Loretta M. Kopelman, Ph.D.

Our department is beginning its twenty-seventh year, and this seems an appropriate time for reflection about its role in our medical school and affiliated hospital. Our faculty and their arrival dates are: John Moskop (1979), Todd Savitt (1982), Kenneth Deville (1992) Janet Malek (2004), Mary Ellen Wojtasiewicz (2004) and myself (1978). From the beginning in 1978, we taught two courses, one in each of the first two years of medical school. These courses were team-taught with physician colleagues in small groups. Today we provide over 65 contact hours in the required medical school curriculum for teaching moral and social issues and over 18 contact hours for a required course for all doctoral students in the basic medical sciences. We also have monthly programs for most residents. In what follows I summarize our goals, methods, and programs.

GOALS for the Department of Medical Humanities include helping students and residents:
 - Identify moral, philosophical and social issues in health care or research and learn central concepts of medical ethics.
 - Reflect on their responsibilities.
 - Appreciate diverse views, and relevant legal, cultural and historical perspectives.
 - Formulate and defend positions on controversial issues.
 - Identify problems they are likely to encounter and give them skills and dispositions to frame and evaluate alternative solutions.

METHODS that we use include seeking a free exchange of ideas in open discussion. We believe this is the format most likely to foster these goals and prepare students for the challenges they are likely to encounter throughout their professional and public lives. We combine case review and theory, focus on readings from prominent medical and scientific journals and use small group instruction with co-instructors from our clinical faculty (for medical students) or basic sciences (for graduate students).

TEAM-TEACHING has been used from the beginning. We believe that it keeps the medical humanities faculty and its programs focused on issues of importance to clinicians and basic science faculty, promotes faculty development, and supports the goals of integration of material within the curriculum. Over a hundred of our colleagues have participated; they reinforce many of the methods for critically examining moral issues into their own programs.

REQUIRED TEACHING IN THE MEDICAL CURRICULUM:

Course	Contact Hours	Topics Include:	Team-Taught	Graded
MS-1: Moral and Social Issues in groups of 11-12	22, meets first half of first year	Professional responsibilities and codes, moral reasoning, autonomy and paternalism, informed consent, competence, voluntariness, truthfulness, confidentiality, respect for persons, discrimination and bias, abortion, death and dying, euthanasia, physician assisted suicide, the end of life decisions, research ethics, and choosing treatment for competent persons, incompetent persons.	With An MD	Exams and short essays taking the form of case reviews to demonstrate how to use moral reasoning.
MS-2: Moral And Social Issues In groups of 12	26, meets first half of second year	Moral, legal or social controversies about: reporting domestic violence, pregnant women who endanger their fetuses, access to health care, genetic screening, advance directives, allocation of scarce resources, affirmative action, treatment of imperiled newborns, and what constitutes medical futility.	With An MD	Exams with short answers and short essays and one paper on a topic of their choice.
MS-3: IN groups of 6-12 students in OB-GYN, Family Medicine, Pediatrics, Medicine, Surgery (in M-4)	Monthly meetings; one to two hours; students select the topics or cases for discussion based upon their own encounters.	Topics often include death and dying, assessing competency, gaining informed consent, respecting confidentiality, cultural diversity, the allocation of health care, domestic violence, or access to health care. Included in these informal sessions is a systematic review of topics covered during the first two years.	Often without an MD	Ungraded
MS-4: Program for all M-4 students	8 Hours, Day-long program on a specific topic.	Different conference topics have included: Informed Consent, Physician-Assisted Suicide, Complementary and Alternative Med, Religion and Medicine, Spirituality, Professionalism, and Moral Choices Under Conditions of Uncertainty.	Many MDs Take part	Ungraded

MS-4 ELECTIVE COURSES: Between a third and half of each graduating class takes two humanities electives. These graded courses include self-designed electives, History of Medicine, Literature and Medicine, Death and Dying, Law and Medicine, Women’s Studies, War and Medicine, Clinical Ethics, Human Genetics, and Foundations of Medicine.

RESEARCH ETHICS is the topic of a course for students enrolled in Ph.D. programs in the basic medical sciences. This grade course covers the following topics: the nature of the scientific enterprise, animal research, human research, authorship, fraud and misconduct, bias, science and politics, patenting, commercialism and conflicts of interest, scientist’s social responsibility, peer review, mentoring, data management and analysis, media relations, genetics research, and conflicts of interest.

RESIDENCY PROGRAMS: Each month, five clinical chairs (pediatrics, OB-GYN, Medicine, Emergency Medicine and Family Medicine) meet with members of our faculty and their respective residents to discuss a recent case selected by the residents or faculty. “Chairs’ Ethics Rounds” more than fulfills the professionalism requirements of the ACGME, which calls for residency programs to provide regular and systematic review of ethical, medical, legal, social, and economic and cost-containment issues. Fellows and faculty often attend as well. Other teaching for residents includes participation in attending rounds and including Grand Rounds presentations.

The encouragement of Dean William Laupus and Dean James Hallock in the past and Dean Cynda Johnson today, along with the support of our basic and clinical colleagues have been critical to the development of these programs. For a fuller account of our faculty and programs, service and publications please visit our website.