of students of good character is of utmost importance. It is in the undergraduate college arena where people begin to see what their development and character is like. Values instilled during upbringing come to the fore. Demphasis on technological aspects of premedical education may be necessary in order to incorporate courses and seminars that allow for deep searching and exploration of what work ethic, ethics and virtue in service to others is about. The thinking of philosophy in other words. The "why" questions need to be answered in the undergraduate setting. Mwedical school and definitelt post graduate training is too late although some may benefit. In order to hold faculty accountable, the leaders of the educational institution must themselves be persons of strong character and value the work virtues. This happens rarely. This why medical student selection, in my view is so important.
Perhaps students should not be allowed to apply to medical scholl unless they have had some real world experience as many students do today voluntarily. But charcter devlopment and valuing of virtue begins at home. How we are raised often determines who we are and how we turn out.
Athene Aberdeen

Athene Aberdeen wrote on 09/22/13 9:47 AM

Thank you for this timely reflection. The field of nursing can also benefit from this orientattion.

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