Rethink "Affirmative Agreement," but Abandon "Assent"

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources.     

Ethics and professionalism: what does a resident need to learn?

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants in 13 specialties including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources.     

Student counsellors’ experiences of mindfulness as a component of their person-centred counselling training: An interpretative phenomenological analysis

Aim

Mindfulness is increasingly integrated into counselling and psychotherapy practices, as well as being introduced to students in academic institutes with the aim of supporting them to balance the responsibilities of academic study, placements and other commitments alongside university life. Despite mindfulness routinely finding its way into counselling settings and being incorporated into counsellor training, there has yet to be any research conducted to explore the experience of student counsellors who have received mindfulness as a part of their undergraduate person-centred training. This study explored the reflections of counsellors who had attended a mindfulness module during the first year of a counselling degree.

Design

Six students completing a university-based undergraduate degree in Counselling and Psychotherapy in the North-West of England, in the UK, participated in the research. The study consisted of two students from each of the three years of the programme. Participants individually attended a semi-structured interview to explore their experiences of mindfulness as a mandatory module of their training in person-centred counselling. Interpretative phenomenological analysis (IPA) was used to analyse the generated data.

Findings

Four superordinate themes were generated: 1) becoming a counsellor, 2) person-centred mindfulness, 3) time, and 4) learning and development.

Discussion

Experiential themes were explored including the process of professionalism, vulnerability, embodiment of person-centred theory and the core conditions and the conflict of approach.

Conclusion

Recommendations are made for mindfulness to be included in counselling training programmes with a person-centred focus. Suggestions for further research include longitudinal studies to follow the development of trainees over time.     

Evoking the moral imagination: Using stories to teach ethics and professionalism to nursing,medical, and law students

Four years ago, as colleagues in our university's law and medical schools, we designed and began offering a course for law, medical, and nursing students, studying professionalism and professional ethics by reading and discussing current and earlier images of nurses, doctors, and lawyers in literature. We wanted to make professional ethics, professional culture, and professional education the objects of study rather than simply the unreflective consequences of exposure to professional language, culture, and training. We wanted to do it in an interdisciplinary course where aspiring professionals could share their self-conceptions and their conceptions of each other, and we wanted to do it by using stories, our primary means for organizing experience and claiming meaning for it. This article tells the story of that experience: why we did it; how we did it; what we learned from doing it.     

Truly intensive clinical ethics immersion at the Washington Hospital Center

Opportunities for practical, hospital-based training in those skills demanded by clinical ethics consultation (CEC) have been limited. Given the number of individuals who provide part-time CEC, greater access to condensed, practical training such as the clinical ethics immersion course offered by the Washington Hospital Center, is necessary. Two participants in the initial cohort evaluate their CE training at a busy, urban referral center, exploring prior expectations, perceptions of its utility and suggestions for improvement. Such training will prove valuable not only for bioethicists who lack practical CEC experience "at the bedside" but also for ethics consultants whose ethics services have a low consult volume who wish to sharpen their skills.     

TEACHING PSYCHOLOGY OF WOMEN

A 38-item questionnaire was sent to 440 instructors of psychology of women courses; 230 surveys were returned. This article examines characteristics of people who teach courses in psychology of women, characteristics of their institutions, characteristics of the course itself, and the instructors' reactions to the course. Among the findings are: (a) instructors in this course vary greatly in the number of years they have taught the course and in their area of graduate training; (b) few instructors had taken a formal course in psychology of women; (c) the course is usually a highly emotional one; and (d) almost all instructors enjoyed teaching the psychology of women course more than their other courses.     

Touching as Teaching: The Effect of Touch on Students' Perceptions and Performance

The effect of instructor touch on students' ratings of the instructor and students' performance in the classroom was investigated. A total of 171 male and female college students participated in individual conferences with their instructors following the first examination in the course. Half were touched by their instructors during the conference; the other half were not. Students then evaluated the instructor, the instructor's teaching effectiveness, and the utility of the conference. Analysis of results revealed that students who were touched during the conference gave their instructors significantly higher ratings than those who were not touched. In addition, students in the touched condition showed superior performance on the next course examination, scoring .58 standard deviations higher on the examination compared to the untouched students. The authors conclude that touching, when conducted in a conference situation to help students improve class performance, can be a highly effective teaching tool.     

