The AMSA Paul R.

Wright
Excellence in Medical Education Award

Medical Ethics

The Students Choice

The American Medical Student Association presents

Baylor College of Medicine
with the Paul R. Wright Excellence in Medical Education
Award, representing the students choice of the American
medical school which best integrates medical ethics into
the process of training tomorrows physicians.

1996

amsa

American Medical Student Association 1996

1902 Association Drive, Reston, VA 20191-1502
Phone: (703) 620-6600 / Fax: (703) 620-5873
http://www.amsa.org
 American Medical Student Association
(AMSA)

Founded in 1950, the American Medical Student Association is the oldest and largest
independent professional association representing the interests of physicians-in-training,
including premedical students, medical students, interns and residents. With nearly
30,000 physician-in-training members, at every allopathic and osteopathic medical school
in the country, AMSA is the national voice of medical students.

AMSAs Mission

The American Medical Student Association is committed to improving health care and
health-care delivery to all people; promoting active improvement in medical education;
involving its members in the social, moral, and ethical obligations of the profession of
medicine; assisting in the improvement and understanding of world health problems;
contributing to the welfare of medical students, interns, residents and post M.D./D.O.
trainees; and advancing the profession of medicine.
 Table of Contents

Paul R. Wright Excellence in Medical Education Award ............... 4

Baylor College of Medicine: Integrating Medical Ethics in

Medical Education .......................................................................... 6

Award Recipient: Baylor College of Medicine ................................ 6

Commitment to the Mission .................................................. 7

Bioethics and the Admissions Process ................................. 7

Bioethics Curriculum............................................................. 7

Ethical Training at the Clinical Level..................................... 8

Biomedical Ethics Through the Years .................................. 8

Block Electives with Other Disciplines ................................ 10

Internal Support System ..................................................... 10

Evaluation Programs' Impact on Bioethics ........................ 11

Evaluation of Student Impact.............................................. 12

Recognition for Ethics Training........................................... 12

School Receiving Honorable Mention ........................................... 13

University of Texas Medical Branch at Galveston .............. 14

 Paul R.Wright Excellence in Medical Education Award

The American Medical Student Association (AMSA) established the Paul R. Wright Excellence
in Medical Education Award in 1992 to recognize annually a medical school, nominated and
chosen by the nations medical students, whose exemplary achievements in medical education
best foster the development of socially responsive physicians who are truly committed to
serving Americas communities. The emphasis of the award changes each year to reflect a
different aspect of medical education. The 1996 award focused on the integration of medical
ethics into medical education. The award encourages medical students to take an active part
in recognizing their schools for exemplifying certain ideals in medical education. This award
is named in honor of Paul R. Wright, long-standing executive director of the American Medical
Student Association.

Past Recipients of the Award

1993-- Mount Sinai School of Medicine, Medical Student Well-Being
1994-- Harvard Medical School, Recruitment and Retention of Underrepresented Minority Students
1995-- Dartmouth Medical School, Integrating Community Service Into Medical Education

The 1995-96 Award Selection Criteria

The 1996 award, presented to Baylor College of Medicine, represents the students' choice of the
American medical school that best demonstrated exemplary achievements in medical ethics.
The award committee believed that the ideal integration of medical ethics into medical
education model would include many, if not all, of the following principles and the ability to
demonstrate success in terms of the impact on the students, faculty and community.

I. Admissions Criteria

The admissions committee considers all applicants previous medical ethics experi-
ences and their future desire through a systematized approach.

II. Institutional Environment

The school exhibits commitment to medical ethics through its mission statement. An
internal support system promotes the integration of medical ethics into education. An
ethics curriculum is required along with elective courses in ethics and humanities, and
introductory-level ethics courses. Training is provided to faculty who teach medical
school ethics and/or ethics-and-humanities programs. Competency of professors in
teaching and training in the major principles of medical ethics. The curriculum is
focused on the relationship of the ethical legacies of medicine to societal values.

4
III. Partnerships

The school supports students who experience personal ethical dilemmas. Collabora-
tion between students and faculty occurs on medical ethics issues. Mechanisms exist
for the resolution of students ethical dilemmas.

