Does Medical School Does Medical School Educate for Educate for Professional Values? Professional Values? Brezis M, Butt O, Haimov T, Shapiro Brezis M, Butt O, Haimov T, Shapiro S, Ilan U, Cohen R, Tal M, Rubinow A S, Ilan U, Cohen R, Tal M, Rubinow A Hadassah-Hebrew University Medical Hadassah-Hebrew University Medical Center Center Jerusalem, Israel Jerusalem, Israel
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Does Medical School Educate for Professional Values? Brezis M, Butt O, Haimov T, Shapiro S, Ilan U, Cohen R, Tal M, Rubinow A Hadassah-Hebrew University.
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Does Medical School Educate Does Medical School Educate for Professional Values?for Professional Values?
Brezis M, Butt O, Haimov T, Shapiro S, Ilan U, Brezis M, Butt O, Haimov T, Shapiro S, Ilan U, Cohen R, Tal M, Rubinow A Cohen R, Tal M, Rubinow A
Hadassah-Hebrew University Medical CenterHadassah-Hebrew University Medical CenterJerusalem, IsraelJerusalem, Israel
Professional schools, such as Professional schools, such as medical, nursing, business and law medical, nursing, business and law schools, do not educate for valuesschools, do not educate for values
Professor Lee Schulman Professor Lee Schulman President, Carneggie Foundation for EducationPresident, Carneggie Foundation for Education
Ex-Finance Minister Hirschson Sentenced to 65 Months In Jail
In the Holy Land…
The corruption industry
MP Benizri (Shas) gets 18 months’ jail for corruption
Former Minister & Party Leader
Deri Begins Serving 3 year Term
Prison for Corruption
Deputy Head of Oncology convicted
of taking bribes from patients
Tax Authority Director resigns amid corruption
allegations
Top gynecologist charged with
fabricating medical data (head of
hospital's Helsinki Committee)
www.transparency.orgwww.transparency.org
Misconduct is a Misconduct is a global challengeglobal challenge
One-third of researchers surveyed in One-third of researchers surveyed in China admit to plagiarism, falsification China admit to plagiarism, falsification or fabrication of data. or fabrication of data. Nature (2010)Nature (2010) UK journal Acta Crystallographica retracted 70 published crystal UK journal Acta Crystallographica retracted 70 published crystal structures - fabrications by researchers at Jinggangshan structures - fabrications by researchers at Jinggangshan University in Jiangxi province. University in Jiangxi province.
Tainted Heparin from China Tainted Heparin from China Cause 81 Deaths in U.S.Cause 81 Deaths in U.S.
Cheating at Israeli UniversitiesCheating at Israeli Universities
Self Reported Cheating at Nine Law Faculties
N=788 studentsCheshin Y, 2002, 2005
Rate of Students Admitting ViolationsRate of Students Admitting Violations(≥2, at exams, assignments or clinical activities)(≥2, at exams, assignments or clinical activities)
80% 97% 31%80% 97% 31%
O. ButtO. ButtThe Medical The Medical
TeacherTeacher20092009
Cheating at Medical SchoolCheating at Medical School
Response Response raterate
Teachers viewed students’
dishonesty problems as not
part of their job to deal with them
E.g., performing intimate examinations without receiving
patient’s consent
No easy solutions to cheatingNo easy solutions to cheating
Technical (Technical (e.g. e.g. camera surveillance): limited camera surveillance): limited and easily defeated by student’s creativityand easily defeated by student’s creativity
Disciplinal: heavy to implement because of Disciplinal: heavy to implement because of legal implications legal implications
Physicians in Health Care CorruptionPhysicians in Health Care Corruption
• Fabricated ResearchFabricated Research• Pharmaceuticals or DevicesPharmaceuticals or Devices• Dubious Research on PollutionDubious Research on Pollution• Misconduct in ManagementMisconduct in Management
T. Haimov, The Medical Teacher, 2009T. Haimov, The Medical Teacher, 2009
Survey of Final Year Medical Students in a Leading Faculty Survey of Final Year Medical Students in a Leading Faculty (representing 1/3 of students concluding studies in Israel) (representing 1/3 of students concluding studies in Israel)
Percentage of Students %
Lifestyle EducationLifestyle Education
““Practicing a healthful behavior was Practicing a healthful behavior was shown to be the most consistent and shown to be the most consistent and
powerful predictor of physicians powerful predictor of physicians counseling patients about related counseling patients about related
prevention issues” prevention issues”
Nutrition 2009, 25: 532Nutrition 2009, 25: 532
& review from the Centers for Disease& review from the Centers for Disease
Control and Prevention 2009Control and Prevention 2009
Example of a Healthy Campus at Stanford University
Healthy Living Center at Mayo Clinic (Rochester, MN)
FORTUNE Magazine: Mayo Clinic One of Best Companies to Work For
1$1$השקעה של השקעה של לקידום בריאות לקידום בריאות
6$6$בעבודה מניב בעבודה מניב בפריון העבודהבפריון העבודה
Percentage %
Attitude Towards Organ DonationAttitude Towards Organ DonationSurvey of Medical Students (N=192) and Teachers (N=68)Survey of Medical Students (N=192) and Teachers (N=68)
In recent years, our school has In recent years, our school has changed the admission process changed the admission process with inclusion of psychological with inclusion of psychological testing to select students with a testing to select students with a more desirable personality. Our more desirable personality. Our
school has also introduced a school has also introduced a program of humanistic courses. program of humanistic courses.
