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Do as I do.

Now that bioethics courses are becoming increasingly common in medical schools, much consideration is being given to how bioethics should be taught. Recently, a series of articles in Academic Medicine has been devoted to proposals for teaching ethics, ranging from discussing cases in small groups with other residents, to utilizing a computer conference format (October 1991). With the latter, medical students enter their discussions of ethical issues into a computer network, which can then be accessed by others in a computer dialogue. This pedagogical program is touted by the authors as promoting active student participation, making it "easier for students to discuss problems and ideas with others."

The motivation for these proposals is not merely the effort to find the best technique for teaching ethics. Many factors, in both society generally and medical education specifically, have produced practical impediments to the creation of ethical physicians. A study in Academic Medicine (June 1992) identifies several barriers to successful ethics education. The one most commonly reported by educators (51% of respondents) was demands on residents' time, often accompanied by fatigue, "which sometimes diminished the receptivity of residents to discussions of ethics." Other common barriers were attitudes of residents (33%), various logistical problems (25%), time demands placed on teachers (19%), and shortcomings in training and background for ethics teachers themselves (13%). Perhaps most disconcerting was the "lack of reinforcement of ethics teaching by other faculty (14%), including lack of participation in ethics teaching and counterproductive role models."

Against this background comes a plan from former Surgeon General C. Everett Koop to create a "doctor for the 21st century." The home of this new breed of doctor will be the C. Everett Koop Institute at Dartmouth, established by Dr. Koop, Dartmouth College, and the Dartmouth-Hitchcock Medical Center. In addition to a solid grounding in science and emphases on disease prevention and outcomes research, what is ethically noteworthy is the attention to the character of the physician and the physician-patient relationship. Koop's doctor would be one "who is more interested in humanitarianism than greed, more interested in low-tech than high-tech--not necessarily a family doctor but someone who would think like a family doctor even if he was a neurosurgeon" (American Medical News, 8 June 1992). The idea is to establish mentorship programs in which students learn ethics and medicine from practicing, master physicians considered to be role models in their fields--not only good doctors but good persons. Furthermore, Koop wants to require students to serve in poverty-stricken areas to learn about poverty and the obstacles that stand between the poor and medical resources. This is to give students a sense of connectedness with the profession, the community, and the medical realities that confront both. The mentorship program will be extended also to doctors seeking postgraduate education and to premedical students, to give them acquaintance with the ethics and the art of medicine.

The Koop-Dartmouth program would seem to overcome many barriers to bioethics education. Ethics would not be something one struggles to add to medical education; rather, it is built into training in the art of medicine itself. While moving the physician into the 21st century, Koop's idea of mentorship actually takes us back to a distant time--before computers and case studies--when education was imitation.
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Title Annotation:bioethics education
Author:Hanson, Mark J.
Publication:The Hastings Center Report
Date:Sep 1, 1992
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