Medical Students and Residents
Introduction
The Center for Medical Ethics and Health Policy of Baylor College of Medicine offers The BCM Ethics Track for medical students seeking to develop greater knowledge and expertise in medical ethics. The BCM Ethics Track was initiated by members of the Class of 1992 and is the first “track” of electives at BCM. Other “tracks” at BCM are modeled on the Ethics Track. The BCM Ethics Track is also the first medical ethics track in any medical school in the United States, which other medical schools have used as a model in developing their own medical ethics tracks.
Students who complete the BCM Ethics Track are awarded a Certificate in Medical Ethics, approved by BCM and signed by the director of the Center for Medical Ethics and Health Policy, Baruch A. Brody, Ph.D. Certificates are presented to BCM Ethics Track graduates the morning of graduation day at an event to which they are invited to bring family members. BCM Ethics Track graduates’ names also appear in a listing in their official graduation program.
There are more than 75 graduates of the Ethics Track, five of whom serve on Baylor’s clinical faculty: Frank X. Placencia, M.D. (BCM 2002), assistant professor of Pediatrics – Newborn; Joseph S. Kass, M.D. (BCM 2001), assistant professor of Neurology and Residency Program director in Neurology; Curtis E. Kennedy, M.D. (BCM 1997), assistant professor of Pediatrics – Critical Care; Joslyn W. Fisher, M.D. (BCM 1995), assistant professor of Medicine – General Medicine; Elizabeth A. Nelson, M.D. (BCM 1992); associate professor of Medicine and senior associate dean of Medical Education. There are currently more than 30 students enrolled in the electives that constitute the Ethics Track.
The BCM Ethics Track was awarded the American Medical Student Association’s Paul R. Wright Excellence in Medical Education Award in 1996, for the best undergraduate medical ethics curriculum. This national recognition was based on BCM students’ nomination of the BCM required ethics curriculum and the BCM Ethics Track in a national competition judged by an AMSA Wright Award selection committee. This award is on display at the entrance to the offices of the Center for Medical Ethics and Health Policy (310D in Jewish Building), along with names and group photos of Ethics Track graduates.
I. First Year Required Course in Medical Ethics
Rebecca Yarrison, Ph.D
This course introduces students to the basic concepts and terms of medical ethics and to using the Ethics Work-Up to resolve clinical ethics cases. The course consists of 13 lectures (given by the faculty of the Center for Medical Ethics and Health Policy), 7 weekly small group case discussions (8 to 9 students in each group, co-led by 40 BCM clinical faculty), and a clinical ethics case experience component in various specialties led by BCM clinical faculty. Topics include an introduction of the Hippocratic Oath and the history of medical ethics, medical professionalism, informed consent and refusal, diminished decision making capacity, pediatric assent, end-of-life decision making, medical confidentiality, the structure of the American health care system, the ethics of medical research, the ethics of fetal intervention, the ethics of organ allocation and procurement, the ethics of personal genomic medicine, and the ethics of neuroimaging. The cases for the small groups are drawn from clinical teaching in medical ethics and from the ethics consultations services of BCM affiliated hospitals.
II. Seminar on the Philosophical Aspects of Health Care
Jennifer S. Swindell, Ph.D
This is the first of three electives constituting the BCM Ethics Track and is typically taken in the second year. The elective meets in a seminar format meets one evening each month from September through April and is designed to provide students with an understanding of the philosophical underpinnings of bioethical debates. The evening meetings are designed to accommodate students on clinical rotations, which start in January of second year. In the seminar, students will explore issues that arise in bioethics by a careful reading (of a minimal amount) and discussion of the associated theoretical and philosophical issues, especially as they relate to the Ethics Work-Up. We will examine questions such as: If I let someone die when I could have aided him, am I as morally responsible for his death as I would have been had I actively killed him, by (say) injecting him with a poison? Should parents be permitted to refuse treatment for their children for religious or other reasons? How do we determine when a patient is rational enough to make decisions about his or her health care? What makes us “persons”? If there is a point when one ceases to be a “person,” are we obligated to keep him alive? Should alcoholics receive liver transplants? May we sell human organs on a free market?
Dinner will be provided in the seminar room one hour before meetings of this elective, and students from the third and fourth years of the BCM Ethics Track will be invited to join us. At each monthly dinner meeting, a faculty member from the Center for Medical Ethics and Health Policy will join the group for dinner to describe his or her current research and to talk with students about their research and areas of interest.
III. Introduction to Clinical Medical Ethics
Laurence B. McCullough, Ph.D.
This four-week elective is offered three times per year (10th month (March-April) and 12th month (May-June) of third year and 3rd month (August-September) of fourth year). The elective combines weekly clinical experiences and seminars to provide an in-depth introduction to clinical ethics. Clinical experiences occur each week, under the mentorship of BCM clinical faculty in such specialties as Medicine, Neurology, Obstetrics and Gynecology, and Psychiatry. Clinical faculty select ethically challenging cases, for which students, working in pairs, complete an Ethics Work-Up. These written case analyses are discussed intensely each week, with the goal of increasing students’ skills of ethical analysis and argument using the Ethics Work-Up. In addition, students will be introduced to clinical ethics consultation by ethics consultants from Ben Taub General Hospital, St. Luke’s Episcopal Hospital, The Methodist Hospital, the Michael E. DeBakey Veterans Affairs Medical Center, and Texas Children’s’ Hospital. The seminars introduce students to methods of research and scholarship in clinical ethics, building, on foundations of the first-year required ethics course and the Discussion Course in Philosophical Aspects of Health Care. A major component of the elective is research seminars focused on helping students to prepare a topic for their scholarly project, which is completed in the capstone elective of the Ethics Track. Students will work Dr. Swindell in achieving this goal of the Clinical Ethics Elective.
