Training manual on how to teach medical ethics to undergraduate medical students by non expert faculty staff

FACULTY OF MEDICINE, KING FAHAD MEDICAL CITY. KING SAUD BIN ABDULAZIZ UNIVERSITY FOR HEALTH SCIENCES (RIYADH, SAUDI ARABIA)

Training manual on How to Teach Medical Ethics to Undergraduate Medical Students by Non-Expert

Faculty Staff

Ghaiath Hussein Version 1.1 (Updated 5/22/2012

How to Teach Medical Ethics to Undergraduate Medical Students by Non-Experts © Ghaiath Hussein 2012 2 of 30

Training manual on How to Teach Medical Ethics to Undergraduate Medical Students by Non-Expert

Faculty Staff

Ghaiath M. A. Hussein, MBBS, MHSc. (Bioethics) – 2012

© 2012 Department of Medical Ethics, Faculty of Medicine, Taibah University

This document is not issued to the general public, and all rights are reserved by the Faculty of

Medicine, Taibah University and the author. The document may not be reviewed, abstracted, quoted, reproduced or translated, in part or in whole, without the prior written permission of Faculty of Medicine, Taibah University and the author. No part of this document may be stored in a retrieval system or transmitted in any form or by any means – electronic, mechanical or other – without the prior written permission of Faculty of Medicine, Taibah University. Requests for permission should be directed to Faculty of Medicine, Taibah University address: College of Medicine, Taibah University PO box 42317, Madinah, 41541 Saudi Arabia . The views expressed in documents by named author are solely the responsibility of this author.


Contents 1. Purpose and Structure of this manual ................................................................................................................. 4

2. What do ethics, bioethics, and medical ethics mean? ......................................................................................... 4

Ethics in healthcare (bioethics) ................................................................................................................................ 4

Ethics in Islam ........................................................................................................................................................... 6

3. Why do we need to teach medical ethics (and professionalism) to medical students? ..................................... 7

4. What to teach in medical ethics and professionalism? ....................................................................................... 9

5. How to teach medical ethics and professionalism for undergraduate medical students? ............................... 13

Overview: ............................................................................................................................................................... 13

Target: .................................................................................................................................................................... 13

Language: ............................................................................................................................................................... 13

Setting: ................................................................................................................................................................... 13

Length/duration of sessions: ................................................................................................................................. 14

Teaching Methodology: ......................................................................................................................................... 15

6. How to evaluate ethics and professionalism in medical students? ................................................................... 19

Student and Course Evaluation .............................................................................................................................. 19

Attendance and active participation ...................................................................................................................... 20

Assignments ........................................................................................................................................................... 20

Assessment of assignments: .............................................................................................................................. 20

Mid-Term Exam ...................................................................................................................................................... 21

Research report & Research presentation ............................................................................................................. 21

Suggested structure of the research .................................................................................................................. 21

The case study .................................................................................................................................................... 22

A Fiqhi study ....................................................................................................................................................... 23

Ethical approval for their research..................................................................................................................... 23

Format and styling in writing and citation ......................................................................................................... 23

The presentation associated with the research ................................................................................................. 24

Practicum (Clinical & Research Ethics practical activities logbook) ....................................................................... 24

Final Exam .............................................................................................................................................................. 28

Course evaluation .................................................................................................................................................. 28


1. Purpose and Structure of this manual This manual is not a textbook on ethics and it is not a training manual on ethics. It is a manual designed

for teachers interested in teaching medical ethics for undergraduate medical students to help them

achieve the best possible outcome, even if they do not have an academic qualification in bioethics.

It falls in 4 main chapters, which try to help in answering the 4 main questions, I assume, anyone

interested in teaching medical ethics may ask. They are;

1- What do we mean by these terminologies (ethics, bioethics, medical ethics and the other

healthcare ethics disciplines)?

2- Why do we need to teach ethics to medical students?

3- How do we teach bioethics to medical students?

4- How to assess the bioethics educational process?

2. What do ethics, bioethics, and medical ethics mean?

Ethics in healthcare (bioethics)

Ethics has been defined as a system of moral principles or standards governing conduct; a

system of principles by which human actions and proposals may be judged good or bad, right or

wrong; a set of rules or a standard governing the conduct of a particular class of human action

or profession; any set of moral principles or values recognized by a particular religion, belief or

philosophy; and the principles of right conduct of an individual. (UNESCO/IUBS/Eubios Living

Bioethics Dictionary version 1.4)

Bioethics is a branch of ethics. It is derived from Greek bio- (means life) and ethicos (means

moral). More precisely, it is the science/art that aims at identification, analysis, and resolution of

the ethical issues in the fields related to human life and health.

Medical/clinical ethics aims, by definition, to help the healthcare providers to identify, analyze

and resolve ethical issues they encounter during their practice.

Ethical issues arise when there are conflicting values, beliefs, commitments and priorities either

between the healthcare team and the patients (or their families), or among the healthcare

members themselves. These issues increase in their scope and complexity in proportion to the

complexity of the provided service. For instance, it is easy to observe that the primary care

ethical issues are quite few and trivial if compared to the ethical issues in secondary or tertiary

care institutions.