Student development and ownership of ethical and professional standards

Ethics and professional conduct are vital to civil engineering undergraduate curricula. Many programs struggle to ensure that students are given an adequate exposure to and appreciation of ethical and professional conduct issues. This paper describes a two-part ethics/professionalism project used in a senior-level course taught at the University of Arkansas. Initially, students scruitinize ethical canons and standards of professional conduct published by the American Society of Civil Engineers (ASCE) and the National Society of Professional Engineers (NSPE), and prepare an essay concerning the applicability of these standards. The second part of the project builds on the first: based on the opinion(s) generated in Part 1, students are asked to develop a set of canons or standards targeted specifically to the undergraduate student, and suggest processes for implementing those standards within the department. Project objectives include: (1) exposure to nationally-recognized ethical canons and standards of professional conduct; (2) personal formulation of ethical and professional standards; (3) skill enhancement for non-technical written communications. Feedback by students prior to and after the project indicates success in meeting all objectives. The feedback also indicates that for some students, definitions and applications of ethics and professionalism are being broadened to include more than academic honesty issues. An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Structuring Case-Based Ethics Training: How Comparing Cases and Structured Prompts Influence Training Effectiveness

This study examined how structuring case-based ethics training, either through (a) case presentation or (b) prompt questions, influences training outcomes. Results revealed an interaction between case presentation and prompt questions such that some form of structure improved effectiveness. Specifically, comparing cases led to greater sensemaking strategy use and decision-ethicality when trainees considered unstructured rather than structured prompts. When cases were presented sequentially, structuring prompts improved training effectiveness. Too much structure, however, decreased future ethical decision making, suggesting that there can be too much of a good thing when structuring case-based ethics education. Implications for designing ethics training programs are discussed.     

An analysis of instructor- and tablet-presented conditional discriminations: Fidelity and rapidity

Matching-to-sample arrangements are commonly used to teach conditional discriminations. In these arrangements, instructors must systematically arrange instruction to ensure that a learner's response comes under the intended sources of stimulus control. Given the multitude of instructional considerations, the instructors' procedural fidelity has been a significant concern. Recently, LeBlanc et al. found that brief training and access to enhanced data sheets produced high levels of fidelity with experienced service providers. The current study extended LeBlanc et al. by examining the effects of a similar training on the fidelity and instructional pacing by participants with and without previous experience. The participants' performance was also compared when using a flashcard or binder (i.e., printed) arrays and relative to a tablet-delivered instructional program. High levels of fidelity were observed following training, although pacing was slow. Slight differences in performance were observed across comparison arrays; nevertheless, the tablet-based program outperformed instructors.     

Can Instruction in Engineering Ethics Change Students’ Feelings about Professional Responsibility?

How can a course on engineering ethics affect an undergraduate student’s feelings of responsibility about moral problems? In this study, three groups of students were interviewed: six students who had completed a specific course on engineering ethics, six who had registered for the course but had not yet started it, and six who had not taken or registered for the course. Students were asked what they would do as the central character, an engineer, in each of two short cases that posed moral problems. For each case, the role of the engineer was successively changed and the student was asked how each change altered his or her decisions about the case. Students who had completed the ethics course considered more options before making a decision, and they responded consistently despite changes in the cases. For both cases, even when they were not directly involved, they were more likely to feel responsible and take corrective action. Students who were less successful in the ethics course gave answers similar to students who had not taken the course. This latter group of students seemed to have weaker feelings of responsibility: they would say that a problem was “not my business.” It appears that instruction in ethics can increase awareness of responsibility, knowledge about how to handle a difficult situation, and confidence in taking action.     