IV. Scholarly Project
Jennifer S. Swindell, Ph.D
This is the capstone elective of the BCM Ethics Track. Typically completed in the fourth year, it is designed to offer suitably prepared students an opportunity to do a scholarly project in medical ethics. The elective is similar to an independent study, in which students engage in a supervised project that could take the form of either a paper or a creative project such as a video on a topic in clinical ethics. Dr. Swindell will work with students willing to prepare their papers for submission for publication, although this is not a requirement of the scholarly project elective.
Each year a $250 prize is awarded for the best scholarly project, as judged by Center faculty.
Recent scholarly projects include:
Muaz Abudiab (BCM 2009), “The Ethics of Heart Hospitals.” This paper identifies and addresses the ethical challenges that are created by for-profit, stand-alone institutions specializing in the treatment of cardiovascular disease.
Lisa Colaco (BCM 2009), “Ethical Justification for Administering a Passive Cocaine Vaccination to Addicted Inpatient Psychiatric Patients.” This paper provides an ethical analysis of the issue at hand and is targeted for publication in a psychiatry journal.
Alyssa Randall (BCM 2009), “Current Challenges in Pediatric Assent in Clinical Practice.” This paper identifies challenges to the ethical concept of pediatric assent and proposes ethically justified responses to those challenges.
Students in the Ethics Track have gone on to publish the papers written for their scholarly projects, in collaboration with Center for Medical Ethics and Health Policy and Baylor clinical faculty.
Mathew SJ, Yudofsky SC, McCullough LB, Teasdale TA, Jankovic J. Attitudes toward neurosurgical procedures for Parkinson's disease and obsessive-compulsive disorder. J Neuropsychiatry Clin Neurosci 1999; 11: 259-67.
Haque MF, Brody BA. The prevalence of genital operations in the Houston metropolitan area. Tex Med 2000; 96: 62-65.
Grimes AL, McCullough LB, Kunik ME, Molinari V, Workman RH, Jr. Informed consent and neuroanatomic correlates of intentionality and voluntariness among psychiatric patients. Psychiatr Serv 2000; 51: 1561-1567.
Lam WA, McCullough LB. Influence of religious and spiritual values on the willingness of Chinese-Americans to donate organs for transplantation. Clin Transplant. 2000; 14: 449-456.
Workman L, Schwartz MR, McCullough LB. Qualitative analysis of value judgments in interpreting cervicovaginal smears using the Bethesda system. Arch Pathol Lab Med 2000; 124: 556-562.
Escobar MA, McCullough LB. Responsibly managing ethical challenges of residency training: a guide for surgery residents, educators, and residency program leaders. J Am Coll Surg 2006; 202: 531-535.
Maa A, McCullough LB. Medical education in the public versus the private setting: a qualitative study of medical students' attitudes. Med Teach 2006; 28: 351-355.
Chwang E, Landy DC Sharp RR. Views regarding the training of ethics consultants: a survey of physicians caring for ICU patients. J Med Ethics 2007; 33: 320-324.
Clinical Medical Ethics Instruction
During the clinical rotations medical students receive medical ethics instruction as a part of special units designed exclusively for medical students and as part of their attendance at programs designed for house staff education.
Medical ethics is incorporated as a required part of clinical rotations in internal medicine, surgery and pediatrics.
Regularly Scheduled Conferences for House Officers on Medical Ethics and Health Policy
Department of Medicine
- Monthly lecture at Ben Taub, Houston Veterans Affairs Medical Center, The Methodist Hospital and St. Luke's Hospital
Department of Pediatrics
- Biweekly ethics rounds at Ben Taub General Hospital Neonatal Intensive Care Unit
- Biweekly ethics rounds at Texas Children's Hospital Pediatric Intensive Care Unit and Progressive Care Unit
- Monthly ethics conference at Ben Taub Pediatric Service
- Quarterly ethics conference at Texas Children's Hospital Pulmonary Service
- Two-hour class in Pediatrics 101
Department of Psychiatry
- Monthly ethics conference at Houston Veterans Affairs Medical Center Geriatric Psychiatry
- Ten conferences for residents at Baylor College of Medicine Psychiatry Department
Department of Ophthalmology
- Four conferences per year
Department of OB/GYN
- Monthly interdisciplinary conference on ethics in maternal-fetal medicine at Baylor College of Medicine
Further Information
More information about the Baylor Ethics Track is available at the homepage for the Center for Medical Ethics and Health Policy: http://www.bcm.edu/ethics/index.htm (click on “Undergraduate” on left of homepage, then click on “Medical Ethics Track” at top of page)
You may also contact Dr. McCullough, associate director for Education of the Center for Medical Ethics and Health Policy at 713 798 3505 or mccullou@bcm.edu.