IV. Clinical Environment

The school's medical ethics curriculum is applied in clinical practice, research and
decision-making, encompassing the basic ethical principles that underlie physician-
patient relationships and treatment decisions. Coverage of ethical issues are examined
in both inpatient and outpatient settings.

V. Evidence of Innovative Medical Ethics Curriculum

5
 Baylor College of Medicine:
Integrating Medical Ethics Into
Medical Education

The American Medical Student Association (AMSA) believes in the importance of medical
ethics and promotes a willingness to go beyond formal classroom discussion and to integrate
ethics into every level of training." Accordingly, AMSAs Board of Trustees selected the
integration of medical ethics into medical education as the theme for the 1996 Paul R. Wright
Excellence in Medical Education Award.

At the 1996 AMSA Annual Convention, Baylor College of Medicine was recognized with the
Paul R. Wright Excellence in Medical Education Award for its remarkable efforts to develop
socially responsive physicians through the integration of medical ethics into its medical
curriculum. Honorable mention went to the University of Texas Medical Branch at Galveston.
Based on the philosophy of the award, all nominations were made by the medical students
themselves, who presented the aspects and components of their schools policies and pro-
grams that actively incorporate or promote medical ethics.

The purpose of this award booklet is to applaud the outstanding accomplishments of the
Baylor College of Medicine and disseminate its programs and policies, as well as the program
at the University of Texas Medical Branch at Galveston. By doing so, AMSA wishes to facilitate
discussion between and within medical schools regarding the importance of medical ethics. It
is hoped that this dialogue will stimulate the development, implementation or enhancement
of programs and policies that are in the best interest of medical students, medical schools and
other institutions across the nation. Ultimately, AMSA hopes to have a nationwide impact on
medical education.

AMSA welcomes any comments, questions or suggestions.

6
 Commitment to the Mission
The mission statement of the Baylor College of Medicine (BCM) exemplifies
their commitment to educate young men and women to become compassion-
ate physicians with high ethical standards and technical competence and a
dedication to deliver the highest quality care to all people." This statement is
included in the curriculum handbook for students which is distributed on the first
day of school. On this day, the dean for medical education and assistant dean
for curriculum personally address the entering class with a discussion of moral and ethical
values, expectations, rules and standards of the profession and the values and principles of
medicine.

Bioethics and the Admissions Process

Bioethics experiences, as well as a potential desire for engaging in bioethics, are an integral
part of the review process for admissions to BCM. A student body with a focus on bioethics is
achieved in three ways in the admissions process. First, the schools bioethics track is
presented as an important and unique selling point for its medical school during the application
process. Second, the application itself consists of two parts: a transcript report and an essay
section. The applicants transcript must demonstrate an exposure to the thought processes
necessary for ethical analysis. The essay section carries this further and prompts the applicant
to describe his or her experiences and their relationship to medicine, significant medical or non-
medical research, and other special experiences. BCM is impressed by and gives preference
to applicants who show a desire to develop their understanding of social and moral responsi-
bility. Finally, the interview process is extensive with up to five interviews by students and
faculty. A survey of the admissions committee reveals that they often probe the applicants
understanding of patient-physician relationships and the tremendous social responsibility held
by physicians and accordingly rank applicants who demonstrate a desire to further pursue
these issues.

Bioethics Curriculum
The curriculum provides multiple opportunities to pursue bioethics training and research.
Required ethics courses enable students to take full advantage of further ethics training
opportunities in medical school and beyond. In addition to the strong medical ethics training
required of all students, many other ethics electives are offered by the college in a variety of
formats, levels and topics. For example, strong ties between the medical school and the Center
for Medical Ethics and Health Policy enable students to take ethics electives in areas of patient-
physician relationships, law, health-care delivery, history and theology. They may also take
courses in ethics, religion, law, policy, philosophy or other humanities courses through inter-
institutional agreements at three universities, another medical school, a public health school
and a nursing school.