In recent years, our school has In recent years, our school has changed the admission process changed the admission process with inclusion of psychological with inclusion of psychological testing to select students with a testing to select students with a more desirable personality. Our more desirable personality. Our
school has also introduced a school has also introduced a program of humanistic courses. program of humanistic courses.
Has cheating decreasedHas cheating decreased??
%
In your opinion, was there a cheating In your opinion, was there a cheating problem at the last exam?problem at the last exam?
NoNo
I cheated myselfI cheated myself
I helped others cheatingI helped others cheating
1-5 students cheated1-5 students cheated
5-10 students cheated5-10 students cheated
10-30 students cheated10-30 students cheated
Over 30 students cheatedOver 30 students cheated
N=96N=96
%
Do you see a problem in cheating?Do you see a problem in cheating?
I don’t have a problem I don’t have a problem with this behavior with this behavior
I have a problem with I have a problem with this behavior and I this behavior and I
oppose itoppose it
Students see a system of competitive Students see a system of competitive evaluation & incentives (e.g. scholarships), evaluation & incentives (e.g. scholarships), exclusivelyexclusively based on factual knowledge and based on factual knowledge and
not on attitudes, behavior, skills & valuesnot on attitudes, behavior, skills & values
“You, teachers, look only at our grades”
Knowledge is less important than the ability to admit you don’t know and the skills to find out answers to what you don’t know
At medical schoolAt medical schoolstudents unlearn to say “I don’t know”students unlearn to say “I don’t know”
A cab hits in hit-and-run accident. 15% of A cab hits in hit-and-run accident. 15% of cabs are blue, 85% are green. An cabs are blue, 85% are green. An eyewitness states cab in accident was blue; eyewitness states cab in accident was blue; its testimony has sensitivity & specificity of its testimony has sensitivity & specificity of 80%. What is the chance that a blue cab 80%. What is the chance that a blue cab caused the accident?caused the accident?
Overconfidence Among Medical Students in Overconfidence Among Medical Students in Cognitive Biases (à la Kahneman & Tversky) Cognitive Biases (à la Kahneman & Tversky)
Don’t Don’t knowknow
1%1%
%%
You donated blood, out of good health. You donated blood, out of good health. HIV test is positive. The sensitivity and HIV test is positive. The sensitivity and specificity of the test are 99% each. specificity of the test are 99% each. What are is chance you are HIV carrier?What are is chance you are HIV carrier?
%%
Don’t Don’t knowknow
1%1%
Should Oocyte Cryopreservation Be Allowed for Personal Reasons?Should Oocyte Cryopreservation Be Allowed for Personal Reasons?
Medical Medical StudentsStudents
General General PopulationPopulation
%%YesYes
Don’t Don’t knowknowDon’t Don’t
knowknow
*p<0.01*p<0.01N=290N=290 N=580N=580
**
Overconfidence Among Medical Students in Overconfidence Among Medical Students in Ethical QuestionEthical Question
Overconfidence & Assertiveness Overconfidence & Assertiveness Are Detrimental to Critical Are Detrimental to Critical
Professional AbilitiesProfessional Abilities
Admit “I do not know”Admit “I do not know” Tolerate uncertainty & ambivalenceTolerate uncertainty & ambivalence Respect patient’s & family’s viewsRespect patient’s & family’s views Team workTeam work Admit error/suboptimal performanceAdmit error/suboptimal performance Ability to change & improveAbility to change & improve
A potential solution might be in granting A potential solution might be in granting students, early on in the curriculum, students, early on in the curriculum,
responsibilityresponsibility for patient care, aligning for patient care, aligning pedagogic and professional goals.pedagogic and professional goals.
Early clinical experience with suffering, Early clinical experience with suffering, disease and death, will expose students disease and death, will expose students to values such as empathy, caring and to values such as empathy, caring and
responsibility to the other - fundamental responsibility to the other - fundamental steps in finding existential meaning.steps in finding existential meaning.
Brezis M. Caring in medicine: missed opportunity for healing? J Eval Clin Pract 2009:990-2Brezis M. Caring in medicine: missed opportunity for healing? J Eval Clin Pract 2009:990-2
Conceptual Solution to CheatingConceptual Solution to Cheating
ConclusionConclusion
Education for Education for professional professional
values during values during medical school medical school deserves a new deserves a new
paradigm. paradigm.
Medical students disclose problematic Medical students disclose problematic attitudes and behavior related to attitudes and behavior related to