This is partially explained by the fact that patients (and maybe doctors as well) have higher

expectations to have a higher level of service. For example, no family would expect to have

aggressive heroic measures to be taken to save their patient's life in a rural primary care center

of clinic. Contrarily, they would not take it as easy in a tertiary specialized big hospital in the

middle of a big city.

The gap between the patients' and family expectations, on one side, and the doctors' ability to

utilize the available facilities that are overcrowded or not sufficient on the other side is the main

source of ethical issues. This is quite natural that the family sees their patient as the patient that

should be given the ultimate and priority care, while doctors have moral commitments towards

other patients who are in dare need for that time and facilities.

Indeed, there are many other sources for ethical issues related to the doctors' poor attitude,

miscommunication, poor leadership, lack of competence, and ignorance to name some.

Historically, medical ethics may be traced to guidelines on the duty of physicians in antiquity,

such as the The Code of Hammurabi dating to ca. 1780 BC, and the Hippocratic Oath ca. 400

BC.

In the medieval and early modern period, the field is indebted to Muslim medicine such as Ishaq

bin Ali Rahawi (who wrote the Conduct of a Physician, the first book dedicated to medical

ethics), Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West) and Ali ibn Sahl Rabban

al-Tabari who produced one of the first encyclopedia of medicine and medical code of ethics in

970 G.

Contemporarily, the American Medical Association adopted its first code of ethics, in 1847.

However, this field has grown as an academic specialty in the western hemisphere, especially

North America only in the last few decades. Nevertheless, ethics has been discussed and taught

for centuries in the old world. Ethical principles are also deeply rooted in the Islamic and other

religious teachings.

Currently, there are growing factors that are shifting the field of bioethics to be internationally

spreading beyond the dominant trend of North American and European dominance, especially

our region including the Saudi Arabia. These could be summarized as follows:

1 - The complexity and expansion of the healthcare service are accompanied by more

complex and diverse ethical issues that need to be resolved.

2 - The increased awareness of the people about their rights, accompanied by aggressive

media coverage of healthcare, especially medical errors.

http://en.wikipedia.org/wiki/Duty

http://en.wikipedia.org/wiki/Hippocratic_Oath

http://en.wikipedia.org/wiki/Islamic_medicine

http://en.wikipedia.org/w/index.php?title=Ishaq_bin_Ali_Rahawi&action=edit&redlink=1



http://en.wikipedia.org/wiki/Muhammad_ibn_Zakariya_ar-Razi

http://en.wikipedia.org/wiki/Encyclopedia

http://en.wikipedia.org/wiki/Medicine

http://en.wikipedia.org/wiki/American_Medical_Association

http://en.wikipedia.org/wiki/Ethical_code


3 - The increasing interest in teaching medical ethics to medical students in more Saudi

medical colleges.

4 - The ongoing trend among governmental and private hospitals to obtain international

accreditation, which necessitates that they provide "ethics service" to their patients.

Ethics in Islam

Morality is an integral part of Islam. Moreover, it is considered the purpose for which the

Prophet Mohammed (PBUH) was sent. He (PBUH) said, "I was sent to perfect good character."

(Malik's Muwatta: 047/8)

He (PBUH) has also stated that, "The best amongst you are those who are best in morals" (Sahih

Muslim; 30/4750); "Righteousness is good morality, and wrongdoing is that which wavers in

your soul and which you dislike people finding out about." (An-Nawawi, 26); "The faithful

reaches, by his good character, the rank of the fasting (from food and water) and the standing

up (praying to God at night)" among many other advices by the prophet (PBUH) that emphasize

the role of morals in the Muslim's life.

Islam itself is unique in terms of how it unifies what is moral with what is legal. In other words,

what is moral is legal/permissible (Halal) and what is immoral is consequently illegal (Haram).

This spares the Muslim from the moral-legal discrepancies in other parts of the world, where

what is ethical is not necessarily legal, and vice versa. This also what makes us discuss the ethical

issues in medical practice within the Islamic context as "Ethical-Fiqhi-Legal" triad.

The discussion and resolution of ethical issues from Islamic prospective will largely adopt the

Fiqhi methodology, as we will elaborate in the relevant sections of this manual.


3. Why do we need to teach medical ethics (and professionalism) to medical

students? Teaching medical ethics is not intended to make virtuous doctors. We cannot re-bring our students up

again, while they are already more than 18 or 20 years old. Thus, it is not practical to think that we need

to make them what we think the doctors should be. That being said, it is important to know that

teachers do influence their students by different ways. Students are affected by the effect of their

teachers as role models, whether good or bad ones. This effect depends on the ability of the students

to change and the traits that the teacher has to influence or inspire his/her students.

So why do we need to teach bioethics then?

Our aim is to provide the student with the guidance on what constitutes an ethical

attitude and explain to him/her how to adopt it, and what is not ethical and how to avoid

it. The bottom-line is that we aim at making our graduates better doctors who adhere, to

their best, to the professional standards to provide the optimum healthcare to their

patients. This is typically similar to what we do quite efficiently in our clinical training.

