Review of ethics curricula in undergraduate medical education

TLDR

Medical ethics education has matured into a formal component of undergraduate medical curricula, with broad agreement on core content but ongoing debate over teaching methods, resources, assessment, and the influence of the hidden curriculum. This review aims to examine the background and consensus on ethics curriculum design in undergraduate medical education and to highlight the need for empirical evaluation studies. The authors analyze curriculum design using Harden’s curriculum and S.P.I.C.E.S models, and propose that identified debate areas serve as a basis for future evaluation studies.

Abstract

Medical ethics education, it has been said, has 'come of age' in recent years in terms of its formal inclusion in undergraduate medical curricula. This review article examines the background to its inclusion in undergraduate curricula and goes on to examine the consensus that has arisen on the design of ethics curricula, using Harden's curriculum and S.P.I.C.E.S models as templates. While there is consensus on content for undergraduate medical ethics education, there is still significant debate on learning and teaching methods. Despite the broad agreement on the need to apply adult education principles to ethics teaching, there would appear to be some tension between balancing the need for experiential learning and achieving the 'core curriculum'. There are also as yet unresolved difficulties with regards to resources for delivery, academic expertise, curriculum integration and consolidation of learning. Assessment methods also remain contentious. Although there is consensus that the ultimate goal of medical ethics, and indeed of medical education as a whole, is to create 'good doctors', the influence of the 'hidden curriculum' on students' development is only beginning to be recognized, and strategies to counteract its effects are in their infancy. The need for proper evaluation studies is recognized. It is suggested that the areas of debate appearing in the literature could be used as a starting point for evaluation studies, which would form the empirical basis of future curriculum development.