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Rationale

A basic understanding of ethical principles and their application to patient care is essential for all physicians. During the internal medicine core clerkship, the student can put into practice some of the ethical principles learned in the preclinical years, especially by participating in discussions of informed consent and advance directives. Additionally, the student learns to recognize ethical dilemmas and respect different perceptions of health, illness, and health care held by patients of various religious and cultural backgrounds.

Prerequisite

Introductory course on medical ethics providing a basic understanding of ethical principles (autonomy, beneficence, nonmaleficence, justice) and their application in clinical medicine.

Specific Learning Objectives

  1. Knowledge: Each student should be able to describe:
    1. basic elements of informed consent.
    2. circumstances under which informed consent is necessary and unnecessary.
    3. basic concepts of autonomy, treatment efficacy, quality of life, and societal
      demands.
    4. potential conflicts between individual patient preferences and societal demands.
    5. the role of the physician in making decisions about the use of expensive or controversial tests and treatments.
  2. Skills: Each student should be able to:
    1. participate in a discussion about advance directives with a patient.
    2. participate in informed consent for a procedure.
    3. participate in the care of a consent-requiring terminally ill patient.
    4. participate in a preceptor’s discussion with a patient about a requested treatment that may not be considered appropriate (e.g., not cost-effective).
  3. Attitudes: Each student should:
    1. take into account the individual patient’s perspective and perceptions regarding health and illness.
    2. demonstrate a commitment to caring for all patients, regardless of gender, race, socioeconomic status, intellect, sexual orientation, ability to pay, or cultural background.
    3. recognize the importance of allowing terminally ill patients to die with comfort and dignity when that is consistent with the wishes of the patient and/or the patient’s family.
    4. recognize the potential conflicts between patient expectations and medically appropriate care.