A systematic scoping review of undergraduate medical ethics education programs from 1990 to 2020

Abstract

Introduction

Ensuring medical students are equipped with essential knowledge and portable skills to face complex ethical issues underlines the need for ethics education in medical school. Yet such training remains variable amidst evolving contextual, sociocultural, legal and financial considerations that inform training across different healthcare systems. This review aims to map how undergraduate medical schools teach and assess ethics.

Methods

Guided by the Systematic Evidence-Based Approach (SEBA), two concurrent systematic scoping reviews were carried out, one on ethics teaching and another on their assessment. Searches were conducted on PubMed, Embase, PsycINFO and ERIC between 1 January 1990 and 31 December 2020. Data was independently analysed using thematic and content analysis.

Results

Upon scrutinising the two sets of full-text articles, we identified 141 articles on ethics teaching and 102 articles on their assessments. 83 overlapped resulting in 160 distinct articles. Similar themes and categories were identified, these include teaching modalities, curriculum content, enablers and barriers to teaching, assessment methods, and their pros and cons.

Conclusion

This review reveals the importance of adopting an interactive, multimodal and interdisciplinary team-teaching approach to ethics education, involving community resource partners and faculty trained in ethics, law, communication, professionalism, and other intertwining healthcare professions. Conscientious effort should also be put into vertically and horizontally integrating ethics into formal medical curricula to ensure contextualisation and application of ethics knowledge, skills and attitudes, as well as protected time and adequate resources. A stage-based multimodal assessment approach should be used to appropriately evaluate knowledge acquisition, application and reflection across various practice settings. To scaffold personalised development plans and remediation efforts, multisource evaluations may be stored in a centralised portfolio. Whilst standardisation of curricula content ensures cross-speciality ethical proficiency, deliberative curriculum inquiry performed by faculty members using a Delphi approach may help to facilitate the narrowing of relevant topics.

Keywords:

• Medical education
• medical ethics
• teaching ethics
• assessing ethics
• medical school

Acknowledgements

The authors would like to dedicate this paper to the late Dr. S. Radha Krishna whose advice and ideas were integral to the success of this study. Assistance provided by Ms. Alexia Sze Inn Lee reviewing the manuscript was greatly appreciated. The authors would also like to thank the reviewers whose comments greatly enhanced this paper. No funding was received for this study.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Author contributions

All authors were involved in research design and planning, data collection and processing, data analysis, results synthesis, manuscript writing and review and administrative work for journal submission. All authors have read and approved the manuscript.

Data availability statement

All data generated or analysed during this study are included in this published article and its supplementary information files.

Additional information

Notes on contributors

Mun Kit Wong

Mun Kit Wong is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. He is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Daniel Zhi Hao Hong

Daniel Zhi Hao Hong is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. He is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Jiaxuan Wu

Jiaxuan Wu is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Jacquelin Jia Qi Ting

Jacquelin Jia Qi Ting is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Jia Ling Goh

Jia Ling Goh is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Zhi Yang Ong

Zhi Yang Ong is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. He is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Rachelle Qi En Toh

Rachelle Qi En Toh is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Christine Li Ling Chiang

Christine Li Ling Chiang is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Caleb Wei Hao Ng

Caleb Wei Hao Ng is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. He is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Jared Chuan Kai Ng

Jared Chuan Kai Ng is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. He is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Clarissa Wei Shuen Cheong

Clarissa Wei Shuen Cheong is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Kuang Teck Tay

Kuang Teck Tay, MBBS, recently graduated from Yong Loo Lin School of Medicine, National University of Singapore and is a House Officer.

Laura Hui Shuen Tan

Laura Hui Shuen Tan, MBBS, recently graduated from Yong Loo Lin School of Medicine, National University of Singapore and is a House Officer.

Yun Ting Ong

Yun Ting Ong is a medical student at Yong Loo Lin School of Medicine, National University of Singapore. She is presently an elective student at the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Min Chiam

Ms Min Chiam MSc (Medical Humanities), is a medical education researcher at the Division of Cancer Education, National Cancer Centre Singapore.

Annelissa Mien Chew Chin

Ms Annelissa Mien Chew Chin, MSc (Info & Lit), is a senior librarian at the Medical Library, National University of Singapore Libraries.

Stephen Mason

Dr Stephen Mason is the Research & Development Lead at the Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre.

Lalit Kumar Radha Krishna

Lalit Kumar Radha Krishna, Associate Professor, is a Senior Consultant at the Division of Cancer Education and the Division of Supportive and Palliative Care at the National Cancer Centre Singapore. A/Prof Lalit holds faculty appointments with the Centre for Biomedical Ethics, Duke-NUS Medical School and the Yong Loo Lin School of Medicine.