Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching in all three subjects combined (...) comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

Background Studies have shown that medical students and residents believe that their ethics preparation has been inadequate for handling ethical conflicts. The objective of this study was to determine the self-perceived comfort level of medical students and residents in confronting clinical ethics issues. Methods Clinical medical students and residents at the University of Maryland School of Medicine completed a web-based survey between September 2009 and February 2010. The survey consisted of a demographic section, questions regarding the respondents’ sense of comfort (...) in handling a variety of clinical ethics issues, and a set of knowledge-type questions in ethics. Results Survey respondents included 129 medical students (response rate of 40.7%) and 207 residents (response rate of 52.7%). There were only a few clinical ethics issues with which more than 70% of the respondents felt comfortable in addressing. Only a slight majority (60.8%) felt prepared, in general, to handle clinical situations involving ethics issues, and only 44.1% and 53.2% agreed that medical school and residency training, respectively, helped prepare them to handle such issues. Prior ethics training was not associated with these responses, but there was an association between the level of training (medical students vs residents) and the comfort level with many of the clinical ethics issues. Conclusions Medical educators should include ethics educational methods within the context of real-time exposure to medical ethics dilemmas experienced by physicians-in-training. (shrink)

Medical students newly arrived on the wards encounter frustrating ethical predicaments that are complicated by students' place in the hospital hierarchy. A careful scrutiny of medical social structure and culture may enable medical schools to offer their students a more effective ethics education.

Abstract“Shut the door,” the chief resident said to me. While I was green enough at the beginning of my clinical clerkships to believe that most of my medical education would happen at the bedside, at that moment, I was learning another important fact: a large part of my ethical education was going to happen behind the closed doors of a call room. The health care team was polluted by a pervasive atmosphere of frustration, as silent but tangible as a thick (...) layer of fog, that obscured the patient's ability to evaluate the consequences of the choice that lay before her. The attending did not permit, let alone create, an environment that provided room for dissent.Institutions should encourage the leaders of clinical education to foster an emotionally safer learning environment in which honest moral dialogue may occur without fear of repercussions. If students cannot learn to apply the principles of ethics actively throughout their clerkships, it will be much harder to do so when they practice independently, and ultimately, patient care will suffer. Conversely, when students and trainees are empowered by their teachers, patient care improves. (shrink)