While shadowing a surgeon for a day as a medical student at Mayo Clinic Alix School of Medicine, Nicholas R. Jarvis mentioned having completed an ethics minor as an undergraduate. In turn, the surgeon, Chad M. Teven, MD, MBA, FACS, HEC-C, noted having completed a Clinical Ethics Fellowship. The discovery of a mutual interest in ethics sparked a larger discussion of the medical school’s ethics curriculum and general trends in medical ethics education. This spurred Jarvis to review the literature, which revealed that there had not been a national survey regarding the state of medical ethics curricula in nearly 20 years.1
Teven, Jarvis, and colleagues decided to conduct a study to learn more about ethics course content at U.S. medical schools. The researchers surveyed 61 course directors and administrators.2 Some key findings:
• All respondents reported having some type of formal ethics education for first-year medical students.
• Most (89%) respondents reported having a formal mandatory introductory course.
• Most schools used lecture and small-group teaching methods, with participation, attendance, and knowledge-based exams used for assessment.
• Most respondents indicated that ethics was equally or more important than other foundational courses.
• Sixty percent of respondents provided faculty with training specifically for teaching ethics.
“As the amount of preclinical curricular time dwindles and the number of topics taught continues to rise, it can be challenging to afford each subject the time that it deserves,” says Jarvis, now a plastic surgery resident at Cleveland Clinic. Since each school deals with these challenges differently, each ethics curriculum takes a different form. “Given the relatively brief amount of time that ethics is formally taught in medical schools, this leads to inconsistencies in what is taught, how it is taught, and how students are evaluated,” says Jarvis.
Medical schools are meeting the standards for ethics education as set by the Liaison Committee on Medical Education. “However, there will always be room to fine-tune these standards,” says Jarvis. For example, the American Society for Bioethics and Humanities provides a guidance on concepts, topics, and skills to incorporate into a four-year ethics curriculum.3
“There is a shift towards a multidisciplinary approach for teaching the humanitarian side of medicine,” reports Jarvis. Medical schools are incorporating the principles of ethics into discussions of healthcare disparities, professionalism, and cultural competency. Some medical schools are integrating simulated patient encounters and role-playing into the ethics curriculum. “This is a method of introducing medical students to the intricacies of the physician-patient relationship and the ethical dilemmas that arise in everyday practice,” says Jarvis.
Inconsistencies in ethics curricula are, in part, an indication that medical schools are experimenting with new methods of training ethical physicians, suggest the authors. The authors hope that the study’s findings will spur institutions to engage in discussions about the best approaches for ethics education. “This hopefully will lead to a more standardized, effective, and meaningful ethics experience for medical students,” says Jarvis.
Overall, the state of medical ethics education in the United States has improved significantly in recent years because of the concerted efforts of many stakeholders who recognize the benefit of it, reports Teven, an assistant professor of surgery at Northwestern University Feinberg School of Medicine.
However, as the study showed, ethics instruction still varies widely at medical schools in terms of the content taught and the amount of time allocated. “To that end, a significant opportunity is to identify key concepts that ought to be taught universally,” offers Teven. This would ensure a baseline level of ethics education, better preparing medical students and residents to face challenging ethical dilemmas.
In Teven’s experience, there is no shortage of interest among students. “As an early-career academic surgeon with a background in ethics, I see a growing interest in ethics,” Teven reports. “Students are looking for opportunities to learn more about it, to participate in ethics-related research projects, and to gain additional formal instruction.”
- Lehmann LS, Kasoff WS, Koch P, Federman DD. A survey of medical ethics education at U.S. and Canadian medical schools. Acad Med 2004;79:682-689.
- Jarvis NR, Meltzer EC, Tilburt JC, et al. Ethics education in U.S. allopathic medical schools: A national survey of medical school deans and ethics course directors. J Clin Ethics 2023;34:328-341.
- American Society for Bioethics and Humanities. ASBH Task Force on Ethics and Humanities Education in Undergraduate Medical Programs. 2009. https://bit.ly/47pcCpW
