In this paper I argue that medical education must remain attuned to the interests that physicians have in their own self-development despite ongoing calls for ethics education aimed at ensuring physicians maintain focus on the interests of the patient and society. In particular, I argue that medical education should advance criteria defining what counts as an educationally worthwhile activity from the perspective of the medical student understood as a learner. I offer a preliminary account and justification of such criteria, arguing (...) that such criteria warrant a process of ethical formation that better serves the interests of medical students, their patients and society. (shrink)

There is evidence that medical students do not develop their moral competence as expected for university students and that medical training, via formal and hidden curricula, somehow contributes to the scenario known as dehumanization of medicine. Education in Bioethics may be an interesting strategy to change this scenario. We investigated the impact of a course in Bioethics and a method of dilemma discussion on medical students’ moral competence. We conducted an observational controlled study at a public Brazilian medical school. The (...) extended version of the Moral Competence Test was applied at first and last days of a course on Bioethics in two consecutive years. These two courses were perfectly similar, except that with the second group two discussions according to the KMDD complemented the course. 165 undergraduate students participated in this research. Competence score slightly decreased in the group who took the traditional course while it slightly increased in the group who had the course complemented by KMDD’s discussions. Though these differences were not statiscally significant, absolute effect size measurement suggests that KMDD’ s discussions had a small but positive effect on students’ moral competence. If, as suggested by empirical evidence, medical education stagnates students’ moral competence, then medicine is severely ill. Treatment may be found in a set of bioethical educative interventions, aimed at cognitive and affective aspects of moral competence. (shrink)

BackgroundThe academic and medical literature highlights the positive effects of empathy for patient care. Yet, very little attention has been given to the impact of the requirement for empathy on the physicians themselves and on their emotional wellbeing.DiscussionThe medical profession requires doctors to be both clinically competent and empathetic towards the patients. In practice, accommodating both requirements can be difficult for physicians. The image of the technically skilful, rational, and emotionally detached doctor dominates the profession, and inhibits physicians from engaging (...) emotionally with their patients and their own feelings, which forms the basis for empathy. This inhibition has a negative impact not only on the patients but also on the physicians. The expression of emotions in medical practice is perceived as unprofessional and many doctors learn to supress and ignore their feelings. When facing stressful situations, these physicians are more likely to suffer from depression and burnout than those who engage with and reflect on their feelings. Physicians should be supported in their emotional work, which will help them develop empathy. Methods could include questionnaires that aid self-reflection, and discussion groups with peers and supervisors on emotional experiences. Yet, in order for these methods to work, the negative image associated with the expression of emotions should be questioned. Also, the work conditions of physicians should improve to allow them to make use of these tools.SummaryEmpathy should not only be expected from doctors but should be actively promoted, assisted and cultivated in the medical profession. (shrink)

Biomedical ethics is an essential part of the medical curriculum because it is thought to enrich moral reflection and conduce to ethical decisionmaking and ethical behavior. In recent years, however, the received idea that competency in moral reasoning leads to moral responsibility “in the field” has been the subject of sustained attention. Today, moral education and development research widely recognize moral reasoning as being but one among at least four distinguishable dimensions of psychological moral functioning alongside moral motivation, moral character, (...) and moral sensitivity. In a reflection of this framework, medical educators and curriculum planners repeatedly advance the idea that educators should be concerned with supporting empathy, and this, very often, as a means of improving on and broadening medical ethics education’s traditional focus on moral reasoning. (shrink)

In Western countries, the ideal professional and ethical attributes of healthcare providers and the ideal patient-doctor relationship have been analysed in detail. Other cultures, however, may have different norms, arising in response to diverse healthcare needs, cultural values and offering alternative perspectives. In this paper, drawing a case study, we introduce the concept of Shinmi, used in Japan to describe a desirable approach to medical care. Shinmi means kind or cordial in Japanese. In the medical context, it refers to doctors (...) treating patients with a degree of emotional closeness as if they were the doctors’ own family. We analyse the concept of Shinmi, drawing on virtue ethics. We distinguish two different elements to a Shinmi-na attitude. As illustrated in our example, excessive Shinmi can be problematic for patients and doctors. Furthermore, elements of Shinmi may conflict with existing Western values (for example, norms that encourage emotional detachment and discourage doctors’ treatment of family members). However, if pursued appropriately, we argue that a balanced Shinmi-na approach can be conducive to the goals of medicine. The concept of Shinmi may be valuable for medical students, in Japanese and potentially other health care systems, and help them to cultivate a virtuous approach to meeting the emotional needs of patients. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

Residency training in the Netherlands is to be restructured over the coming years. To this end a general competence profile for medical specialists has been introduced. This profile is nearly the same as the Canadian CanMEDS 2000 model, which describes seven general areas of medical specialist competence, one of which is professionalism. In order to establish a training programme for residents and their instructors based on this competence, it is necessary to develop a vision that does justice to everyday medical (...) practice. The two most prevailing views of professionalism—as personal, or as a behavioural characteristic—fall short of this. Only when professionalism is understood as reflective professionalism does it encompass the fundamental contextuality of medical treatment. This means that the focus of training and assessment must be shifted to accountability for treatment. (shrink)

While doctors generally enjoy considerable status, some believe that this is increasingly threatened by consumerism, managerialism, and competition from other health professions. Research into doctors’ perceptions of the changes occurring in medicine has provided some insights into how they perceive and respond to these changes but has generally failed to distinguish clearly between concerns about “status,” related to the entitlements associated with one’s position in a social hierarchy, and concerns about “respect,” related to being held in high regard for one’s (...) moral qualities. In this article we explore doctors’ perceptions of the degree to which they are respected and their explanations for, and responses to, instances of perceived lack of respect. We conclude that doctors’ concerns about loss of respect need to be clearly distinguished from concerns about loss of status and that medical students need to be prepared for a changing social field in which others’ respect cannot be taken for granted. (shrink)