Does Medical School Educate for Professional Values Brezis

Does Medical School Educate for Professional Values? Brezis M, Butt O, Haimov T, Shapiro S, Ilan U, Cohen R, Tal M, Rubinow A Hadassah-Hebrew University Medical Center Jerusalem, Israel

Professional schools, such as medical, nursing, business and law schools, do not educate for values Professor Lee Schulman President, Carneggie Foundation for Education

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Misconduct is a global challenge www. transparency. org

One-third of researchers surveyed in China admit to plagiarism, falsification or fabrication of data. Nature (2010) UK journal Acta Crystallographica retracted 70 published crystal structures - fabrications by researchers at Jinggangshan University in Jiangxi province. Tainted Heparin from China Cause 81 Deaths in U. S. ad Le s oy n. T i Tainted milk scandal resurfaces in China

Industry’s Misconduct Involves Professionals

Cheating at Israeli Universities Self Reported Cheating at Nine Law Faculties N=788 students Cheshin Y, 2002, 2005

Cheating at Medical School Rate of Students Admitting Violations (≥ 2, at exams, assignments or clinical activities) E. g. , performing intimate examinations without receiving patient’s consent Response rate 80% 97% Teachers viewed students’ dishonesty problems as not part of their job to deal with them 31% O. Butt The Medical Teacher 2009

No easy solutions to cheating Technical (e. g. camera surveillance): limited and easily defeated by student’s creativity Disciplinal: heavy to implement because of legal implications

Physicians in Health Care Corruption • • Fabricated Research Pharmaceuticals or Devices Dubious Research on Pollution Misconduct in Management

Lifestyle Education Survey of Final Year Medical Students in a Leading Faculty (representing 1/3 of students concluding studies in Israel) Percentage of Students % T. Haimov, The Medical Teacher, 2009

“Practicing a healthful behavior was shown to be the most consistent and powerful predictor of physicians counseling patients about related prevention issues” Nutrition 2009, 25: 532 & review from the Centers for Disease Control and Prevention 2009

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Attitude Towards Organ Donation Survey of Medical Students (N=192) and Teachers (N=68) Percentage %

In recent years, our school has changed the admission process with inclusion of psychological testing to select students with a more desirable personality. Our school has also introduced a program of humanistic courses. Has cheating decreased?

In your opinion, was there a cheating problem at the last exam? N=96 No I cheated myself I helped others cheating 1 -5 students cheated 5 -10 students cheated 10 -30 students cheated Over 30 students cheated %

Do you see a problem in cheating? % I don’t have a problem with this behavior I have a problem with this behavior and I oppose it

“You, teachers, look only at our grades” Students see a system of competitive evaluation & incentives (e. g. scholarships), exclusively based on factual knowledge and not on attitudes, behavior, skills & values Knowledge is less important than the ability to admit you don’t know and the skills to find out answers to what you don’t know At medical school students unlearn to say “I don’t know”

Overconfidence Among Medical Students in Cognitive Biases (à la Kahneman & Tversky) Don’t know % 1% A cab hits in hit-and-run accident. 15% of cabs are blue, 85% are green. An eyewitness states cab in accident was blue; its testimony has sensitivity & specificity of 80%. What is the chance that a blue cab caused the accident? 1% You donated blood, out of good health. HIV test is positive. The sensitivity and specificity of the test are 99% each. What are is chance you are HIV carrier?

Overconfidence Among Medical Students in Ethical Question Don’t know % Yes * General Population Medical Students N=290 *p<0. 01 N=580 Should Oocyte Cryopreservation Be Allowed for Personal Reasons?

Overconfidence & Assertiveness Are Detrimental to Critical Professional Abilities ü ü ü Admit “I do not know” Tolerate uncertainty & ambivalence Respect patient’s & family’s views Team work Admit error/suboptimal performance Ability to change & improve

Conceptual Solution to Cheating A potential solution might be in granting students, early on in the curriculum, responsibility for patient care, aligning pedagogic and professional goals. Early clinical experience with suffering, disease and death, will expose students to values such as empathy, caring and responsibility to the other - fundamental steps in finding existential meaning. Brezis M. Caring in medicine: missed opportunity for healing? J Eval Clin Pract 2009: 990 -2

Conclusion Medical students disclose problematic attitudes and behavior related to honesty, lifestyle & overconfidence. Education for professional values during medical school deserves a new paradigm. Thanks to Ms. Lois Gordon for graphic assistance Dad, I’m considering a career in organized crime Government or private sector?