7
Most notably, an ethics track is available to motivated students. Students who successfully
complete this higher-level ethics training, including ethics reading electives, clinical ethics
electives, and research in clinical ethics under the supervision of one of the 17 faculty in the
Center for Medical Ethics and Health Policy graduate with the notation of medical ethicist on
their diplomas. These students have become key ethical leaders within their medical
communities.

Ethical Training and Analysis at the Clinical Level

At the clinical level, BCM offers courses in medical ethics which are supplemented by ethical
training and analysis. All students are required to attend a series of lectures and rounds on
ethics during their clinical rotations. Students are expected to present relevant cases and are
evaluated on their management of ethical issues. These conferences are held in cooperation
with the specific departments and faculty from the Center for Medical Ethics and Health Policy.
The Center for Medical Ethics and Health Policy faculty are all part of a clinical ethics group
which is on call to respond to clinical ethical emergencies. Students are not only participants
but are indispensable players in these discussions as they often have a more intimate
knowledge of the patient and the family for which they are responsible more than the house
staff.

Two popular electives at BCM are the Longitudinal Care for Indigent Cancer Patients and
Clinical Medical Ethics. The former is a six month course in which students accompany indigent
cancer patients to clinic visits and perform home visits. Students then discuss with faculty the
issues of oncology, death and dying, hospice care, and treatment ethics. Clinical Medical
Ethics is a one month elective in which students are assigned to an ethics faculty member and
observe the analysis of ethical issues raised by actual cases.

Biomedical Ethics Through the Years

The following are the available, and mostly required, opportunities at BCM for students to
develop aptitude in the management of bioethical dilemmas:

First year-and-a-half of medical training (Basic Sciences):

ETHICS COURSEAll first-year students take a required 24-hour medical ethics course
as part of the general curriculum. This course is taught by two full- time medical ethics
faculty members from the Center for Medical Ethics and Health Policy. This introductory
course combines a series of 16 lectures with eight small group case discussions.
Approximately 12 other associated faculty members of the center, from a variety of areas
in the college, participate in these discussions. The course objectives include teaching
ethical theories, historical and moral context of medicine, placement of professional and
legal obligations within broader moral and social concerns, significant medical, social and
economic changes, and approach to the treatment and diagnosis of patients within the
larger context of moral obligations and concerns.

8
 PATIENT, PHYSICIAN, AND SOCIETY (PPS)In this course, all first- and second-
year students form small groups and meet three hours one afternoon each week for 18
months. Students learn professional values, physical exam and interviewing skills, and
the social context of patients and physicians, with special focus on the health-care
system. PPS sessions with explicit bioethical content include medical profession:
curing, caring and the publics trust, professional communication, and therapeutic
doctor/patient relationships. A key feature of this course is the introduction of themes
that define the physician-patient relationship before students are exposed to rigors of the
clinical clerkships. Students observe physicians in their offices and talk to patients
focusing on the patients' stories. Integrated into this experience are discussions with
mentor groups about the ethical dimensions of the patients' relationship to the doctor,
and the doctors responsibilities to his or her patient as an individual and society as a
whole.

INTEGRATED PROBLEM SOLVING COURSEAll first- and second-year students

gather in groups of six to eight with a faculty facilitator to investigate the problems of a
sick patient. The students explore the biology that underlies the patients problems, as
well as the behavioral and social/ethical issues that impinge on the patient to form a
framework for successful treatment.

Second-and third-year of medical training (Core Clinical Rotations):

CLINICAL ROTATIONSIn the following years, all students are required to attend a
series of clinical medical ethics conferences as a part of their clinical rotations.
Discussions of ethics issues also occur during morning teaching rounds with the faculty,
residents and students as they are evaluating patients. During this time, the competing
theories of bioethics are explored through a careful reading of major texts in the field.