The following summarizes the importance of teaching ethics and professionalism,

including Islamic ethics, to undergraduate medical students.

1- Training on moral reasoning about ethical issues (and not only the medical facts)

makes the physician more competent to deal with his patients as a whole (body

and soul), and not merely dealing with their sick bodies.

2- It improves the analytical thinking abilities, and the learning of important skills like

asking questions, effective listening, problem solving and conflict resolution skills,

which are beneficial not only in the ethical analysis but also in the logical analysis

needed for medical practice in general.

3- Empower the attachment of the Muslim doctor to the set of moral framework that

was clarified by the Koran, Sunna and the guidance of our ancestors, so that the

intentions become purified for Allah in what we do, and not merely a materialistic

approach to medicine as a source of income.

4- Acquaint the Muslim doctor to the set of Fiqhi standards that s/he should know,

like the conditions of examining a patient of different sex, or the Fiqhi issues

related to diseases, like fasting, and prayers.


5- Moreover, the Muslim doctor may be consulted from Scholars (Ulama) about a

certain medical issue that he wants to issue a Fatwa about. Therefore, you should

know the basics of Fiqhi approaches to medical practice to be able to help.

6- In addition, it was found that teaching ethics and professionalism to clinicians

during their undergraduate medical education will help in improving the outcome

of the healthcare they provide.

Miles and colleagues1 suggested five main objectives for the teaching of medical ethics: – To teach doctors to recognize the humanistic and ethical aspects of the medical

career; – To enable doctors to examine and affirm their personal and professional moral

commitments; – To equip doctors with a foundation of philosophical, social and legal knowledge; – To enable doctors to use this knowledge in clinical reasoning; and – To equip doctors with the interaction skills needed to apply this insight,

knowledge, and reasoning to human clinical care.

1 S.M. Miles, L.W Lane, J. Bickle, R.M. Walker & C.K. Cassel. Medical Ethics Education: Coming of Age. Academic Medicine 1989; 64:

705–14.


4. What to teach in medical ethics and professionalism?

To answer this question, let’s put our practice in its natural context by answering this long question: while

providing healthcare, or conducting research, who is doing what in which context for whom?

The following diagram will help us visualize the doctor’s interactions during the provision of healthcare.

As we have mentioned earlier that ethical issues arise from the interaction of humans who

have different duties, priorities, and visions. Therefore, doctors can face ethical issues

arising from any of their interactions with their patients (or the patients’ families), the

colleagues in healthcare team (whether other doctors, nurses, therapists, lab. or radiology

technicians), the administration of the facility in which s/he is working, or even with the

law or national policies in the country s/he is working in.

Therefore, if we need to prepare our students to deal with the ethical issues they may

encounter in practice, we have to introduce them to these ethical issues in the safe

Country

Public Health

Laws/ Fatwas

Policies, guidelines

Hospital

health-allied

personnel

Admin., Resources

Bedside

Doctor Patient/family


educational environment of the faculty of medicine. This is how we decide what to teach

in bioethics for our students.

Needs’ assessment may be needed to have a more accurate, evidence-based approach to

teaching what is really needed by the students and the clinical teachers, as well.


Phasing of teaching bioethics: when to teach bioethics?

Phase Students’ characteristics Educational Objectives (what we want to do for/with them?)

suggested topics

Pre-clinical Fresh from high school

No previous personal exposure to patients

‘Ideal’ figure of the doctor as ‘angel of mercy’

Effect of the personal (good or bad) situations and experiences with the health system

Ethics is inherited from their communities and family (the way they were raised up)

Clinical Students are exposed to and start communicating with patients

Students begin to ‘feel (and maybe act) like doctors’

Students’ imagination becomes more realistic by exposure to the system (how the system really works?)

Feelings of frustration, shock, confusion, coping, surrender… when what they think right/ethical doesn’t match what their seniors do

Near-graduation (specialized)

Students are technically almost doctors

They feel the direct responsibility towards the patients, colleagues and the system

Main focus and concern on ‘whatever it takes to get graduated’

Personal clinical specialty preferences start to get established

Near-mature clinical style of practice

Students’ mindsets are more towards ‘clinical analysis’ kind of thinking and doing things


To put it in a more practical way, the topics to be taught would include:

1- Foundation and the basics of bioethics

2- Ethical issues related to doctor-patient relationships

3- Ethical issues related to doctor-colleagues interactions

4- Ethical issues related to the allocation and management of resources

5- Ethical issues in Public Health and health Promotion

6- Ethico-Legal-Fiqhi Issues (ELFIs) in healthcare

i.Introduction to the concepts of ethics, bioethics, and medical ethics ii.Comparison between the western and Islamic approaches to medical ethics

iii.Professional duties of the doctor towards self, colleagues, patients, and community.

iv.Professionalism in being a medical student and a doctor v.Basic ethical principles and guidelines (national and international)

vi.How to manage ethical issues in clinical practice?

