Techniques in Conscience Sensitive Medical Education
|9166||April 27, 2012||8|
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:
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.
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.
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.
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.
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.
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.
Gaffney M, Galvin M. Techniques in conscience sensitive medical education. MedEdPORTAL Publications. 2012;8:9166. http://doi.org/10.15766/mep_2374-8265.9166
- To engage in conscience sensitive tasks.
- To participate in a group discussion of each accomplished task.
- To explore the essential domains of conscience.
- To appreciate change and diversity in the contours of conscience across the lifespan and among individuals.
- 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.
- To promote recognition of moral dilemmas and identifies some strategies to manage their resolution.
- During this course, participants should be introduced to demoralization and harm prevention planning.
- Bioethical Principles, Bioethics, Conscience Domains, Conscience Sensitive Tasks, Intrinsic Values, Moral Development, Moral Dilemmas
This information is made available under the Creative Commons license.
- ACGME Memorandum (2002): ACGME General Competency Requirements.
- A Companion to Ethics, P. Singer, ed., Oxford: Blackwell Publishers Ltd, 1991.
- Bowlby J (1988): A Secure Base. Basic Books, New York.
- Branch W (2000): Supporting the Moral Development of Medical Students. J Gen Intern Med, 15:503-506. http://dx.doi.org/10.1046/j.1525-1497.2000.06298.x
- Chrousos G & Gold P (1992): The concept of stress and stress system disorders, overview of physical and behavioral homeostasis. JAMA, 267, 9: 1244-1252. http://dx.doi.org/10.1001/jama.1992.03480090092034
- Eckles R, Meslin E, Gaffney M and Helft P (2005): Medical Ethics Education: Where Are We? Where Should We Be Going? A Review. Academic Medicine, 80(12): 1143-1152. http://dx.doi.org/10.1097/00001888-200512000-00020
- Gaffney M, Galvin M, Abram J, Srinivasan M and Stilwell B (2005): Trying on the rings of Glaucon: conscience centered medical ethics.
- In Conscience Works, an On-line Periodical, Conscience and Ethics, 2(2):1-22. http://shaw.medlib.iupui.edu.
- Gaffney M, Galvin M, Stilwell B (2002): Conscience sensitive medical education. Conscience Works, an On-line Periodical, Conscience and Ethics, 1, (1): 1-17. http://shaw.medlib.iupui.edu
- Gaffney M, Galvin M and Stilwell B (2007): A conscience sensitive approach to ethics and teaching caring attitudes. In Conscience Works, an On-line Periodical, Conscience and Ethics, 3(1): 6-20. http://shaw.medlib.iupui.edu
- Galvin M, Stilwell B, Shekhar A, Kopta S, and McKasson S (1997): A dopamine beta hydroxylase and conscience functioning in emotionally disturbed boys. Child Abuse and Neglect, buse/neglect,21, 1: 83-92. http://dx.doi.org/10.1016/S0145-2134(96)00128-7
- Galvin M and Stilwell B (1997): Conscience in the mental health professional: from moral development to medical ethics with excursions in moral philosophy edited by M. Galvin and M. Gaffney. In Conscience Works, an On-line Periodical, Conscience and Ethics, 2 (1): 1-104, 2005. http://shaw.medlib.iupui.edu.
- Galvin M, Gaffney M, Stilwell B and Abram J (1997): Conscience Centered Psychiatric Ethics, A Course, Department of Psychiatry, Indiana University School of Medicine.
- Galvin M, Stilwell B, Adinamis A, and Kohn A (2001): Conscience sensitive psychiatric diagnosis of maltreated children and adolescents. Conscience Works, An On-line Periodical, Theory, Research and Clinical Applications. 1(1): 1-81.http://shaw.medlib.iupui.edu.
- Galvin M, Gaffney M, Stilwell B (2005): Preliminary observations and reflections on conscience sensitive group therapy. Conscience Works, An On-line Periodical, Theory, Research and Clinical Applications. 2(2): 1-23. http://shaw.medlib.iupui.edu
- Galvin M, Stilwell B, Gaffney M, Hulvershorn L (2009): The psychobiology of conscience; signatures in brain regions of interest. Conscience Works, An On-line Periodical, Theory, Research and Clinical Applications, 3(1): 1-36. http://shaw.medlib.iupui.edu
- Goenjian A, Stilwell B, Steinberg A, Fairbanks A, Galvin M, Karayan I, Pynoos R (1999): Moral development and psychopathological interference in conscience functioning among adolescents after trauma. Journal American Academy Child & Adolescent Psychiatry. 38 (4): 376-384. http://dx.doi.org/10.1097/00004583-199904000-00009
- Hoffman M: Empathy, social cognition, and moral action. In: Handbook of Moral Behavior and Development, Vol. I: Theory, Kurtines WM, Gerwitz JL, eds. Hillsdale, NJ: Erlbaum, 1991, pp. 275-301. http://dx.doi.org/10.4324/9780203763070
- Indiana University Conscience Project (2007): A guide to conscience. In Conscience Works, an On-line Periodical, Conscience and Ethics, 3(1) supplement: 1-32. http://shaw.medlib.iupui.edu
- Izard C (1977): Human Emotions. New York & London: Plenum Press. http://dx.doi.org/10.1007/978-1-4899-2209-0
- Jonsen, A and Toulmin, S (1988): The Abuse of Casuistry: A History of Moral Reasoning. Berkeley: University of California Press. http://dx.doi.org/10.1017/s0033291700022558
- Kagan J (1989): Temperamental contributions to social behavior. Am. Psychol 44: 668-674. http://dx.doi.org/10.1037/0003-066X.44.4.668
- Kirk K (1999): Conscience and Its Problems, An Introduction to Casuistry, with an introduction by D.H. Smith. Louisville, KY: Westminster John Knox Press.