Fourth-year of medical training:

MECHANISMS AND MANAGEMENT OF DISEASE (MMD) and INTEGRATED CLINI-

CAL EXPERIENCES (ICE)These courses are taken by all fourth-year students with
the goal of preparing them for residency. MMD meets half a day each week for nine
months and uses lecture, panel and small group formats. This course deals with
common patient interactions encountered by physicians. Examples include immuniza-
tions, infertility, aging, AIDS and substance abuse. These sessions often emphasize the
social and ethical aspects of patient interaction, diagnosis and treatment of these
common encounters. ICE, a one-week course, discusses stress management in
residency, training for teaching in residency and important medical/legal issues.
Students work for one week to prepare themselves for the difficult physical, mental,
emotional and ethical challenges of residency.

RESEARCH IN CLINICAL MEDICAL ETHICS This one-month clinical elective is

designed to offer students an opportunity to do clinical research in medical ethics.
Students whose work is judged to be of potentially publishable quality are assigned a
grade of honors and are encouraged to submit their work for publication.

9
 Block Electives with Other Disciplines
BCM has fortunately maintained long-standing arrangements with several universities for
inter-institutional exchange of knowledge. The commitment is in fact so strong that full-time
students can take courses without cost. BCM students are able to pursue studies in
humanities, sociology, law, philosophy, economics or any other subject matter offered at
these diverse institutions. The value to the students extends into and well beyond the scope
of a specialization in ethics, but it is certainly true that any student that felt a need to further
his or her bioethical or humanitarian education using any of these institutions would have
virtually any subject matter of interest at his or her disposal.

The Internal Support System

A broad and integrated framework exists at BCM to mandate education
on bioethical perspectives, from the start of the selection of future
medical students to the availability of a specialized degree concerning
medical ethics. Specific structural and philosophical support comes
from the colleges executive faculty committee, the assistant dean of
curriculum, the curriculum committee, the Center for Medical Ethics and Health Policy, the
clinical rotation coordinators, the curriculum subcommittee on evaluation and the students.
The executive faculty committee developed the educational goals statement based on the
school mission which has high ethical standards as a central theme. The curriculum
committee works with the Center for Medical Ethics and Health Policy and the Patient,
Physician, and Society Course curriculum subcommittee to monitor content and provide
introduction of ethics and professional values from the first day of medical school. BCM co-
sponsors the Center for Medical Ethics and Health Policy whose faculty are devoted to
teaching required courses in medical ethics and facilitating required clinical ethics confer-
ences. The ethics faculty have dual appointments in medicine, pediatrics, critical care, family
and community medicine, and psychiatry, and there is additional expertise in obstetrics and
gynecology. The clinical rotation coordinators use this rich resource to provide lecturers and
facilitators for student ethics teaching. The ethics faculty also offers a special set of classes,
the ethics track, which trains future physicians to respond appropriately to ethical dilemmas
in clinical practice. The ethics faculty are involved in assisting students in research of medical
ethics for which there is a special fourth-year elective. The evaluation committee monitors
course content, teaching proficiency, and student satisfaction, with one evaluation criterion
being ethics training.

While personal ethical dilemmas are heard informally in the office of student affairs at BCM,
the deans are always available to hear and counsel students with personal problems. In the
event of a true ethical dilemma, the Deans consult with or request the students to talk with
faculty at the Center for Medical Ethics who encourage discussion. One of the small group
sessions taught in the first year ethics course is entitled, Ethics of Being a Medical Student."
This session works through ethical dilemmas faced by students, such as: being asked to do
an unfamiliar procedure without supervision; being attracted to a patient; being Catholic and

10
asked to participate in counseling patients about prenatal diagnostic procedures and
participating in abortions; and observing unethical behavior in peers. Also, there is a group
of peer counselors and counseling services available to students 24 hours a day in the case
of personal or clinical ethical dilemmas.

Evaluation Programs' Impact on Bioethics

By rigorously evaluating student performance, teaching, course content, and overall training
in the field of medical ethics, BCM ensures that its graduates are highly trained in and aware
of ethical issues. BCM is confident that the evaluation process described below is key in
providing future leaders in the field of Bioethics.

Examinations:
The required ethics course is evaluated by an exam. The ethics electives and ethics track
courses are evaluated by written analysis of bioethics reading or actual clinical cases.

