Democratization of Medical Education as a need to Teach Medical Ethics: Perspectives from Developing Countries

Ghaiath HusseinAbdulaziz Alkaabba

Department of Biomedical Ethics Faculty of Medicine, King Fahad Medical City King Saud Bin Abdulaziz University for Health Sciences Riyadh, Saudi Arabia

Democracy …Redefined!!

Nikita: What is the big fuss you make about the US as the land of democracy...what is it anyway?Nixon: For example any American citizen can stand in front of the White House, protest against the American President without being arrested.Nikita: So what?!! Now any Soviet citizen can stand in front of Kremlin, protest against the American President without being arrested!

Outline of the presentation Developing Bioethics in the ‘developing

world’, how does it differ? Bioethics: what affects teaching bioethics? What is democratization of medical

education? How does it affect teaching bioethics? Challenges and Practical steps

The developing world.. A closer look

The world map proportional to Human Development Source: www.worldmapper.org

How does that affect Bioethics’ development?

• Free to ask• The right to have

them answered• Free press

• Free public debates

• Politicians’ & practitioners’

accountability

• Sophisticated services

• Higher expectation

• More Conflicts

• Set of ethical values and principles

• Community agreement

Freedom of speech

Democratic Political System

Developed Health System

Cultural & Moral

Heritage

At the smaller scale… the Medical College

Poor/No ethics

curriculum

“Sub-ethical doctor”?

Vulnerable

patient

‘Dictator’

professor

Strict hierarch

y

Sub-ethical researcher

Sub-ethical clinicianSub-ethical teacher

Sub-ethical…etc.

Poor/No accountabili

ty

Democratization of ME: Why? What? How?

Hypothesis: Free informed medical students who contribute to the educational process without exploitation will be doctors who will work on making patients free, informed, and actively involved in healthcare.

Ideally, students will practice what they have been taught as right, whether in classrooms, or at bedside affected by their community (social, cultural, religious, etc.)

Democratization of medical education is about: Interactive teaching (listen, ask, answer, e.g. PBL & COME) Participatory decision-making (academic meeting,

management & leadership) Make them informed and accountable (informed decision

making)

Challenges to democratization of ME

Political level: Overall lack of freedom (people don’t seek their rights) Inherited fear of participation

Academic Level: Students don’t get much ‘extra-marks’ for being ethical Inherited traditional hierarchical teaching (resistance to

change) Institutional affiliations to the Gov. and laws (lack of

academic independence) Public & Community Level:

People do not miss what they do not know. Patients who don’t dare (or want) to know & stand for their

rights will not help in making doctors who care to give them.

How to manage these challenges? Adopt interactive medical education, where

students ‘get marks’ for effective communication Adopt, develop and empower the ethics curriculum Establish ‘safe’ routes and forums for student-

student, student-dean, student-patients interactions

Make university/teaching hospitals more patient-centered in their care.

Enhance academic transparency and accountability through regulations and policies.

Educate the people about their rights (preferably through students)

Thanks…Questions

& Discussion