Ethics training for future doctors needs updating, say medical educators

The "Romanell Report" builds on the DeCamp Report to address contemporary concerns, including cultural diversity, clinician work-life balance, and team-based health care coordination. The report also highlights the enduring goals of medical professionalism, citing the need for "sustaining medicine as a public trust, rather than a guild primarily concerned with protecting the economic, political, and social power of its members."

In a separate perspective article published in the same issue, some contributors to the Romanell Report expand on its ideas and provide recommendations for how professionalism can be integrated into medical education, from the pre-medical curriculum to medical school to residency training.

"We all want medical students and doctors in training to abide by ethical norms and conduct themselves professionally; the question is, how do we get there?" says Joseph Carrese, MD, MPH, faculty at the Johns Hopkins Berman Institute of Bioethics and lead author on the Romanell Report. "We need to have some agreement on educational goals, methods to teach, and assessment strategies if we want to train all future medical professionals effectively," says Carrese, also a professor at Johns Hopkins School of Medicine and co-author of the perspective accompanying the report.

The Romanell Report expands the Decamp Report's list of learning objectives for medical ethics education and addresses new issues including teaching methods, assessment strategies, learning environment, and ensuring sufficient support and rewards for faculty.

"It is crucial to have skilled and engaged faculty to teach, mentor and assess our learners, so focusing on faculty should be a top priority," says Carrese.

The report discusses the difficulty of assessing crucial desired character attributes of professionalism like humility, compassion, and integrity. "If assessment is limited only to what is formally taught, to what can be quantitatively assessed, or to the requirement of positive change, we risk a much less nuanced evaluation of some of the most important qualities of professionalism," the report states, calling for a hybrid assessment strategy incorporating both quantitative and qualitative methods.

"We need to recognize the limitations of quantitative assessment strategies and be flexible enough to adopt novel strategies that better fit the outcome of interest," says Gail Geller, ScD, MHS, a co-author on the Romanell Report and also a faculty member at the Berman Institute.

The report also discusses the importance of connecting changes in ethics education to patient outcomes, and cites a 2011 study by Hojat, et al, on the relationship between physician empathy and improved glucose control.

"Ultimately, all medical education and training is about preparing future doctors to provide excellent and respectful care, broadly defined, to their patients and making patients' needs their top priority," says Carrese. "That's the main goal of ethics education, and that's the main focus of a true medical professional."