Objective Structured Clinical Examinations (OSCE):

Students in The Patient, Physician and Society Course and Family Medicine Rotation are
evaluated with model patient encounters (OSCE). Some of these encounters are specifically
designed to deal with ethical issues and require the student to base their decision-making on
ethical principles. The PPS OSCE occurs in the first year and the Family Medicine OSCE
occurs in the third year. BCM monitors student improvement by comparing the first-and third-
year OSCEs for each student. Assessment includes whether students are at greater ease
in counseling patients and whether there is increased sophistication in the ethical analysis of
the case.

Clinical Evaluation:
The coordinators of the core clinical rotations are required to complete forms which expect
attendings to comment on students ethical or unethical behavior and students ability to
analyze ethical problems.

Student Focus:
Student members of the curriculum and evaluation committees coordinate biweekly student
meetings with the ethics faculty to suggest changes to improve the quality of ethics training.

Course Evaluations
Students formally evaluate the ethics courses with a standardized evaluation form, devel-
oped from issues raised in the above-mentioned groups.

Exit Surveys:
Graduating seniors are asked to comment on all aspects of their education and preparedness
for residency, and one of these components includes ethical and legal issues involved in the
practice of medicine. In addition, recent changes have been made in the curriculum, and the
evaluation committee is devising new evaluation methods. In a recent workshop the
evaluation committee has made ethics one of the end goals to assess as a product of BCM's
curriculum.

11
 Evaluation of Student Impact
BCMs curriculum was designed to provide students an integrative education which prepares
them for the next task. The curriculum exposes students to clinical situations from the first
day of school. They have two small group classes to learn about real-life clinical situations
which often involve ethical issues. The curriculum has laid a foundation to manage real-life
ethics cases in the clinical years. The clinical rotations emphasize practical ethical decision-
making in the typical physician-patient encounter including clinical ethical problems associ-
ated with the issues of advance directives and informed consent. One example includes a
rotation at the Thomas Street Clinic treating psychiatric manifestations of HIV/AIDS. A
significant focus of patient care at this clinic revolves around ethical issues. Students on
clinical rotations are evaluated on their ability to address ethical issues and counsel patients.
While on rotations, students are also expected to have patients sign treatment plans and
continually update the patients code status. Students are given lectures relating to specific
ethical problems pertaining to various specialties, participate in ethics rounds and may call
ethics consultants to help with decision- making or patient/family counseling. By their senior
year, students realize the intersection between law, medicine and ethics, and know how to
utilize advance directives and informed consent to assist patients to receive treatment in
accordance with their wishes.

Recognition for Ethics Training

At BCM, students and faculty are recognized for their training in ethics. Students who finish
a special ethics track in the curriculum receive special acknowledgment at graduation and
have found residency programs to be very interested in their background in medical ethics.
Students also have the opportunity to publish their research or present their findings at
meetings due to the close support given by the faculty at the Center for Medical Ethics and
Health Policy. These accomplishments are recognized publicly through the institutional
publication which has a section to recognize the student achievements. Finally, service to
BCM or the community is rewarded by the opportunity to earn federal financial aid and
compete for the CIBA Pharmaceuticals Service Award. One group of students received such
recognition by promoting issues of health and ethics concerning HIV to local high school
students.

Faculty with ethics training gain recognition in four ways. First, they are valuable resources
to the departments as consultants and teachers. Accordingly, they are given the time and
resources to perform ethics research. Second, these faculty often receive dual appointments
at the Center for Medical Ethics and Health Policy. Third, these faculty members teach the
ethics course, facilitate clinical ethics rounds and teach very popular ethics electives. Thus,
the ethics faculty are very well known by the students. Fourth, faculty may participate in a
Master Teacher Fellowship and receive recognition as a Master Teacher. One aspect of this
fellowship is training in teaching ethics. These additional responsibilities and the recognition
as a Master Teacher are important in issues of financial compensation and promotions.

