Phronesis and the Medical Community: Follow on Impact and Engagement

通过我们的“实践经验和医学界”（PMC）的传播活动进行到目前为止，我们知道，目前还没有共识存在于英国医学院的最佳方式来教授和评估医学伦理。有些主要使用讲座，其他基于问题的学习和互动资源。在评估方面，一些医学院使用论文，其他反思工作，客观结构化临床考试（OSCES）和多项选择题（MCQ），或这些方法的混合。因此，为了对教育产生影响，我们需要灵活和适应性强的资源。此外，不同的医学院分配不同的时间来教授伦理学。我们的项目，PMC，已经表明，在各种各样的实践美德方面的道德原则是由学生，学员和经验丰富的从业人员通过他们的经验学习在多学科环境和临床背景下，沿着其他临床技能。这些美德在医学院或持续专业发展（CPD）教育中没有得到应用或充分理解。我们还发现，在我们的参与者通过医学界不同职业阶段队列的故事中，许多医疗实践美德存在显著的纵向和横向碎片化。我们的目标是以灵活、可访问和互动的资源形式应用PMC的研究结果，包括原项目中三所合作大学医学院（伯明翰、诺丁汉和沃里克）以外的教学材料，以供英国其他医学院和CPD医学培训机构使用。其结果将是资源和能力，将改善道德决策的培训和教育，为更广泛的医疗界。其影响将是改善临床结果，患者体验和对医学专业的信任，在整个社区中不断增长。我们目前正在制作一部六集的视频连续剧，与现有的健康和社会护理虚拟社区“史迪威”相连接。（社区所在的虚构城镇），它将把医学院的研究成果中的公认智慧（包括良好和有问题的做法）结合起来，运用到经验丰富的顾问或全科医生（使用专业演员）身上。沿着的将是指导资源使用的导师笔记。像以前的史迪威应用程序（为护理和专职医疗人员），它可以作为一个安全的安置资源，由医学院和持续专业发展提供者，我们从事这个项目。它将允许医学生与顾问和全科医生角色所描绘的伦理困境进行互动，并就他们认为哪种行动方案适合患者和社会进行道德辩论。它也可以以同样的方式用于CPD应用。 总之，史迪威的道德辩论资源和导师笔记将提供一个机会：1。通过可访问的视频和其他媒体资源为医学伦理学的学习提供临床背景。提供一个安全可控的位置/环境，有时间进行反思性学习。围绕医学伦理学的教学和评估展开讨论，并开始形成共识，作为安全有效的临床实践的基础。项目设计我们将在三个研讨会上与英国各地的医学院合作，看看如何最好地调整学习资源，以满足他们的需求。这些讲习班将与以下人员共同制作教学包的改进版（视频系列和导师笔记）：a）医学院负责医学伦理的工作人员; B）继续专业发展培训提供者的工作人员，以涵盖医学院以外职业阶段的其他医学群体。（c）我们亦会邀请医学教育政策制订者、主要执业医生及医学教育界的主要学者参与。

Through our 'Phronesis and the Medical Community' (PMC) dissemination activity undertaken to date, we know that currently no consensus exists across UK medical schools about the best way to teach and assess medical ethics. Some principally use lectures, others problem-based learning and interactive resources. In terms of assessment some medical schools use essays, others reflective work, Objective Structured Clinical Examinations (OSCES) and Multiple Choice Questions (MCQs), or a mixture of these methods. Therefore in order to impact on education we need a flexible and adaptable resource. In addition, different medical schools allocate differing amounts of time to the teaching of ethics. Our project, PMC, has shown that ethical principles in terms of a wide variety of practice virtues are expressed by students, trainees and experienced practitioners through their experiential learning within a multi-disciplinary environment and clinical context, along with other clinical skills. These virtues are not applied or fully understood in medical schools or Continuing Professional Development (CPD) education. What we have also found is a significant vertical and horizontal fragmentation in the many medical practice virtues accounted for in the stories from our participants through the different career stage cohorts in the medical community. Our aim is to apply the PMC findings in the form of a flexible, accessible and interactive resource, including teaching material beyond the three partnering University Medical Schools in the original project (Birmingham, Nottingham and Warwick) to other medical schools and CPD medical training providers across the UK. The outcome would be resources and capabilities that would improve ethical decision-making training and education for the wider medical community. The impact would be improved clinical outcomes, patient experience and trust in the medical profession, growing in the community as a whole.We are currently producing a six-episode video serial drama connected to an existing health and social care virtual community called 'Stilwell' (the fictional town in which the community is based), which will enact the combined received wisdom (covering accounts of good and questionable practices) in the research findings from medical school to experienced consultant or GP (using professional actors). Along with this will be tutor notes to guide the use of the resource. Like previous Stilwell applications (for nursing and allied health professionals) it can be used as a safe placement resource by the medical schools and CPD providers we engage with on this project. It will allow medical students to interact with the ethical dilemmas depicted by the consultant and GP characters and have the moral debates about which course of action they think is appropriate for patients and society. It can also be used for CPD applications in the same way. In summary the Stilwell moral debating resource and tutor notes will provide an opportunity to:1. Give clinical context via accessible video and other media resources to the learning of medical ethics.2. Provide a safe controlled placement/ environment with time for reflective learning.3. Enable discussion around what should be taught and assessed in terms of medical ethical and start to generate a consensus as a basis for safe and effective clinical practice.Project DesignWe will engage with medical schools across the UK at three workshops to see how best to adapt the learning resources to fit with their needs. The workshops will co-produce refined versions of the teaching package (video series and tutor notes) with: a) Staff from the medical schools responsible for medical ethics.b) Staff from CPD training providers to cover those from the other medical cohorts at career stages beyond medical school. c) We would also involve medical education policy makers, leading practitioners and medical education leading academics.