Teaching Ethics in Medical Schools: A Systematic Review from 2000 to 2018

Background: Ethics education in medical schools enhances ethical reasoning skills and prepares medical students for ethical dilemmas in clinical practice. However, variations in teaching ethics and mounting reports of unethical behaviour amongst medical students have raised questions as to the efficacy and benefit of ethics education in medical schools. A systematic review is undertaken to study the prevailing methods of teaching ethics in undergraduate and postgraduate medical schools to better understand teaching methods and to guide the design and redesign of ethics programs. Methods: Braun and Clarke’s (2006) methodological framework for conducting systematic reviews and PRISMA guidelines were employed in this study. PubMed, ERIC, Embase, and PsycINFO databases were searched for articles published between January 1st, 2000 and December 31st, 2018 on teaching medical ethics in medical schools. Also scrutinised were the ethics curricula of the top 20 medical schools on the 2019 Times Higher Education World University Rankings. Results: 5368 abstracts were identified, 559 full text articles were retrieved, 97 articles were included and thematically analysed in tandem with the curricula from top 20 medical schools. The two themes identified were the structure and approach of prevailing ethics programs. Conclusion: An effective medical ethics curriculum must include ‘core’ and ‘speciality’ topics that must be accompanied by clearly defined learning objectives. A spiralled case-based interactive ethics curriculum must be integrated within the medical curriculum and supported and overseen by the school. The teaching techniques and contents must be regularly reviewed, and tutors must be longitudinally supported and trained to support students as they develop ethical sensitivity and the ability to employ their learning in a clinical context.