12
Honorable Mention

University of Texas Medical

Branch at Galveston

Select Programs and Policies

13
 University of Texas Medical
Branch at Galveston
The University of Texas Medical Branch at
Galveston (UTMB) is committed to training ethi-
cal physicians and considers ethics to be a high
priority. "In fulfilling its mission, UTMB adheres
to the highest standards of ethics, intellectual
integrity, professional practice, efficiency, and
accountability." A few years ago, the faculty and
administration of UTMB held a research retreat to
identify areas to be developed as core research
strengths. The consensus recognized10 areas to
be focused on as core research strengths; ethics
was one of them. UTMB's ethics program studies
ethical and legal problems in medicine and bio-
medical research as well as educating their stu-
dents, faculty, and staff. The importance of medi-
cal ethics is conveyed to both students and faculty
at every stage with both clarity and frequency. On
the first day of medical school, the freshman class
recites a "Declaration of Commitment" which is
adapted from the Declaration of Geneva and the
International Code of Medical Ethics. Students,
both medical and biomedical, are required to take
an ethics course. Third-year clerkships, ethics
grand rounds, ethics committee, ethical seminars
on clinical visits, and lectures to new residents and
senior students all incorporate the teaching of
ethics and emphasize its importance.
Teaching Method
UTMB provides a well-rounded education for all
medical students. One of the many roles of the
ethics program is to facilitate and strongly encour-
age discussion and consideration of ethics in both
scholastic and clinical environments. The univer-
sity begins this ethical training in the first term by
requiring students to take part in a medical ethics
course. The purpose of this course is to develop
awareness of ethical issues in medicine and allow
students to examine their personal and cultural
value systems and how those may influence deci-
sions about bioethical cases. This objective is
facilitated through class discussion of assigned
reading where students articulate and critique in-
dividual ethical perspectives.
During the third year, a course in medical jurispru-
dence is required. This course investigates a
variety of issues including physician-assisted sui-
cide, euthanasia, advance directives, informed
consent and confidentiality, treating permanently
unconscious patients, and medical malpractice.
Students gain expertise in identifying ethical is-
sues and developing ethically valid goals through
presentation of specific cases and study of the
corresponding state statutes relating to physicians.
Students also are required to write a research
paper, original essay, a case report or design a
project for future research to be carried out as a
fourth-year elective.
Third-year students are also required to participate
in a six-week ethics clerkship during the internal
medicine rotation. A typical clerkship engages
students in discussion of student responsibilities
(responsibilities to self, to patients, and to resi-
dents and faculty), conflicts of interest, confiden-
tiality and so forth. The clerkships, which meet
once weekly, consist of groups of 10 to 12 students
and are led by a one M.D. and one Ph.D. ethics
faculty. Students examine ethical issues that may
influence the patients' care as well as considering
the patient's own belief systems. Other issues that
are often considered include conflicts of interest
between health care providers ethical obligations
to patients and legal requirements set forth in state
or federal law. A listing of resources available to
aid with the identified ethical dilemmas and ex-
amination of valid options to achieve the overall,
desired outcome for the patient, are also available.
While course work and ethical training for medi-
cal students alone is helpful, the faculty at UTMB
also feels that a multi-disciplinary approach to
medical ethics broadens the overall development
of ethical character. In this capacity, the ethics
program sponsors campus-wide colloquia for all
staff and students that present and encourage dis-
course on specific ethical issues.
14

