As in other areas of medical education, the evolution of teaching in medical ethics has been heavily shaped by the availability (or, for many programs, the scarcity) of qualified faculty. Throughout the 1970s and early 1980s, a central debate involved the question of whether medical ethics teaching should be done primarily by physicians or by those trained in the humanities, such as philosophy or religious studies. Mark Siegler, for example, stressed the ways in which the knowledge and professional experience of clinicians was central to an understanding of the true complexities and realities of clinical-ethical problems and their possible solutions. He therefore urged that primary teaching responsibility should lie with the physician-ethicist. Respected clinical teachers who emphasize the importance of medical ethics can be important role models who can help shape students' ethical sensibilities. On the other hand, strong reasons for using nonphysicians to teach medical ethics have been offered. First, many important aspects of the identification, analysis, and resolution of ethical problems in medicine do not fall within a physician's own specialized training or expertise, but depend instead on the intellectual background and analytic skills of individuals trained in other disciplines. Second, involving nonphysicians in teaching medical ethics can help sensitize students to the importance of other viewpoints and improve physicians' ability to communicate with nonphysicians—two primary educational goals. This controversy regarding who should teach has largely been replaced by a consensus that a variety of disciplines have important and distinct contributions to make.
The limited number of trained faculty, more than disputes regarding the academic background of those faculty, restricted the growth of ethics education. Many programs depended on faculty who, despite an interest in medical ethics, had little formal background in the field. Over time, this problem has abated as the number of faculty with prior training in ethics has increased. Moreover, in part to address this shortcoming, both short courses and longer master's programs in medical ethics have been developed around the world. The growth of healthcare providers with graduate training in ethics reflects the degree to which medical ethics has become integrated in the culture of medical education.
In their attempts to develop ethics curricula, medical ethics faculty have encountered a number of other barriers, including financial and time constraints, students' attitudes toward medical ethics, and the lack of reinforcement by other faculty (Strong, Connelly, and Forrow). Ethics teaching programs occupy a tenuous position in most medical schools. Although the inclusion of ethics test questions in certifying exams has improved this situation a bit, ethics training is rarely viewed as central to the education of physicians in the way that the "basic sciences" and traditional biotechnical clinical training are.
Economic constraints are a limiting factor in ethics education. Ethics education, conducted in small groups, is very faculty intensive. Moreover, at the same time that ethics has become integrated into medical schools, funding for teaching programs has decreased. This has happened during a period in which physicians are under increasing pressure to generate income. Thus, trained faculties' availability for teaching may again become a rate-limiting factor in ethics education.
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