Teaching ethics and medical humanities to medical students in Sri Lanka: a multicultural approach

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Teaching ethics and medical humanities to medical
students in Sri Lanka a
multi-cultural approach

• ANOJA FERNANDO
• Faculty of Medicine
• University of Ruhuna
• Sri Lanka

8th Asian Bioethics Conference, Bangkok,
Thailand 19 - 23 March 2007
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THE FACULTY OF MEDICINE, UNIVERSITY OF RUHUNA
(GALLE) Established 1980
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• At inception, in 1981, ethics teaching was in
• Forensic Medicine course (professional, legal)
• History of Medicine lecture

• Code of Hammurabi 2000 BCE
• Lord Buddha, Vinaya Mahavagga 1st century CE
  
• (500 years after Buddha)
• Hippocratic Oath 5th century BCE
• Declaration of Geneva, W M A 1948

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Lord Buddha (Vinaya Mahavagga) 5
characteristics of a good caregiver

• To be capable of prescribing the proper medicine
• To administer what is suitable
• To nurse the patient out of charity and not out
  of greed
• Not to be squeamish about removal of excrement,
  vomit etc
• To teach the patient, to be able to cheer him and
  comfort him

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• Formal Medical Ethics course 1995
• Medical Humanities introduced 2005

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• Formal course on
• Medical Ethics
• 1995

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Traditional Curriculum - Ruhuna
Clinical
Pre-clinical
Para-clinical
ETHICS
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Medical Ethics Course
At entry to medical school
Medical Students Oath (2001) Introductory lecture
7 lectures and one seminar on ethical scenarios
At entry to clinical course in 3rd year
Forensic Medicine
Professional and legal ethics
Pharmacology
Research ethics
3rd to 5th year
Specialised topics Clinical ethics discussions
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Clinical Ethics Discussions

• During Professorial Appointments (5th YR)
• Students identify and present ethical issues in
  ward patients
• Discussion in the wards
• Guidelines provided
• Assessment
• Simple student assessment
• Final course evaluation

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Formative assessment of students at end of course
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Evaluation of ME Course by students
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Innovations in 2005

• Use of Asian sources for teaching
• medical ethics
• Introduction of Medical Humanities
• into the Ethics Course

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Drawing on Asian literature may lead to greater
cultural relevance in teaching and acceptance of
medical ethics in Sri Lanka.
Prof S N Arseculeratne
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• Medical Ethics of Susruta and Charaka

Medical Ethics of Arab physicians eg Rhazes
Buddhist Jataka Tales
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Comparison of Hippocratic Oath with Charakas
Code of Conduct
(n114)

• Hippocratic oath more about doctor-patient
  relationship, while Charakas Code stresses
  personal morals also. (more difficult as well)
• About 25 thought Charakas Code better and more
  relevant to Sri Lanka (Asia), while about 8
  thought Hippocratic Oath better.

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• Medical Humanities
• 2005

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In favour of introducing Medical Humanities
2005
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Introduction of Medical Humanities in 2005

• Course of short optional lectures from October to
  December 2005.
• First time in a medical faculty in Sri Lanka.
• Experimental in nature

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• MEDICAL HUMANITIESArts subjects related to
  Medicine
• OBJECTIVES
• To promote
• Reflective practice and personal development
• Empathy with patients
• Compassionate understanding of individuals in
  society

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• METHOD
• Ten half hour lectures
• Fourth year students
• Handouts
• Western and Asian sources
• Optional
• No assessments
• Lecturer qualified in med humanities
• Evaluation of course

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EXAMPLE
Students comments It made me feel special to
be a doctor in the future and an impulse to do
good. It touches our deep emotions and makes
us think back - do we practice real medicine at
present? I liked the painting because I have
never related to one so before. It was really
interesting to actually UNDERSTAND a painting.
This was voted the most popular lecture by the
students
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Preliminary evaluation of course

• 99 students (out of 135) responded
• 96 wanted course continued
• Enjoyed the lectures (80-97)
• Agreed on relevance to objectives (80-88)
• Preference half-hour (69)
• lectures (71)
• Comments were positive and appreciative,
  indicating that lectures were effective.

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• STUDENT COMMENTS ON COURSE
• Talks on humanities are a very good approach to
  create a better doctor.
• This is a really good idea to introduce this
  kind of thing to medical students.
• This series should be continued.
• It makes our life a little relaxed and also some
  at least can think about our patients in a
  different way, more empathetically, and
  emotionally, and care for their feelings in the
  future.

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• CONCLUSIONS
• Short, didactic lectures are feasible,
  acceptable to students, and effective as a method
  of introducing medical humanities to
  undergraduates, in a developing Asian country
  with limited resources.

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2nd course of lectures October 2006

• Lecture duration 1 hour
• External lecturers
• Simple assessments

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Lecture topics

• Evolution of ethics during the 20th century
  (hist)
• The doctor-patient encounter in western art (art)
• Anatomical drawings of Leonardo da Vinci (art)
• The history of the Nuremberg Code (hist)
• Anatomy lesson by Jack Coulehan (poetry)
• Use of Jataka stories in psychotherapy (lit)
• Tapestry art depicting end of life (art)
• Medicine and hospitals in ancient Sri Lanka
  (arch)
• Ethical Codes in Medicine East and West (hist of
  med)
• Racism in medicine some examples (hist of med)
• Alternative systems of medicine (hist of med)
• The music of Mozart (music)

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ACKNOWLEDGEMENTS My thanks are due to Dr A A G
Abeysinghe, Dr K K R P Kodituwakku and Dr P G D
Tharanganee for collection and entry of data from
questionnaires.