TEACHING ETHICAL REASONING ON-LINE: AN EXPERIENCE IN ETHICS EDUCATION FOR MEDICAL RESIDENTS

BACKGROUND
Despite the scientific and technological advances that make medical specialties’ practice more efficient, they also bring new ethical dilemmas to light. Based on this and the analysis of a students’ needs assessment survey, UNAM developed the on-line course “Ethical Reasoning Applied to Clinical Practice” for its 8,500 residents enrolled in 78 medical specialty programs implemented in 89 clinical sites in Mexico.

COURSE DESCRIPTION
The high enrollment and geographical dispersion of its clinical sites made e-learning a viable option for this three-level course.
Basic concepts discussed in the first level assure a common ethics theoretical foundation for residents representing the 82 medical schools in different countries where they finished pregraduate training. The stages of medical ethical reasoning are demonstrated in the second level through clinical cases with a detailed description of all components: medical contexts; patients’ and doctor’s values, duties, rights and obligations; legal framework and ethical decision characteristics. The third level is dedicated to the revision of ethical conflicts experienced by residents during their training.
The course is self-sufficient in its content through a variety of original documents in html, PDF or Word format and links on the subject as well as references to additional information. Reflection and reasoning is encouraged through short texts, clinical vignettes and links to other websites. Surveys on self-perception and opinion on ethical conflicts have also been included for this purpose.
Assessment includes an initial two part diagnostic test on theoretical aspects and elements applied in ethical reasoning. An automatically generated multiple case question exam determines passage between first and second level and is also used during the third level. A fill-in on-line format is used by residents to present a complete clinical case with an ethical conflict. There is also space for self-assessment through crossword puzzles, quandaries and other recreational means. The design includes a questionnaire for course assessment by residents. The results obtained from more than 3900 respondents to this particular questionnaire have founded the modifications applied to the second edition of the course.

CONCLUSION
The first edition of the course functioned on a voluntary basis. It was designed for residents and has had the unexpected but welcomed enrollment of over 300 professors. Residents’ feedback on the course indicates it complements residents’ on-site clinical training. It has also brought forth enrollees' needs and interest on the subject
The course will become mandatory this year. However, further study of its impact on residents’ and clinical tutors’ needs will determine modifications in its design.