i.Doctor-patients communication skills ii.Breaking bad news (BBN)

iii.Informed consent to treatment

iv.Privacy and confidentiality v.Patient's Autonomy and Consent to treatment

vi.Privacy & Confidentiality

vii.Terminally Incurable Diseases and the End of Life (EOL) Decisions

viii.Ethics of public health and health promotion

ix.Islamic Fiqhi Rulings in Major Medical Specialties

i. Doctor’s roles ii. Professionalism

iii. Collegial relationships

iv. Conflict resolution

-

i. Resource allocation in the health-care system ii. Ethical issues in organ transplantation

i. Public health vs. clinical care, and PH practice vs. PH research

ii.Research Ethics in Public Health

iii.Ethics and Infectious Disease Control: STDs, HIV, TB

iv.Ethics of Health Promotion and Disease Prevention

v. Ethical Issues in Environmental and Occupational Health

vi.Public Health Genetics: Screening Programs and Individual Testing/Counseling

i. Medical Malpractice, Misconduct & Medical Errors

ii. Financial Aspects in Practice and Conflict of Interests (COI)

iii. Ethical issues in medical insurance


5. How to teach medical ethics and professionalism for undergraduate medical

students?

Overview:

Teaching medical ethics does not depend on the formal structured teaching given by the ethics teacher in

an ideal learning format. If the teaching of ethics is really intending making a change in the student’s

understanding, attitude and practice; it should consider the following:

1- Students should play an active role in the learning process

2- Minimize the load of theoretical knowledge in favor of practical application

3- Ethics and professionalism can be introduced at any stage of the medical school, but they need to

be integral to the clinical teaching.

4- Students learn in the clinical phase from their clinical teachers how to deal with patients. The

problem that is usually encountered is the contradiction, or at least the discrepancy, between what

is idea as taught in the ethics course and what is practiced in real life by the clinical teachers. This is

what is referred to as the ‘hidden curriculum’. Thus, it is advisable to include the clinical teachers in

the ethics learning process, as described below.

5- Teaching ethics is preferably given as interdisciplinary curriculum in terms of teachers and students.

This means that it can/should be given by teachers from different professional and academic

backgrounds to students of different disciplines (e.g. students from the colleges of medicine,

nursing, dentistry, radiology, physiotherapy, etc.)

Target:

It is advisable, if applicable, to introduce the topics of the course, at least part of it to both undergraduate

medical and health-allied students. This will help in building rapports between the healthcare team to be,

and train them on proper professional communication. Moreover, when they work on resolving the ethical

issues together as students, it would be easier for them to do the same exercise later when they start to

practice.

Language:

As most of the literature is in English and most of the universities teach medicine in English, the language

of instruction will be in English. However, some lectures should be presented in both languages or even in

Arabic only, like those related to the Fiqhi issues.

Setting:

The needed setting to teach the medical ethics course topics vary according to the most used format. For

example, large lecture halls are needed if there are lectures, and the small class (discussion) rooms are

needed for group work and case discussions. There are other technical facilities that are needed, including

PCs (or laptop), projector, show screen for presentations, while flipcharts, markers, A4 size blank paper is

needed for groups’ discussions and smaller workshops.


Length/duration of sessions:

The length is left to the available time, but it is usually between (40-120 minutes) divided into the

following:

- 20% of the time for theoretical introduction and outline of the presented topic

- 40% for practical or interactive students-oriented activity (based on a case, scenario, or )

- 30% group discussion and presentation of what the students discussed in the small groups (or in the

interactive session)

- 10% conclusions, wrap up and take-home messages (may also include the session’s evaluation)

Note: for any session more than 60 minutes, it is advisable to have 5-10 minutes break.


Teaching Methodology:

To materialize the characteristics of the teaching methods that we outlined in the ‘Overview’ paragraph, the teaching

method will be based on the following modalities:

Modality When to use it? How to do it?

1- Interactive sessions (lectures)

- Foundation and principles - Outline of presentation

- PowerPoint presentations are the most common used method

2- Problem solving and case discussion

- Almost any ethical issue can/should be presented as a problem for the students to think about and discuss, whether clinical or research ethics

- Cases are either developed by the faculty, or used from open resource, or used with permission of the author. - Make sure that each case has clear instructions of the group should do, few probing questions, and a clear time allocation - Students are divided into smaller groups in the small rooms - Each group assigns a leader, and a note-taker (presenter). A staff facilitator should be around, if not present all the time with the group. - Students are given time to read the case silently, then loudly, then discuss based on the given hints or probing questions, brainstorm, decide on what they will say about each of the points mentioned in the hints, and write them down for presentation for the other students.

3- Assignments done by students

- Topics that have a room for thinking and personal reflection - Preferably given on intervals (i.e. not with every new topic) to include more than one topic in the same assignment

- Choose a case as indicated above, whether developed for educational purposes, or a true case from the hospital of media. - Give it the students with clear instructions on what they are expected to do, preferable through some probing questions. - Give them a due date that is reasonable for them to think about and reflect, usually 3-7 days should suffice. - Ask them to submit the assignment to you. Typically, the


facilitators should mark them, or even double mark them by two markers, if feasible, and give feedback to the students, not just the mark or grade.

