Felicity Jones, Thomas Hindmarch, Vita Sinclair, Anika Rahim, Molly Fyfe, Paula Baraitser.
A student-faculty collaborative project designed and delivered by The King’s Centre for Global Health and medical students from King's College London Medical School. Poster presented by Dr Felicity Knights (neé Jones) – now Academic Foundation Doctor at Newcastle Hospitals Trust: felicity.knights@nuth.nhs.uk
WHY THIS INTERVENTION? Peer-teaching enables role-modelling, sharing of personal experiences, and often more frank and open conversations on difficult topics. These attributes are relevant for students navigating complex ethical and professionalism issues, such as those which arise working overseas.
Peer-teaching enables students to “construct their own meaning and understanding”, and encourages “intellectual, emotional and social engagement.”
We designed, implemented and evaluated peer-led workshops for 57 students preparing to learn and practice overseas. HOW DID WE DESIGN THE WORKSHOP?
- Boud, 2001.
• • • •
A student-faculty group systematically reviewed the literature regarding ethical challenges arising for students overseas. We collected personal accounts from students at King’s and internationally, and categorised these by ethical theme. We then conducted informal consultations with students interested in the area about how best to explore these themes. We gathered examples of best practice in the field such as peer-teaching programmes run through IFMSA (International Federation of Medical Student Associations) exchanges, over 8,000 of which take place between 86 countries each year. • We conducted 2 pilot workshops, refined the workshops according to feedback, and delivered the final version twice.
WHAT WAS THE WORKSHOP’S CONTENT? 1) Introductions and sharing personal stories 2) A consideration of ethical frameworks and how they can be applied to these issues. Frameworks: Beauchamp & Childress (1979) Four principles of bioethics as applied to all of medicine. Pinto (2009) Four principles of overseas engagement.
3) A short presentation by a near-peer sharing our practical, evidence-based approach to ethical challenges followed by a worked-through example. Questions to ask yourself: 1) What are the ethical issues/themes here? 2) What is my role in this situation? 3) What factors should I consider? 4) What resources or forms of support are available to help me think about/manage this? 5) What should I do next?
4) A peer-facilitated discussion of real-life scenarios. Facilitators had help-sheets to support them enable a wide-ranging discussion.
Real life case study: (A worked example in the workshop presentation): A student working in a rural hospital in Western Africa is asked for money by the family of a dying woman who needs 30$ for antiretroviral therapy for 1 month’s treatment. Although an insurmountable amount of money for the family, the student later spent that on dinner. HOW DID WE EVALUATE AND WHAT WERE THE RESULTS? We collected 55 student’s written responses to an ethical scenario before and after the workshop. These were deductively coded to examine changes in ethical reasoning. Students considered a wider range of ethical issues and demonstrated increased evidence of weighing different issues following the workshop. Larger numbers of students considered issues relating to social justice (e.g. lack of resources, allocation of power etc), and views of patients from a different culture. We also asked for formal and informal feedback using a survey and post-it notes . respectively. Feedback was largely positive: 12 students filled in the feedback survey : 9 agreed the content was relevant, whilst three did not agree or disagree. Qualitative Feedback: “I liked the really varied case studies with really excellent structure to work/think through! Great facilitation of the discussion & very practical: 5/5!” “Hearing experiences from another student made me think about issues I hadn’t considered before. It was good to be able to refer back to the structure to help think about the real life case studies.” “Honestly, for me there wasn’t so much of a difference between before and after but that may be because I think about this area of medicine/ethics fairly regularly, so may have been more aware.”
Benefits to Individuals and Workforce
Conclusions
- The 40 individual benefits codes were grouped into 7 key There is little published or unpublished literature on the impact domains: clinical skills; management skills; communication & of volunteering within health partnerships. The existing evidence CONCLUSION: teamwork; patient experience & dignity; policy; academic base is descriptive and focuses on the benefits. Our skills; peer-led replicable method of enabling students to grapple with real-life ethical challenges. andworkshop personal demonstrated satisfaction & ainterest. More work is required to quantify the costs and benefits of Students confidence and reported feeling much benefits better prepared following the workshop. commented positively on the structure volunteering withinThey health partnerships for individuals and - A highgained degree of concordance was shown between and cited methodology and weredevelopment better able to identify within ethicalUK issues and apply learning from the to specific written scenarios. institutions, andworkshop the associated challenges and barriers. and professional indicators workforce development frameworks, including the Knowledge Despite these limitations our analysis suggests that skills acquired TAKE-HOME MESSAGES: & skills framework (KSF), The NHS Leadership framework and throughand volunteering map closely to workforce Learning from peers is a cheap and effective approach which enables role-modelling may encourage students to engage development with complex continuing professional development competencies. frameworks and cantools be theoretical to improved service issues. Thoroughly researching the area, and providing experienced near-peers with facilitatory can help tolinked maximise the impact of the delivery within the NHS. Benefits could in bedifferent maximised by formally - A theoretical from volunteer experiencerelevant to UK for the ethical challenges intervention. Thistrajectory educational method is particularly that arise practising medicine countries. embedding volunteering within health partnerships within service delivery outcomes was demonstrated in most areas, but continuing professional development processes. not all (see Model of Transferring Benefits).
Acknowledgements We would like to thank King’s College London and the department of Medical Education for the financial support of this project. We would like to thank the King’s College Global Health department for their practical support and encouragement, in particular Dr Janagan Alagaraja. We would like to thank the IFMSA, its small working group on ethical exchanges, and Dr Geneviève Bois for their provision of resources, ideas and advice.