Etika dalam pembelajaran

klinik
Dr. Mufdlilah, S.SiT., MSc
Universitas ‘Aisyiyah Yogyakarta
 “students should acquire a knowledge and understanding of
ethical and legal issues relevant to the practice of medicine
and an ability to understand and analyse ethical problems so
as to enable patients, their families, society, and the doctor to
have proper regard to such problems in reaching decision”
(General Medical Council, 1993)
 Teaching Clinical Ethics
Why?

Prof. Alan Rubinow M.D. Hadassah-Hebrew University Medical School

 Why Teach Ethics?

Much debated:

“ if you can’t evaluate it, don’t teach it”

Prof. Alan Rubinow M.D. Hadassah-Hebrew University Medical School

 Teaching Clinical Ethics

Justification
Practice of medicine moral issue
Clinical medicine more than technical skills
Ethics has its own content and method
Ethics is as teachable as any discipline
Make ethically defensible decisions
 Goals of Teaching Ethics
Philosophy of medicine/principles
Sensitize students to value issues
Teach moral reasoning
Highlight the uniqueness of patient- doctor
relationship
Place medicine in broader, social, professional
perspective
Not to teach students to be ethical
Teaching Clinical Ethics

What?
 Teaching
Ethics and Professionalism

• What concepts should be

• highlighted in a course designed to
• foster empathy, respect,
• responsibility and commitment?
 “… initiatives for teaching medical humanities
and bioethics have the goal of turning high-tech
medical performance into a high-touch one in
which the human essence is revalued”

Prof Donatella Lippi Bull.Med.Ethics (2005)

 Topics in Clinical Ethics
Philosophy and medicine
Informed Consent
Truth-telling
Confidentiality
Justice, resource allocation:
macro/micro
Transplantation Ethics
Ethical issues in HIV/AIDS
Maternal-fetal conflicts
Family-dispute resolution
Ethical issues in surgery
Theories and principles
Brain death, dying, DNR
Advance directives
Disclosing mistakes
Ethical issues in pediatrics
Ethical issues in psychiatry
Ethical issues in intensive care
Patients who refuse food/water
Research on human subjects
Ethics in geriatric care
Ethics in stem-cell research
Teaching Clinical Ethics

When?
 Clinical Ethics
Throughout the Medical Curriculum and Clinical
Practice
Pre-clinical - intellectual tools
- interpersonal skills

Clinical - teaching essential in clinical years

- ethics only relevant in resolving
practical questions
- integrated into medical curriculum
Teaching Clinical Ethics

Who?
 Clinical Ethics

Physicians vs non-physicians
Consensus : physicians with adequate ethics training
Benefits of clinician teaching ethics
- credibility with students
- serve as role models
- bring relevant experience/ cases

•
Teaching Clinical Ethics

How?
 How to Teach Ethics?

Frontal lectures
Seminars (small groups)
Programmed, simulated patients
Role - playing
Video interviews
Case studies
Teaching ethics in small groups
• Use cases and vignettes
• Create a safe envirotment
• Use students’ names
• Set out ground rules
• Encourage discussion
• Allow experiences to be shared
• Aim to develop:
- tolerance
- the ability to cope with ambiguity
- the ability to appreciate different views
Teaching ethics to large groups

• Keep the session interactive

• Use video clips and other media
• Set up an ethics debate
• Divide the students into ‘buzz’ groups
• Team-teach with others
• Vary the style and pace
The Bristol Approach
• Student-centred teaching
• Patient-centred ethics
• Structured and incremental
• Case-based
• Grounded in theory but applied to clinical practice
• Inclusive and humanistic approach
• Team-teaching wherever appropriate
• Interactive and non-didactic
• Opportunity for discussion within a safe environment
• Positive critique employed throughout
How Bristol was able to develop ethics teaching
• A clearly visible senior academic leader
• Dedicated academic and support staff
• A physical focus for ethics learning in the form of the new centre
• Policy documents which strongly emphasised the requirement for
medical ethics teaching
• Synchronicity of a major process of medical curriculum change
across the UK
• A remit to coordinate and improve ethics teaching across the
curriculum
• The enthusiasm of fellow teachers and student to embrace the
teaching of medical ethics
Faktor-faktor yang mendasari etika

– Nilai-nilai
– Norma
– Sosial budaya
– Religus
– Kebijakan
Masalah yang dihadapi terkait kode etik dalam
pengajaran klinik
• Kurang waktu untuk membimbing
• Dianggap semua mahasiswa sama bisa semua
• CI langsung tegur depan pasien
• Tidak mengayomi mahasiswa
• Langsung memberi contoh full dan hanya meminta
tolong saja tanpa breafing.
 Teaching Medical Ethics

“ ability to present a conceptual

framework that students (and young
physicians) can grasp and build on and to
create a teaching milieu which fosters
self-criticism and personal development
”
S. Benatar. 1991
 Summary

• A good understanding of medical ethics is central to

the practice of good medicine.
• Ethics teaching is able to benefit from the synthesis
of many approaches from the arts humanities, and
law, science, technology and medicine.
 Thank you
“Medical education is nol completed at medical school: it is only
begun” (Wiliam H Welch, 1850-1934)