This post is republished from Into Practice, a biweekly communication of Harvard’s Office of the Vice Provost for Advances in Learning
Dr. Sadath Sayeed, Assistant Professor of Global Health and Social Medicine, introduces issues of ethical reasoning in medicine (e.g., confidentiality, professional boundaries, conflicts of interest, informed consent) with hypothetical cases and vignettes.
The benefits: Discussing anonymized cases helps first-year students in “Medical Ethics and Professionalism” (one component of Harvard Medical School required course Essentials of the Profession) contend with abstract considerations and terminology: “For example: autonomy. It’s a ubiquitous term, but also an abstract idea. Grounding it in a real scenario helps students recognize it on a personal, subjective level, and appreciate its practical constraints.” Students establish their views through written response, peer discussion, and personal reflection.
The challenges: Traditionally “successful” medical students are hardworking, disciplined, and accustomed to being rewarded for their efforts, but these traits can distance future physicians from the lived experiences and challenges of their patients: “It’s much harder to master the art of being an effective communicator, ally, and friend to patients. To feel genuine empathy is difficult with little common experience in life and it is easy to be critical of those in poor health who struggle to make healthy life choices.”
Takeaways and best practices:
•Encourage frustration. Issues students find particularly difficult or interesting drive class discussion and tend to reveal disparate opinions. Sayeed refines and steers the conversation so that students appreciate how their own beliefs and values inform their position: “I try to impress upon students that there may be no ‘right’ answer and that they’re doing really good work mentally if they are struggling with or feel unsettled by the discussion.”
•Make it stick with personal experience. Sayeed encourages students to reflect on their own experiences: “I ask them to pause and imagine what they would want if they were the patient. It enables them to reflect on the inherent biases they bring to the clinical encounter as professionals with knowledge and power.”
•Define ‘learning role models.’ Students often ask Sayeed for his opinion as a practicing clinician. He shares his personal insights in an effort to model a conscientious practitioner, but reiterates the reality of ambiguous answers. “I tell them to look out for excellent role models: Who are the clinicians you would want for your own or your family’s care? Why? It’s probably because they make it clear that they care about their patient.”
Bottom line: Case analysis trains students to approach the world from another’s perspective, to understand their position of power, and to respect those in a vulnerable state. Sayeed hopes that students take from the course a little bit of humility about what they know, don’t know, and may never know: “If they start there, they will be fine physicians but, more importantly, compassionate people.”