Public Health Ethics Education in a Competency-Based Curriculum: A Method of Programmatic Assessment

Public health ethics began to emerge in the 1990s as a development within bioethics. Public health ethics education has been implemented in schools of public health in recent years, and specific professionalism and ethics competencies were included in the Master of Public Health (MPH) competency set developed nationally and adapted by individual schools of public health around the country. The University of Texas School of Public Health approved the present set of MPH competencies in 2005. After 4 years of experience, we now report information measuring the extent to which “Professionalism and Ethics” competencies and subcompetencies are being met in the MPH degree program. To this end we have audited the MPH “Professionalism and Ethics” competency forms for FY2009 MPH graduates (n = 61). Eight courses, including required MPH core courses plus the practicum and culminating experience, were found to have substantial professionalism and ethics content. Further, 67.2% of graduates met eight or more of the 13 competencies and subcompetencies, but only 36.1% met all thirteen, indicating a need to identify topic areas to be added to, or enhanced in, the MPH curriculum. In addition, these findings will inform ongoing efforts to enhance ethics education in our health science center. Assessment of these competencies and subcompetencies is an essential step in strengthening ethics education at our institutions and in better preparing our graduates for a challenging future. We report our efforts here to demonstrate one way of carrying out programmatic assessment of ethics education in a school of public health.     

An Empirical Evaluation of Training Using Multi-attribute Utility Analysis

Purpose

This paper aims to develop and apply a multi-attribute utility analysis model (MAU) to assess the benefits of HRM interventions as an alternative to the traditional utility analysis method.

Design/Methodology/Approach

MAU adopts a cost-benefit multi-variant approach to assess HRM efficiency using a non-monetary metric. The study employs a quasi-experimental design to examine the training effects on job performance, comparing pre- and post-intervention measures mostly from sub-groups of random sample of 367 trainees.

Findings

We showed that is feasible to adopt a multi-attribute evaluation approach in HRM area by adapting the MAUT technique. Our formal MAU model also demonstrated that it is possible to adopt a broader and more global evaluation approach than other more ??myopic?? models such as traditional UA models. Results after applying our MAU model in a real organization indicated considerable utility from training employees.

Implications

The commitment and involvement of the organization in the evaluation project seem to suggest an interest in comprehensive evaluative models for HRM such as MAU. Because the amount of information that MAU model entails, it may be also used as a strategic instrument for continuous improving of HR interventions and as a mechanism to analyze the evaluation policy of different stakeholders groups.

Originality/Value

We provide a theoretical development of a MAU model and offer its first empirical application in a firm to calculate the utility of training. This contributes to utility analysis research and provides a guide for practitioners evaluating HRM benefits.     

A Spectrum Pedagogy for Christian Ethics: Respecting Difference without Resorting to Relativism

This paper presents an overview of a newly developed spectrum pedagogy of Christian ethics that emerged from the authors' experience of teaching a contemporary Christian ethics course for seven years. A spectrum pedagogy is a comprehensive approach to teaching Christian ethics that combines the modeling of key dispositions using specific tools (issue‐specific spectrums and ethical theories) and learning experiences (engaging multiple positions and responding to concrete situations). The pedagogy gains its name from the issue‐specific spectrums used by instructors to orient students to contemporary debate on a given issue and by students in their ethical reflection. The goal of this pedagogy is to empower students to construct their own responses while respecting differing viewpoints without resorting to relativism. This article surveys the essential elements of a “spectrum pedagogy,” describes its implementation into a semester‐long course, and identifies multiple benefits of using this pedagogy.     

Educational technologies and the teaching of ethics in science and engineering

To support the teaching of ethics in science and engineering, educational technologies offer a variety of functions: communication between students and instructors, production of documents, distribution of documents, archiving of class sessions, and access to remote resources. Instructors may choose to use these functions of the technologies at different levels of intensity, to support a variety of pedagogies, consistent with accepted good practices. Good pedagogical practices are illustrated in this paper with four examples of uses of educational technologies in the teaching of ethics in science and engineering. Educational technologies impose costs for the purchase of hardware, licensing of software, hiring of support personnel, and training of instructors. Whether the benefits justify these costs is an unsettled question. While many researchers are studying the possible benefits of educational technologies, all instructors should assess the effectiveness of their practices.     

