Techniques in Conscience Sensitive Medical Education

Publication ID Published Volume
9166 April 27, 2012 8

Abstract

The resource offered is teaching material for an interactive conscience sensitive approach to ethical and professional practices. The resource provides a coherent translation of evidence based moral developmental psychology not only to moral decision making and moral dilemma resolution but also to personalized harm prevention planning. The resource has been incorporated in an Introduction to Medicine (Doctor-Patient Relationship course), in a senior elective course in ethics and in CME. It provides a stepwise progression from an appreciation of the domains of moral psychological development to an awareness of these in contouring personal conscience and thence to the reflective shaping of professional conscience. It provides techniques useful in conscience sensitive approaches to patient interviewing and in acquiring deeper knowledge of and respect for the values of those served.

Conscience sensitive tasks are in the form of operationally defined exercises that expand mindfulness of intuitive, tacit or implicit moral decision-making processes and strengthen insightful and deliberative processes. A brief description of the conscience sensitive tasks follows:

  1. Learners are asked to render an image of personal conscience. Teachers provide developmental background on Theory of Mind (human mentalizing capacity) and assist the group in arriving at a composite conscience. DOMAIN: Conscience Conceptualization or Moral Imagination. INTRINSIC VALUE: Moral Meaning Making.

  2. Learners are asked to construct and share moralized genograms. Teachers provide developmental background on Attachment and assist the group in appreciating its ramifications in professionalism. DOMAIN: Moralized Attachment. INTRINSIC VALUE: Connectedness.

  3. Learners are asked to compose letters of gratitude to imaginary persons who have helped or letters of apology to imaginary persons who have been harmed. Teachers provide developmental background on relevant topics such as Affective Regulation, Harm Recognition, influences of approbation and disapprobation on moral emotions and will promote discussion of what strengthens and what weakens amendatory and reparative strategies. DOMAIN: Moral Emotional Responsiveness. INTRINSIC VALUE: Balance.

  4. Learners learn to use the Value Matrix. Teachers assist the group in arriving at moral dilemmas and approaches to moral dilemma resolution. DOMAIN: Moral Valuation. INTRINSIC VALUE: Respect. In this process, the learner is introduced to approaches to ethics, namely: intuitionist, deontological, consequential and virtue or care based. Teachers bridge from values that are considered intrinsic to personal conscience functioning for the sake of which a person negotiates accommodations respecting worth (authority, peers and self) and freedom to traditional bioethical principles (beneficence, non-maleficence, justice and autonomy).

    However the teacher also assists the learner in recognizing the possible transformation of three other values intrinsic to personal conscience into professional conscience, namely: moral meaning making, connectedness and moral emotional balance.

  5. Utilizing a template, learners engage in and present their ideas for personalized Demoralization and Harm Prevention Plans. Teachers discuss relevance of competency in self awareness and the processes of reflective supervision among the forms of help-seeking. DOMAINS: Moral Valuation and Moral Volition. INTRINSIC VALUES: Freedom and Responsibility.

The course materials being submitted have been effectively incorporated in an Introduction to Medicine I (ICM I) course conducted in twenty two hour sessions in the first year of medical school 1997-present. A small pilot study was conducted to assess effects of the materials.

Pilot Study

The purpose of the study was to measure the degree of change before and after the above described educational intervention. The responses were collected over a two-year period from the first year medical students participating in the ICM I small groups. Each of 16 ICM I students responded to a moral dilemma case before and after the educational intervention. Conscience sensitive criteria were developed which expanded upon competency criteria related to Moral Reasoning and Ethical Judgment, level 1. Responses were transcribed and coded so that the scorer was blind to the identities of the students. The average responses pre and post were 6.7 and 10.7 respectively, representing a positive change of 4.1 with a standard deviation of 4.9. The median pre and posttest scores were 6.5 and 9.8 respectively. The minimum change was –5 (only one student actually dropped) and the maximum was +12. The sample size was not deemed large enough to do a meaningful test of statistical significance.

Citation

Gaffney M, Galvin M. Techniques in conscience sensitive medical education. MedEdPORTAL Publications. 2012;8:9166. http://doi.org/10.15766/mep_2374-8265.9166

Educational Objectives

  1. To engage in conscience sensitive tasks.
  2. To participate in a group discussion of each accomplished task.
  3. To explore the essential domains of conscience.
  4. To appreciate change and diversity in the contours of conscience across the lifespan and among individuals.
  5. To construct bridges from an understanding of the psychological nature of conscience to bedrock human values and from bedrock human values to healing professional values.
  6. To promote recognition of moral dilemmas and identifies some strategies to manage their resolution.
  7. During this course, participants should be introduced to demoralization and harm prevention planning.

Keywords

  • Bioethical Principles, Bioethics, Conscience Domains, Conscience Sensitive Tasks, Intrinsic Values, Moral Development, Moral Dilemmas

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  39. Courses, Workshops and Presentations
  40. Galvin M, Gaffney M and Stilwell B: “Conscience Centered Psychiatric Ethics” Issues Workshop 103, American Psychiatric Association 151st Annual Meeting, Toronto, Canada, 6/4/1998.
  41. Galvin M and Gaffney M: “Conscience Centered Professional Ethics” Workshop at Pleasant Run/Hamilton Center Alliance Family Service, Indianapolis, Indiana, 2/15/99.
  42. Galvin M, Gaffney M and Stilwell B: “Conscience Centered Professional Ethics in Child Psychiatry” Workshop at The Academy of Child and Adolescent Psychiatry Annual Meeting, Chicago, Illinois, 10/23/99.
  43. Galvin M and Gaffney M: “Conscience Centered Professional Ethionscience Centered Professional Ethicscs" Workshop at Annual Meeting Association for Moral Education, Minneapolis, Minnesota, 11/18/99.
  44. Galvin M, Gaffney M and Stilwell B: “Conscience Centered Medical Ethics” I.U. School of Medicine Program in Medical Ethics Workshops for Faculty 8/28/98, 12/05/00, 12/07/00.
  45. Gaffney M, Galvin M and Stilwell B: “A Conscience Sensitive Approach to Ethics and Teaching Caring Attitudes.” Paper submission and presentation by Dr. Gaffney, Boston Colloquium for Philosophy of Science, 46th Annual Program, The Robert S. Cohen Forum: Contemporary Issues in Science Studies: Values, Ethics, and Medical Science: The New Medical School Curriculum. Boston University, Boston, Massachusetts, 9/23/05.
  46. Gaffney M and Galvin M: “Conscience and Medical Education” Presentation at Seventeenth Annual Meeting Association for Practical and Professional Ethics, San Antonio, Texas, 2/22/08.
  47. Gaffney M and Galvin M: “A Conscience Sensitive Approach to Ethics and Teaching Caring Attitudes” Grand Rounds John J Conley Department of Ethics, St Vincent Catholic Medical Centers St Vincent’s Manhattan(New York Medical College Office of CME)Ethics Faculty Development Series, 10/16/08.
  48. Gaffney M: “A Conscience Sensitive Approach to Ethics in Early Childhood Fields” Thirteenth Annual Meeting of the Indiana Association for Infant and Toddler Mental Health, Riley Hospital for Children, Indianapolis, Indiana, 8/12/11.

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