4- Student seminars - Topics that are not covered in the curriculum, e.g. many of the Islamic rulings (Fatwas) and Fiqhi issues can be presented in this way

- It is preferable to have a list of the topics that will not be covered by facilitators/instructors from the beginning of the course. - Distribute this list to the students and let the groups choose their topic of interest from the list. - Make a schedule, ideally from the beginning of the course, of which group will present which topic. - Make sure to invite an expert in the topic to attend the presentation.

5- Case studies and case presentation

- This is typical to the class case discussions (#2) in terms of the topics to be covered using this method.

- Ideally, each group should be given a case to discuss, each covers a different aspect of the topic. However, the same case can be given to more than one group. - The case should have clear instructions and questions underneath. - The groups are given a period of time (3-7 days) to discuss and present the case, either as presentation to the other students, or as written report, or preferably as both.

6- Mock ethics consultation meetings

- This method covers the topics that are commonly presented to the ethics committees for consultations. - These include the ethical issues related to the end-of-life (EOL) and research ethical review.

There are many ways to do that: - Make the students attend a ‘real’ ethics committee meeting; - Invite members of the ethics committee to meet in front of the students as a ‘role play’ to discuss a real or developed case; or - Make the students themselves play the role the members of the ethics committee and give them the case (or the research proposal) to be discussed. Let them discuss guided by facilitator or some guiding documents or hints.

7- Watching movies or - This is perfectly well with the topics - There is a list of movies that cover a variety of ethical issues


documentaries that discuss ethical issues.

that you need to make the students feel for or against an attitude. - For example, topics like doctor-patient communication, pain management, cultural differences, etc. are well covered in a number of drama movies and documentaries.

available in the internet, and as annex to this manual. You need to be careful when choosing a movie, especially in a conservative milieu, or when you have female and male students. - Avoid movies that have a lot of distraction from the ethical concepts that want to cover. If there is no much choice, you can only show the part of the movie or the documentary that best conveys the ethical message. - This method need to be used with caution, and never be mandatory on any student to attend. Some may refuse due to religious or cultural causes.

8- True story telling (by patient, patient relative, or a doctor)

- Topics that have doctor-patient interaction/communication (e.g. consent, EOL care, etc.)

- Ask a patient or a relative to come and share his/her story or experience with his/her illness, and how his/her healthcare team managed him/her. - Ask them to be free to talk and to describe what they really felt at the time, whether it was a good or bad experience. - Ask the patient to send a message for the students (what s/he would love these students do (or not) when they become doctors?) - Be cautious, asking a patient to recall some illness experience may be upsetting, depressing, or frustrating to some patients. Be ready for such an incident if it happens.

9- Standardized patients (SPs)

- This is a more advanced method that is based on making professional actors work on simulating a patient with a given condition. - This SP is then interviewed by the student in front of the other students, and supposed to behave like a real patient.

- The SP is given a scenario with full details about the patient’s history, symptoms, and even some signs that could be simulated. - The students are then divided into groups (or as demonstration for the whole class), each with a SP. - The students are given the task of communicating with this patient for a given purpose, e.g. telling him that he has cancer, or that her mother is candidate for DNR order, etc.


- This could be used in many topics, but it is more efficient in topics that needs direct doctor-patient communications like breaking bad news, or taking consent

- One student is chosen to play the role with the SP, who is trained to react to any possible question, or action from the student. In case the student gets stuck, he can ask for ‘freeze’ or ‘timeout’, where the SP (actor) keeps the position and gesture, while the student asks for help from his/her colleagues. - The session ends with discussion and consultations on how to do things (or not) when dealing with a patient.


6. How to evaluate ethics and professionalism in medical students?

Student and Course Evaluation

Student evaluation methods should be variable and continuous. They aim at evaluating the

student's ability to reflect what s/he learnt in hypothetical or simulated situations. Some tools are

individual, like assignments, while others depend on group work, like course research.

The following table summarizes the suggested students’ evaluation methods and their respective

percentage of the total mark.

Method Mark/100

Attendance and Active class participation

Assignments

Mid-term exam

Practicum (Clinical & Research Ethics practical activities)

Research report and presentation (the report & presentation)

Final exam

Students

•knowledge

•comptencies

•skills

•attitude (bedside)

Teachers

•knoweldge

•ability to deliver

•interaction with students

Content

•clear objectives

•relevant methods

•applicable concepts

Method

•relevant to topics & culture

•engaging to students


Total 100

Attendance and active participation

In many instances, the physical attendance for at least X% in the lectures is a perquisite by the

faculty's regulations to attend the exam. Any absence of more than (100-X)% will decline the

student from sitting for the exam.

However, attendance is not just about signing the attendance sheet!

The student should participate and contribute to the session by asking questions, positive

contributions in group discussions, and answering questions.

Assignments

Along the course, the student will be asked to submit few assignments. These assignments are

usually about cases with ethical problems. The student should be guided in each assignment by a

set of questions that s/he may need to follow in order to attain the best mark.

They are intended to be a self-reflection on what the student has learnt so far along the course.

Students should be left free to express their understandings and feeling than to focus on reaching

a correct answer. Many themes in ethics do not have agreed on clear cut right answers.