- Kochanska G (1991): Socialization and temperament in the development of guilt and conscience. Child Development. 62, 1379-1392. http://dx.doi.org/10.2307/1130813
- Kochanska G (1993): Toward a synthesis of parental socialization and child temperament in early development of conscience, Child Development, 64, 325-347. http://dx.doi.org/10.2307/1131254
- Pellegrino E (1993): The metamorphosis of medical ethics, a 30 year retrospective. JAMA, 269, 1158-1162 http://dx.doi.org/10.1001/jama.1993.03500090094039
- Self D & Baldwin D (1994): Moral reasoning in medicine. In: Moral Development in the Professions: Psychology and Applied Ethics, J.R. Rest and D. Naváez, eds. Lawrence Erlbaum, Publishers, Hillsdale, New Jersey, pp. 147-162
- Schmetzer A (1997): Behavioral science -- best taught in a psychiatry course or a primary care course? Association of Directors of Medical Student Education in Psychiatry Newsletter, pp 6-8, Spring 1997. http://www.admsep.org/1997nl.html#Behavior%20Science
- Srinivasan M, Bodgewic S, Gaffney M, Galvin M, Mitchell G, Treadwell P, Willis L, Litzelman D (1999): “Effectiveness of a Faculty Development Program on ‘Teaching Caring Attitudes’” abstract, Journal of General Internal Medicine, v. 14, April (supplement 2), p.156.
- Srinivasan M, Litzelman D, Seshadri R, Lane K, Zhou W, Bodgewic S, Gaffney M, Galvin M, Mitchell G, Treadwell P and Willis L (2004): Developing an OSTE to address lapses in learners’ professional behavior and an instrument to code educators’ responses. Academic Medicine 79:888-896. http://dx.doi.org/10.1097/00001888-200409000-00017
- Stilwell B & Galvin M (1985): Conceptualization of conscience in 11-12 year olds. Journal of American Academy Child Psychiatry, 24: 630-636. http://dx.doi.org/10.1016/S0002-7138(09)60066-2
- Stilwell B, Galvin M and Kopta S (1991): Conceptualization of conscience in normal children and adolescents ages 5 to 17. Journal of the American Academy of Child and Adolescent Psychiatry, 30: 16-21. http://dx.doi.org/10.1097/00004583-199101000-00003
- Stilwell B, Galvin M, Kopta S & Norton J (1994): Moral-emotional responsiveness: two domains of conscience functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 1: 130-139. http://dx.doi.org/10.1097/00004583-199401000-00017
- Stilwell B, Galvin M, Kopta S, and Padjett R (1996): Moral valuation: a third domain of conscience functioning. Journal American Academy Child and Adolescent Psychiatry, 35, 2: 230-239. http://dx.doi.org/10.1097/00004583-199602000-00017
- Stilwell B, Galvin M, Kopta M, Padgett R, and Holt J (1997): Moralization of Attachment: a fourth domain of conscience functioning. Journal American Academy Child and Adolescent Psychiatry, 36(8): 1140-1147. http://dx.doi.org/10.1097/00004583-199708000-00024
- Stilwell B, Galvin M, Kopta S, and Padgett R (1998): Moral volition: the fifth and final domain leading to an integrated theory of conscience understanding. Journal American Academy Child and Adolescent Psychiatry, 37 (2): 202-210. http://dx.doi.org/10.1097/00004583-199802000-00013
- Sullivan J (2007): The conscience autobiography completed with commentary pertinent to Islam Conscience Works, An On-line Periodical, Conscience and Ethics, 2 (2): 24-63. http://shaw.medlib.iupui.edu
- The Patient-Doctor Relationship, an Introductory Course for First Year Indiana University Medical Students, ed. G. Mitchell, K. Gilkey, and M. Gaffney, Indianapolis: Indiana University Department of Medicine, 1993.
- Courses, Workshops and Presentations
- 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.
- Galvin M and Gaffney M: “Conscience Centered Professional Ethics” Workshop at Pleasant Run/Hamilton Center Alliance Family Service, Indianapolis, Indiana, 2/15/99.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Authors & Co-Authors
Margaret Gaffney, MD
Indiana University School of Medicine
Matthew Galvin, MD
Indiana University School of Medicine