Abstract
Teaching Ethics to Undergraduate Medical
Students
Pakistan is an Islamic country where overwhelming
majority Of undergraduate medical students are
Muslims.' In our settings thus moral ethical values
take their origin from religion and get reinforced by
religious knowledge.' This fact is of great advantage
to the educators in this country as they do not have
to advocate too strongly the practice of ethical
values. They only need to reinforce the faith of the
students in order to ensure observance of ethics by
the Students. Similarly the concept Of accountability
is built-in to religious beliefs and does not need any
different emphasis.' It appears that it will require
strong role modeling for this purpose'S However, for
those who have faith in Islam, the Holy Quran sets
the Holy Prophet asthe role model in these words:
033.21 Ye have indeed in the Apostle of God a
beautiful pattern (Of conduct) for anyone whose
hope is in God and the Final Day, and who engages
much in the Praise of God.
It is further reinforced by these words of the Holy
004.080 He who obeys the Apostle, obeys God.'
'Department Of Surgery
Islamic International
Riphah international University, Islamabad
ZDepartment of Medical Education
Institute of Health Professions Education and Research
Khyber Medico' University, Peshawar
'Department of Riphah Academy of Research and
Education
Riphah University Islamabad
Correspondence: Dr. Usman Mahboob
Assistant Professor, Medical Education
Institute of Health Professions Education and Research
Khyber Medical University, Peshawar
Email: usmammahboob@kmu.edu.pk
Whereas this fact does not lessen the requirement of
an appropriate faculty development program for
preparing role models, the very program has to focus
on the Holy Prophet as the role model.
Here, it is pertinent to refer to the concept of ethics in
Islam and its practice by the Muslim doctors. The
basis of ethical concepts in Islam is not client
satisfaction or professional responsibilities, but it is
the divine teachings conveyed to the mankind by the
Prophet Muhammad (PBUH).• This is in contrast to
the usual perception that the Islamic ethics is based
on Islamic law.' The origin of these concepts is not
any philosophical thought but the code created by
the Creator, Almighty Allah. A Muslim doctor is
bound to abide by the ethical principles of Islam not
by the reason Of client satisfaction or merely good
professional behavior but for the sake of his own
eternal salvation.
In the words ofthe Holy Quran:
099.007 Then shall anyone who has done an atom's
weight of good, see itr
190
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JIIMC 2015 vol. 10, No.3
Actions are dependent on intentions"
These explanatory notes are intended to put the
Islamic ethics in the right perspective before any
detailed deliberations are added on the topic. Islamic
medical ethics was documented formally by the chief
Muslim physician Of 970 A.D. Since then
many texts on Islamic bioethics have been
Many of them interpret Islamic ethics
in the perspective of philosophical ethical
foundations.'
Consistent with aforementioned facts, the
curriculum for medical ethics should be strongly
need-based and should be supported by religious
teachings in an Islamic state. Discrepancies in
practice and principles need to be specifically
recognized and addressed in the ethics curriculum.
The principle attributes of professionalism;
subordination of one's self interests, adherence to
high ethical and moral standards, responsiveness to
societal needs, and demonstration of humanistic
values can be best fulfilled in this manner.
A proposed outline of a S-year MBBS ethics course
may look like this:
The table shows many teaching and learning
strategies to teach Ethics however we have
mentioned two teaching learning strategies that will
be explained in detail. They are the 'one minute
preceptor' (0M p), and critical incident meetings.
One Minute preceptor
The OMP is a convenient learning strategy in which
the teacher provides feedback to the student
regarding a patient encounter that has taken place in
the presence of the teacher and the teacher has an
opportunity to watch the entire encounter. n Five
Ethiß
Table I: A proposed outnne Of a 5-vear MBBS ethics
Curricular
Years
content
Basic concepts,
religious
principles,
situational
ethics related to
ethical issues.
dilemmas and
conflicting
Situations.
Application Of
ethical
principles in
patient
e n COunterS,
demonstration
Of ethical
behaviors,
feedback on
ethical issues.
Behavioral
aspects of
ethics,
professionalism,
application of
ethics in patient
encounters,
ethical
judgments in
conflicting
situations,
ethics related
communication
skills
Teaching
strategies
I nteractive
lectures, small
group
discussions.
Task-based
learning (TBL).
PBL, role plays,
Case-based
learning (CBL),
critical incident
meetings. E
TBLs, OMPs,
role plays,
community
based learning,
reflection
sessions on
clinical
encounters and
critical
incidents.
Assess ment
tools
Written
examinations:
Mcas, EMQs,
SAQs, SEQs.
OSCES, peer
assessment,
assessment.
multisource
assessment.
oscEs, peer
patient
assessment,
multisource
assessment,
professionalism
mini-evaluation
exercise (P-
MEX).'O'
simple
OMP:n
1.
2.
3.
4.
5.
steps are followed by the teacher in the
Get a commitment
Ask for evidence
Teach a general principle
Appreciate good performance
Correct errors
The step 3 provides opportunity to a teacher to
recognize and address an ethical challenge in the
encounter and provide essential corrective or
narrative feedback.
191
Critical Incident Meetings
The earliest studies related to critical incident
technique arose from failure of the American pilots
to learn flying. Further studies continued in the
same context of aviation psychology. u The critical
incident technique in its developed form was
described by Flanagan in 1954.19 He defined an
incident as "any observable human activity that is
sufficiently complete in itself to permit inferences
and predictions to be made about the person
performing the act."" In order to be critical the intent
behind the act should be fairly obvious by the
situation in which it occurs. In its practical form, the
activity is carried out in a small group format in a safe
educational environment. An ethically challenging
situation is described as a critical incident and
reflections are invited by the group participants.
There is no absolutely right or wrong answers to the
situation and only opinions and points of view are
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JIIMC 2015 vol. 10, No.3
presented, discussed and reflected upon.
Development of a safe educational environment
appears to be a problem." It provides the
participants discuss the issues of beneficence, non-
maleficence, autonomy, and justice.
Assessi ng Professional Ethics
Assessment instruments for professional ethics with
good validity and reliability are scarce.n» Some of
these instruments for such assessments have been
mentioned in the table l.
The appropriate assessment instrument for OMPs is
OSCE. A Short patient encounter may be thoroughly
simulated in a tactfully prepared OSCE with a
judicious use of standardized patients (SP).
Standardized patients (SP) training may pose a
problem particularly if specified behavior patterns
are to be simulated, such as breaking bad news,
obtaining informed consent for surgery, or conflict
resolution.
Assessment Of critical incident meetings may be
multisource assessment, and peer assessment. Such
an assessment may be useful for formative purposes
but its use as summative evaluation appears to be
difficult.
Khalid Farooq Danish, Usman Mahboob, Rahila Yasmeen. (2015) Teaching Professional Ethics in Undergraduate Medical Education: An Islamic Perspective, Journal of Islamic International Medical College, Volume-10, Issue-3.
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