It is also expected that the student should abide to the professional academic conduct, especially

the proper citation without the abuse of internet. Many faculties use software to detect

plagiarism; thus the student should be warned not to just 'copy and paste' from the internet.

Plagiarism Similarity Score of 20% or more means that your work will be rejected and you will have

to resubmit your work.

We take academic misconduct seriously. It is a course on ethics and professionalism after all.

Assessment of assignments:

Your assignments will be assessed based on the following criteria:

1- Originality of content. This means the student needs to reflect themselves in what you

submit

2- Novelty of content. This may be difficult to achieve in the topics of ethics, where there are

many articles already in the literature. However, the student still needs to add a new flavor

to the already discussed topic, or even better to choose a less discussed topic.

3- Strength of arguments. The students need to defend what they present. This means that

the students need to present a supported argument to what they submit. A well-supported


argument also means that the student needs to present the possible counter-arguments to

theirs and how they would respond to them.

4- Uniform editing. The great content should be presented in a professional neat outlook and

layout. It is advisable to keep the text to 1-2 fonts, to make sure that the sizes of the

subheadings are uniform, and to avoid using pictures and colors extensively unless

justifiable.

5- Proper citation. Students have to show that they have read well about the topic they are

writing on. This is best reflected by the professional use of the suggested readings AND

proper citation in a uniform citation style.

Mid-Term Exam

The mid-term exam will be composed of MCQs, with one best answer, and short essay questions.

These may include short cases with questions to answer, or you are asked to "discuss" or "list". The

weight of each MCQ and short essay will be mentioned in the questions sheet.

Answering in either Arabic or English is allowed; however, each question should be answered in

only one language.

Research report & Research presentation

As a part of the course evaluation, every student has to submit a written work that reflects his/her

understanding of what s/he got in the course. This work should reflect his/her abilities to search

the literature, organize ideas, develop objectives, develop a research plan, and implement it to

discuss the relevant ethical aspects.

Each group of students should find an ethical problem related to the objectives of the course,

study it guided by your research objectives, and present and discuss its results and conclusions

from what they found. Finally, they should have practical recommendations that they come up

with at the end of the research.

Their research is expected to contribute new knowledge to the scientific community and not a

repetition of what is already known about the subject.

Suggested structure of the research

Typically, the research should contain the following sections:

I. Title page: (Header of the FOM; Title of the project; Names and IDs of the research team; Name of the supervisor; and Date of submission


II. Table of contents: you are strongly recommended to use the [Add Table of contents from your Word software]

III. Acknowledgment: This section is to acknowledge the efforts of those who helped you in your research.

IV. Introduction: This is a key section. You need to tell the reader of your research what you are studying, and why do you need to study it ( i.e. the rationale)

V. Review of literature: in this section you should show your reader that you really know what you are studying and that what you're studying is not a repetition of work that is already there. Remember: we expect new knowledge from your research.

VI. Objectives (general and specific): use action verbs, and make them SMART (Specific, Measurable, Attainable/Acceptable/Achievable. Relevant/Reliable, and Time-bound)

VII. Methodology: in this section, you tell the reader how did you do your research. Make sure this sections tells in details about the following: study area, study population, data collections techniques and tools, and data analysis

VIII. Results: this section contains the findings of your data collection, preferably as tables and figures.

IX. Discussion: In this section you discuss the results in comparison to what other found on the same issue. You are expected to provide justifications for what you found in the results.

X. Conclusion & Recommendations: You are expected to provide some practical steps to be taken by relevant stakeholders to improve the situation regarding the topic of your research.

XI. References: This section contains the references that you used in your work, especially in the introduction and the review of literature. You are strongly recommended to use reference management software (like Reference Manager, End Note, or RefWorks). Discuss this option with your supervisor.

The case study

Along the medical ethics course, we aim that the student knows how to define, analyze and be able to use the relevant tools to resolve ethical issues. This is best demonstrated by a case study. In a case study the students are asked to find a case with one or more ethical issues around it. They should be strongly recommended to find a true case, though they have to make sure they completely de-identify it.

A case study will be typically composed of these sections:

I. The presentation of the case, very similar to the way the students do in clinical rounds with the exception that the students describe the aspects related to the ethical issue the students will discuss, and not only the medical and clinical facts. II. What are the ethical issues in the case? In this section, the students are supposed to list the ethical issues that the students found in the case

http://www.refman.com/rmdemo.asp

http://www.endnote.com/endemo.asp



http://www.refworks.com/individual/index.html


III. What are the ethical and Fiqhi principles at stake? In this section, the students are supposed to list the ethical principles followed by the Fiqhi and Islamic issues related to the case. IV. Ethical case analysis: This section reflects the way the students analyze the case, using any of the analysis frameworks and tools (e.g. 4-boxes model) that the students have gone through in this course. V. Fiqhi Case analysis: In this section, the students should present the Fiqhi approach to their case, for example what are the Goals of Shariya (مقاصد الشريعة) involved, which Fiqhi Maxims (القواعد الفقهية) are applicable and if there are previous Fatwas on the issue. VI. Case resolution: although the students may not be always able to resolve the issue, or suggest definitive steps to be taken; the students should present their approach to resolve the case.