Medical Ethics Education: A Survey of Opinion of Medical Students in a Nigerian University

In Nigeria, medical education remains focused on the traditional clinical and basic medical science components, leaving students to develop moral attitudes passively through observation and intuition. In order to ascertain the adequacy of this method of moral formations, we studied the opinions of medical students in a Nigerian university towards medical ethics training. Self administered semi-structured questionnaires were completed by final year medical students of the College of Medicine, University of Ibadan, Nigeria. There were 82 (64.1%) male and 44 (34.4%) female respondents. The median age was 26 years. Most students (80.5%) responded that they did not receive enough training in medical ethics. The ethics instructions they received did not sufficiently prepare them for the ethical challenges they came across as medical students. Though inadequate, the few hours of lecture and discussion on human values and professional etiquette which they received positively influenced their moral reasoning. They identified end-of-life issues, dealing with financial issues and handling socio-cultural beliefs of patients and relations as some challenges that medical doctors are ill-prepared for by their current training. Most, 85.9% believed that formal medical ethics education would be worthwhile as it would enhance the making of complete and better doctors. They recommended incorporating bioethics as a course in the medical school curriculum. Nigerian medical students encounter ethical challenges for which they have not been adequately trained to resolve. They recommended formal medical ethics training in their curriculum and a uniform bioethics programme in the country.     

Training in clinical ethics: launching the clinical ethics immersion course at the Center for Ethics at the Washington Hospital Center

In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. "Immersion" refers to a high-intensity clinical ethics experience in a busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients' charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants' evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics.     

Essential ethics — embedding ethics into an engineering curriculum

Ethical decision-making is essential to professionalism in engineering. For that reason, ethics is a required topic in an ABET approved engineering curriculum and it must be a foundational strand that runs throughout the entire curriculum. In this paper the curriculum approach that is under development at the Padnos School of Engineering (PSE) at Grand Valley State University will be described. The design of this program draws heavily from the successful approach used at the service academies — in particular West Point and the United States Naval Academy. As is the case for the service academies, all students are introduced to the “Honor Concept” (which includes an Honor Code) as freshmen. As an element of professionalism the PSE program requires 1500 hours of co-op experience which is normally divided into three semesters of full-time work alternated with academic semesters during the last two years of the program. This offers the faculty an opportunity to teach ethics as a natural aspect of professionalism through the academic requirements for co-op. In addition to required elements throughout the program, the students are offered opportunities to participate in service projects which highlight responsible citizenship. These elements and other parts of the approach will be described.

King Solomon

An earlier version of this paper was presented at the “Ethics and Social Responsibility in Engineering and Technology” meeting, New Orleans, 2003.     

Psychiatry Residents' Attitudes on Ethics and Professionalism: Multisite Survey Results

Recent studies show that psychiatry residents express a relatively greater need for ethics curricula than their colleagues in other specialties. Such studies have been limited in their generalizability because they were conducted at one site. This study of 151 psychiatry residents at seven U.S. psychiatry programs aims to address that limitation. Residents were surveyed on issues pertaining to ethics and professionalism education. Participants were found to support such curricula during training and to value its relevance to the practice of psychiatry. Gender differences and the influence of the “hidden curriculum” on such results merit further study.     

Reflections on teaching health care ethics on the web

As web instruction becomes more and more prevalent at universities across the country, instructors of ethics are being encouraged to develop online courses to meet the needs of a diverse array of students. Web instruction is often viewed as a cost-saving technique, where large numbers of students can be reached by distance education in an effort to conserve classroom and instructor resources. In practice. however, the reverse is often true: online courses require more of faculty time and effort than do many traditional classes. Based on personal experience teaching an online course in health care ethics for students in the Allied Health Professions, it is evident that there are both benefits and challenges in teaching online courses, particularly in ethics. Examples of benefits are (1) the asynchronous nature of web instruction allows students to progress through the course at their own pace and at times that are convenient given their clinical responsibilities; (2) web courses allow for a standardization of content and quality of instruction over a diversity of programs; and (3) examples can be tailored to the differing experiences of students in the course. Some challenges to teaching online ethics courses include (1) the fact that online instruction benefits visual learners and disadvantages those lacking good reading comprehension or strong writing skills; (2) developing meaningful student-student and student-instructor interaction; and (3) teaching ethics involves teaching a process rather than a product. Allowing students to apply their knowledge to real-world cases in their disciplines and encouraging them to share experiences from clinical practice is an effective way to meet several of these challenges. Building an online community is another good way to increase the interaction of students and their engagement with the material.