Medicine

Education in medical ethics is as old as medical education itself. The Hippocratic school of medicine of fourth-century b.c.e. Greece is best remembered for the Hippocratic oath, which has provided moral guidance to students of medicine for more than two millennia.

For most of medicine's history, efforts to inculcate ethical precepts relied on the apprenticeship model, through which medical students were guided in the simultaneous development of their knowledge, technical skill and judgment, and evolving sense of proper professional conduct (Bosk). Direct observation and emulation were the primary methods apprentices used to develop clinical judgment regarding right action.

In the second half of the twentieth century, however, the emerging field of biomedical ethics catalyzed a radical reexamination of the ways in which students learn to understand and manage ethical issues that arise in professional medical practice. Initially, this effort was led by nonphysician humanists—philosophers, theologians, and others—who developed interests in applied ethics and the medical humanities. In the early 1970s, medical schools, led by Penn State University, hired these humanists and began to offer first elective, then required, ethics courses for medical students. Rather than concentrating on the importance of mentorship and role modeling, these courses were rooted in a philosophical model, stressing ethical concepts such as autonomy and the importance of learning to apply ethical principles to discern the proper course of action. Lectures and seminars became the dominant method used to teach these cognitive skills. Unfortunately, with rare exceptions, the content of ethics training, particularly in the clinical years, has been either on the extreme ends of life or on technological innovations rather than on the day-to-day work of doctoring or justice-based concerns. Starting in the late 1990s, the difference in goals and methods between an apprenticeship model and a philosophical model of teaching medical ethics began to blur as programs focusing on professionalism arose. These programs concentrate more on physician character and offer the opportunity for medical ethics to focus more on the mundane ethical issues of doctoring.

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