A Fiqhi study

A Fiqhi study is a different format that can reflect their ability to search and analyze. As the students know, many of the practices and medical interventions have been studied by the Scholars (Ulama). Many issues have been discussed in many conferences and had resolutions from Fatwa and Fiqhi complexes. However, it is quite impossible for us as teachers to present to the students along this course each and every fatwa or religious approach to medical practice in different specialties. Therefore, we encourage that few groups of the students present a Fiqhi study to present the Islamic approach to a given issue related to illness, diseases, or medical practice. The students are strongly recommended to approach NEW topics. For example a study on cleanliness or fasting for patients (taharat al-maridh) is not acceptable, as there are already tens of books on the issues. May be the students can consider Islamic approach to ethical issues in specialties, like Emergency Medicine, Oncology, Anesthesia, etc.

Ethical approval for their research

Usually the research at their level are classified as "Low-Risk, Low Vulnerability" studies, so they rarely need a full ethical review. However, NO data collection should take place without a written permission from the faculty, preferable from the dean's office. Students should consult their supervisor and the course coordinator on whether their research needs one and how to obtain it.

Format and styling in writing and citation

Their work should follow the following instructions: i. Make a separate page for title ii. All sections of the proposed format for each kind of research work the students want

to submit should be there. iii. Preferably, start each section in a separate page iv. Any omission of any section should be justified v. All their work should be in Arial Font, double spaced, size of font should be as follows:


Main headers/titles (size 18); Subtitles (size 16);

Sub-subtitles (size 14); and

The rest of the text (size 12).

vi. Using Photos should be justified, with proper acknowledgment of the source and copyright

vii. Don’t' use colors other than black unless justifiable and needed. In total, not more than two colors allowed. viii. Citation should be either in AMA, Vancouver, or Harvard Styles. Arabic references and Fiqhi studies need to be agreed on with an expert relevant scholar.

The presentation associated with the research

The presentation is the way the students tell others in summary about their research or case study. It should summarize the whole work in 15 minutes presentation. Although there is no objection to PowerPoint presentations; innovation in presenting their works will be highly appreciated and will receive extra marks for that. Innovative ideas and ways of presentation may include making a short movie, a role play, use of posters, or models, etc.

Each student will be individually evaluated, so make sure the students know the research thoroughly. This means that the work among the group members should be organized fairly with all group involved.

The students need to make sure with their supervisor that their presentation is relevant to the objectives. The students should make sure that a copy of their presentation is ready on the PC of the hall at least one day before the presentation.

Practicum (Clinical & Research Ethics practical activities logbook)

As a part of their training in bioethics, the students need to actively participate in activities

related to ethics. The students need to attend a total of at least 4 hours in bioethics-related

activities, within or outside the KFMC.

These activities include (for example and not exhaustive):

- Ethics book review - Public awareness campaign - Producing short film (documentary) on an ethical issue


- Ethics education material - Short Play or scene - Movie review - Ethics consultation meeting - Research ethics review meeting - Other activities that may think relevant

Activity , Description and purpose of activity

Suggested steps (as given to the student) Deliverable product

1. Ethics book review (3 marks) - This aims to make you read a book on ethics, and tell us what you think about it. - You are NOT asked to read it as ‘reading a textbook for an exam’, rather to read with critical reflection and critique.

1. Go to the COM or the KFMC library 2. Ask the librarian on the books on ethics 3. Discuss with our group on which book to choose (reading the content is the most first step you should do when deciding on reading a book) 4. You all read it all, or divide the chapters among your group (chapter for each). 5. Read and summarize the book (or chapter) your opinions and reflections on what you read 6. Each student should write down a review on what s/he read. 7. The group should assign the members to do the collective final review. 8. The group will present to the whole batch when done

A written book review of not less than 1500 words


2. Public awareness campaign (5 marks)

- This refers to a set of activities that aim at enhancing the knowledge and attitudes of the targeted by these activities about a given cause.

1. Meet with one or more of the main related departments in the FOM or KFMC (e.g. public relations, patients’ affairs, admission office, religious affairs, medical errors committee, medical ethics committee, etc.) 2. Ask the department you managed to meet for their areas of gap of knowledge or attitudes. In simple words, what are the topics they are interested to make patients and or clinicians to be more aware of? 3. Decide among yourselves, after consulting the supervisor, on which topics are more relevant and feasible to do. 4. Discuss and decide on the activities you think should be there in the campaign. 5. Distribute the roles among yourselves (Who should do What When?) 6. Set you plan from preparation to delivery in a Gantt’s chart, or other time management/planning tool (MS Project Manager is a good one) 7. Have your plan approved by the relevant department, including the needed resources 8. Conduct the campaign as decided by the relevant department.

