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Journal of Pharmacy & Bioallied Sciences logoLink to Journal of Pharmacy & Bioallied Sciences
. 2024 Mar 5;16(Suppl 3):S1900–S1902. doi: 10.4103/jpbs.jpbs_1250_23

Illuminating Medical Education Through Moral Case Deliberations: A Narrative Review

Saurabh RamBihariLal Shrivastava 1,, Ujwal Gajbe 2, Brij Raj Singh 2, Prateek Saurabh Shrivastava 3, Nandkishor J Bankar 4, Manju Chandankhede 5
PMCID: PMC11426798  PMID: 39346247

ABSTRACT

In the field of medical education, moral case deliberations refer to a structured process, wherein health professionals together discuss and analyze moral issues or ethical dilemmas encountered in their clinical practice. The purpose of the current review is to explore the merits of moral case deliberations, identify the components, enumerate the strategies that can be used for implementation, and enlist the potential challenges and the remedial measures to overcome them. Moral case deliberations can be implemented in medical education in several ways that can be seamlessly integrated into the existing medical curriculum without stretching the overall duration of the training period. The path to successfully implement moral case deliberations in a medical school has its own share of challenges, and we must be aware of them to adopt countermeasures to overcome them. In conclusion, moral case deliberations play a vital role in augmenting ethical competence and establishing a culture of reflective practice among medical students. As medical students are bound to encounter multiple ethical dilemmas in their future clinical practice, it is our responsibility to incrementally expose them to such cases as a part of their undergraduate training to eventually prepare them for effective healthcare delivery.

KEYWORDS: Medical education, moral case deliberations, reflections

INTRODUCTION

In the field of medical education, moral case deliberations refer to a structured process, wherein health professionals together discuss and analyze moral issues or ethical dilemmas encountered in their clinical practice.[1] As a part of these deliberations, medical professionals discuss the moral scope and principles with reference to the selected cases.[1] The objective of such deliberations is to develop a common understanding of the ethical aspects of the given situation and use the same to arrive at morally informed decisions.[2] This approach plays a defining role in the improvement of ethical competence, encouragement of effective communication, and promotion of a better understanding of the complexities involved in healthcare.[1,2] The purpose of the current review is to explore the merits of moral case deliberations, identify the components, enumerate the strategies that can be used for implementation, and enlist the potential challenges and the remedial measures to overcome them.

Merits of moral case deliberations

Moral case deliberations have been linked with multiple benefits to medical students, which is crucial to developing a competent and compassionate cohort of healthcare professionals.[2] The first benefit of such deliberations is in terms of the development of ethical competence, which helps the student to effectively respond to ethical dilemmas in their clinical practice.[1,2,3] Students who are involved in these discussions gradually learn the art of critical thinking because they cannot decide till they discuss the given case from different perspectives and that too keeping ethical principles in mind.[3] Furthermore, students can also enhance their learning by indulging in reflective behavior, wherein students have to reflect on their personal values and beliefs within the ethical context.[4] Also, as students engage in discussions on the given scenario, they soon realize the importance of being respectful toward their peers, and this eventually results in improvement in their communication skills.[2,5]

In addition, owing to the exposure to a wide range of ethical cases, students realize the importance of sociocultural and personal attributes in making ethically sound decisions.[1,3,6] As students realize that their ethical decisions are influencing the well-being of patients, they must give priority to patients (learn the art of patient-centered care).[7] In the process, students become aware of the legal and ethical dimensions of medical practice. Finally, students become confident in dealing with ethical dilemmas and also become motivated to make efforts to stay abreast with recent developments (lifelong learner).[2,5,7]

Components of moral case deliberations

The first and foremost step in moral case deliberations is to identify the issues in clinical scenarios that might have ethical implications.[4] This is followed up by fruitful and meaningful discussions between medical students to enable thorough analysis of the identified complex issues.[4] In these discussions, perspectives, interests, beliefs, and views of all the involved people are discussed, enabling a comprehensive analysis of the identified issues on ethical grounds predominantly.[8] It is expected that participating medical students must take into account the principles of ethics for deciding a plan of action, which is consistent and transparent.[9] Another important facet of these deliberations is to consider the potential consequences of each decision, not only on the involved patient, but also on the extent of trust of patients, and on the healthcare facilities.[9,10]