Student and Faculty Involvement
Several different approaches are used to ensure
continuity of ethics instruction throughout the
medical curriculum at UTMB. All first-year medi-
cal students are required to take a 14 week course
titled "Medical Ethics." This course investigates
personal, ethical, philosophical, and social dimen-
sions of modern medicine with the goal of en-
abling medical students to become more ethically
competent physicians. Second-year students are
required to take a course offered by the Depart-
ment of Preventive Medicine and Community
Health. Lectures on aspects of the ethics of health
policy are incorporated into this course. Third-
year medical students are required to participate in
a six-week ethics clerkship during their internal
medicine rotation. Instruction is provided by
faculty from that department and the ethics pro-
gram. Within the context of case discussions,
students develop a deeper understanding of the
physician-patient relationship, a basic understand-
ing of what professionalism means, and a working
understanding of the principles of medical ethics.
Third-year students also take a required medical
jurisprudence course, which is taught by a lawyer-
philosopher and graduate students in medical hu-
manities who have law degrees. Third-and fourth-
year students assigned to the following wards also
participate in ethics rounds with teaching faculty
from the respective departments: the AIDS ward,
the pediatric rehabilitation ward, the state Depart-
ment of Criminal Justice Hospital, the medical
intensive care unit, and the neonatology unit. These
rounds, which occur either weekly or bimonthly,
attempt to identify both the medical and psycho-
logical variables that may lead to ethical conflicts
in clinical cases and the resources available to
resolve these issues. During the fourth year of
medical school, students have the opportunity to
take electives offered by ethics program faculty.
Finally, an ethics consultation service is provided
for all faculty, hospital staff, and students. Fac-
ulty, staff, and students at any level may use this
service to discuss ethical concerns of a particular
clinical case, or even ethics aspects of hospital
policies or legal regulations. The goal of these
consultations is to clarify ethical issues and pro-
vide the means for students and faculty to establish
an appropriate plan of action.
Curriculum Impact
UTMB's firm belief in the importance of ethics
and the programs designed to teach the values and
ethics of medicine have a strong impact on stu-
dents. Every medical student is required to take a
term-long medical ethics course that explores many
important philosophical ideas in ethics and also
clinical and social aspects of values and medical
ethics. The Hippocratic oath and other codes of
ethics are analyzed, moral problems in medicine
and ethical reasoning are explored, opinions on
what is a "good physician" and on the nature of a
therapeutic relationship are examined, and ethical
issues students face are discussed. HIV/AIDS,
euthanasia, living wills, and other pertinent topics
are also addressed in this introductory course. In
addition to the required ethics courses that both
medical and graduate students take, elective courses
are offered that focus on different aspects of medi-
cal ethics. Topics range from "Law and Ethics in
Clinical Practice" and "Privacy and Confidential-
ity in Health Care" to "Medicine and Religion" and
"Trust and Power in the Doctor-Patient Relation-
ship." Excluding the number of students in the
mandatory ethics courses, approximately 480 stu-
dents have enrolled in ethics-related elective
courses since 1985.
Students at UTMB have many opportunities to
learn about real-life ethical situations. Their eth-
ics coursework provides a strong foundation by
offering both a philosophical background and an
introduction to many important ethical issues in
medicine. The real-life ethical situation examina-
tion and analysis are taught both formally and
informally at every stage of schooling. Infor-
mally, ethics is taught from first year to fourth year
when students visit the wards or clinics. Addition-
ally, seminars in ethics are regularly offered. For-
mally, there are several programs that teach ethics
in real-life situations. One of these programs
15
include "Ethics Case Conference Series--Third-
Year Medicine Clerkship Rotation." All third-
year students participate in ethics case discussions
during their third-year clerkship rotations. In
these conferences,the students are presented with
medical cases for which they are required to study
and analyze the ethical issues and principles in-
volved and present the cases in an open forum,
consisting of students and faculty, for discussion.
Ethics rounds are another program designed to
focus on ethics in true patient cases. Students
present their patient's medical variables, psycho-
logical variables, and ethical issues. The goal of
these rounds is to give students an opportunity to
"clarify some of the broader issues and the per-
sonal and professional values that are part of every
patient-provider relationship.

At UTMB, students learn to counsel patients on

ethical issues through the courses, and in the
clinical setting through faculty who are not only
aware of the importance of medical ethics, but
who strive to incorporate it into their teaching.

Awards

Students and faculty at UTMB are recognized in

many ways for their training in ethics. First-year
students in medical ethics may compete for awards
in a medical ethics essay contest as well as com-
pete in the National Student Research Forum which
highlights scholarly work in bioethics. The UTMB
ethics program faculty participate in the screening
of residents and are also part of the orientation
program of the residents and employees. UTMB
recognizes faculty by having designated profes-
sorships and lectureships in which the school has
set aside funds in order to exclusively facilitate
education in bioethics. The university's dedica-
tion to the teaching and learning of bioethics and
the humanistic aspects of medicine is embodied in
the establishment of the ethics program itself.

16