1. The educational material 2. The activity report 3. Certificates from the collaborating department with your names on them 4. Any educational or advocacy material that you developed for the campaign

3. Producing short film (documentary) on an ethical issue(5 marks)

- To produce a short video (3-30 minutes) that presents an ethical issue in a drama or documentary

1. Meet with your team and supervisor to choose a topic

2. Discuss the possible scenarios 3. Discuss and write the script 4. Distribute the roles among yourselves 5. Prepare the technical needs, e.g. video

camera, recorder...etc. 6. Set a time for video taping 7. Edit the video, and make it

presentable

A good quality finished edited video

4. Developing Ethics education material(3 marks)

- To develop a new educational material that can be used to educate a target group on one or more ethical issue

1. Meet with the group, the supervisor and the relevant department in the hospital 2. Decide on the topics you want to cover 3. Assess your target group’s pervious knowledge about the topic(s) 4. Discuss and decide on how best to present topic (brochure? poster? snowman in the main hospital’s entrance? BE INNOVATIVE)

The developed material and any other supporting material, e.g. photos for preparations or meetings.


5. Design and develop printed materials to be used in ethics education for patients, families, and staff

8. Short Play or scene(3 marks) - The purpose of this activity is to prepare a short play of one or more scenes that presents an ethical issue. - The main difference between this and the activity 3 (short movie) that it will be done live and not video-taped

1. Meet with your group and supervisor to decide on the ethical issue your role play will discuss 2. Start developing the script, including the distribution of roles 3. Rehearsal is very important. You need to give enough time to practice. Remember you will play it live!

A written Script and a play of a short role play (not more than 10 minutes) that presents and discusses an ethical issue

Movie review (3 marks) - This is bit more than watching a drama movie and cry! - you should watch a movie, if you don’t have religious reasons not to do, and answer a set of questions that are related to ethics:

What are the ethical issues discussed/presented in the movie?

Who did what wrong, ethically speaking? Explain why you think it is ethically wrong.

How would have you done, if you were in his/her position?

- Discuss with your team on the movie(s) that you have access to and talks about one or more ethical issues. - These links may give you some guidance: http://www.cityethics.org/Top10%20Ethics%20Films http://faculty.deanza.edu/burkelarry/stories/storyReader$163 - Watch a movie that presents a set of healthcare ethical issues - Write down your reflections on the movie with the answers for the mentioned questions.

An individual written movie review by each member with the answers to the related questions

9. Ethics consultation meeting (2 marks/ meeting)

- Almost every clinician faces an ethical issue/dilemma as s/he practices. Some of these issues need experts opinion to help in resolving them. - The purpose of this activity is to acquaint yourself to the process taken by ethics experts to help clinicians resolve ethical issues

- Coordinate with your supervisor to attend the next ethics-related meeting. - Attend the meeting on time, observe, and take notes of what took place in the meeting. - Write down your reflections on what you attended (what was the problem? who submitted it? What are the ethical issues at stake? How did the experts managed it and what have they recommended?)

Your reflections on each meeting should be written down and signed by the head of the committee, or your supervisor

10. Research ethics review meeting (2 marks/ meeting)

- Every research that involves human participants should be reviewed scientifically and ethically before being conducted. - The purpose of this activity is to acquaint yourself to the process taken by ethics experts to help researchers manage the ethical issues in their research before starting

- Coordinate with your supervisor to attend the next ethics-related meeting. - Attend the meeting on time, observe, and take notes of what took place in the meeting. - Write down your reflections on what you attended (what were the ethical points identified? How did the experts managed it and what have they recommended?)

Your reflections on each meeting should be written down and signed by the head of the committee, or your supervisor

http://www.cityethics.org/Top10%20Ethics%20Films

http://www.cityethics.org/Top10%20Ethics%20Films

http://faculty.deanza.edu/burkelarry/stories/storyReader$163

http://faculty.deanza.edu/burkelarry/stories/storyReader$163


It is the student's responsibility to:

1- Register for the intended activity individually (don’t expect that their leader or friend

will do it for the students)

2- Make sure that all the activities the students attended are recorded and signed by

their supervisor

3- Attach any published works and printed material with the logbook.

Final Exam

As for the mid-term exam, the final exam will be composed of (about X) MCQs, with one

best answer, and (X-Y) short essay questions. These may include short cases with questions

to answer, or the students are asked to "discuss" or "list". The weight of each MCQ and

short essay will be mentioned in the questions sheet.

Answering in either Arabic or English is allowed; however, each question should be

answered in only one language.

Course evaluation

The course will be evaluated through their feedback after each lecture and each test, or

exam. Their feedback is crucial to help improving the course for the students and for the

batches to come.

The items to be evaluated include the students’ satisfaction with:

A. Teachers’ ability to…

- Deliver the material

- Engage the students

- Use the teaching aids effectively

B. The content’s:

- Clarity of learning objectives

- Relevance of the presented material to the objectives

- Amount in the allocated time

- Method of delivery (lecture, case, group work, etc.) suitability to the content

C. The Exam’s…

- Format (MCQs, short essays, case analysis, etc.)


- Length

- Given time

- Relevance to the content

- Ratio of questions related to knowledge (vs. logical thinking)


Training manual on how to teach medical ethics to undergraduate medical students by non expert faculty staff

Documents

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