Moral case deliberations: Points to ponder

We must aim to identify the potential issues that must be looked into to ensure the ethical development of medical students and healthcare professionals. To enhance the effectiveness of these deliberations, teachers must possess clarity in ethical principles, moderating discussions, and creating an environment for fruitful discussions.[11] This can be accomplished by organizing a series of faculty development programs, including refresher training.[11] Like any other teaching-learning session, we must specify learning objectives for the discussions because it will keep the sessions focused and in alignment with the learning outcomes and the curriculum.[2,3]

There is an immense need that students must feel comfortable when they share their opinions during deliberations, and this will essentially require the creation of a safe and respectful learning environment.[11] To enhance inclusivity and to prepare holistic medical professionals, we must encourage the selection of a wide range of cases because it will expose students to multiple ethical dilemmas.[2,3,7] Furthermore, it is advised to use a wide range of teaching approaches during these sessions to accommodate the learning needs of students with varied preferences and learning styles.[11] Furthermore, we can even involve students from other disciplines to promote collaboration and communication among them to give them a feel of interdisciplinary practice.[1,2,3]

Strategies to implement moral case deliberations

Moral case deliberations can be implemented in medical education in several ways that can be seamlessly integrated into the existing medical curriculum without stretching the overall duration of the training period. By all practical means, the Attitude, Ethics, and Communication Module (AETCOM) presents an ideal opportunity for medical educators to expose students from all professional phases to such kinds of moral case deliberations.[12] As the role of teachers will be the actual catalyst in the success of such deliberations, there is an immense need to organize faculty development programs and sensitize them on ethics and train them to integrate these deliberations in existing theory or practical sessions.[11] We can develop case-based learning modules with a component of ethical dilemmas to motivate students to participate in these discussions.[2] The same thing can also be integrated during simulation training with or without standardized patients because this gives students a chance to apply moral case deliberations in a realistic environment.[2,3] At Datta Meghe Medical College, Nagpur, the Off-Campus of Datta Meghe Institute of Higher Education and Research, Deemed-to-be University, Sawangi, Wardha, Maharashtra, medical students from different professional phases are being exposed to different practical and ethical case scenarios as a part of the AETCOM training to prime them for their future clinical practice. Further, we can use different small group discussions to promote active engagement and encourage collaboration among students.[12]

Probable barriers and potential solutions

The path to successfully implement moral case deliberations in a medical school has its own share of challenges. Primarily, every student might adopt different ethical frameworks due to which students might not reach common ethical decision, and this can be overcome by sensitizing all students about common ethical frameworks.[1,2] At the same time, personal bias and values can also influence the deliberations and thus we must sensitize the students to always adopt a rational approach while deciding about patients and not be biased.[2,3] Further, we must orient students about cultural competencies before subjecting them to moral case deliberations to avoid any cultural issues.[3,4]

Students might feel reluctant to express their views freely if some of the participants are from senior batches, and thus, we can involve students from the same batch, at least during initial sessions. To avoid resistance from teachers, they must be trained about the benefits of these deliberations.[11] It is quite essential that we must safeguard the privacy of the patient while discussing these cases, and all precautions should be taken to maintain patient confidentiality.[7] Finally, it is not easy to assess ethical competence among medical students, and thus, we must carefully adopt a combination of both quantitative and qualitative assessment tools to measure the same.[13]

CONCLUSION

In conclusion, moral case deliberations play a vital role in augmenting ethical competence and establishing a culture of reflective practice among medical students. As medical students are bound to encounter multiple ethical dilemmas in their future clinical practice, it is our responsibility to incrementally expose them to such cases as a part of their undergraduate training to eventually prepare them for effective healthcare delivery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

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