Teaching & Learning Medical Ethics in UK

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A review of Taking Education Seriously: Developing Bourdieuan Social Theory in the Context of Teaching and Learning Medical Ethics in the UK Undergraduate Medical Degree, by Nathan Emmerich.

This thesis is an attempt to bridge philosophical inquiry and social theorizing. Drawing upon a wealth of academic literature from several disciplinary areas, Emmerich expands on Bourdieu’s concept of “habitus” to develop its cognitive dimension and a theory of ethical thinking enculturation. His analysis is grounded in the teaching and learning of medical ethics in the context of undergraduate medical education in the UK. The dissertation has a theoretical focus and his discussion of the processes of enculturation and socialization in medical education aims to offer a conceptualization of the ways in which medical students develop their professional moral dispositions.

In his introductory chapter, Emmerich offers an overview of his project and a framing of the various perspectives that inform his interpretation of Bourdieu’s “habitus” and of medical ethics learning. Here he also delineates some important distinctions for example between “enculturation” and “socialization”, between the “acquisition” and “participation” metaphors of learning; and between the formal and informal dimensions of medical learning which will guide his analysis through the following chapters. In addition, Emmerich also underlines the centrality of an essentially Wittgensteinian understanding of the relationship between thinking and language to his analysis of the teaching and learning of medical ethics in the undergraduate medical degree.

Chapter 2 explores the foundations of Emmerich’s social theorizing: a Winchean reading of the relationship between philosophy and social science, and the corresponding methodological approach for the researcher and theorist. In this chapter Emmerich also draws extensively upon Jarrett Zigon’s anthropological work on morality and ethics, proposing a distinction  within medical learning between “institutional morality” (i.e. the codes and guidelines of the profession) and “professional discourse morality” (the discussions on moral issues between students and their teachers with or without reference to codes and guidelines). Outlining the different emphases of “embodied dispositions” as framed in Zigon’s work (where the focus is on individual life trajectories) and in Bourdieu’s “habitus” (where the focus is on social groupings), here Emmerich also describes his brief experiences as an observer in the medical school and the distinct character of applied ethics as taught in the context of undergraduate medical education.

Deepening the theoretical roots of the analysis, in Chapter 3 Emmerich develops the cognitive dimension of Bourdieu’s “habitus”. He does so by first offering a useful overview of existing sociological work of Bourdieusian framing in the field of medical education, and then engaging with the Bourdieusian concepts of “habitus” and “field” and discussing in depth the most useful of way of understanding “habitus”. Finally, he examines in some detail the work by Simon Sinclair on medical students’ dispositions and that by Shari Tishman and colleagues on the teaching of thinking dispositions.

An overview of the main features of undergraduate medical education in the United Kingdom and a historical examination of the developments in medical ethics teaching before and after the publication of the General Medical Council guidelines are at the core of Chapter 4. Here we find a picture of the context of undergraduate medical education in practice and of the place of medical ethics education within it. Emmerich explains how the teaching of medical ethics takes place along three main directions in the undergraduate degree: the formal teaching of ethical principles and concepts (e.g. beneficence and non-maleficence, justice, and autonomy, but also confidentiality and consent); the issue-focused teaching in the optional Student Selected Components; and the discussion of medical ethical issues in the course of clinical placements.

In Chapter 5 the discussion revolves around how reflection can be seen to be the “signature pedagogy” of medical education and how “metacognition” has received far less attention than reflection in this area of professional education. Emmerich proposes to see medical ethics teaching in the undergraduate curriculum as an exercise in dialogical metacognition; a practice that aims to equip students with the metacognitive skills that will enable them to recognize and engage with specific ethical aspects of individual medical cases. On these grounds, we are invited to think of medical ethics education as a cognitive apprenticeship  that is, a process of enculturation in a specific mode of reasoning.

Reviewing and consolidating some of the links and relationships established in previous chapters, in Chapter 6 Emmerich returns briefly to language by drawing some analogies between acquisition and use of language and development and use of professional ethics reasoning. In this chapter, he also argues that approaching medical ethics education as a form of cognitive apprenticeship allows the analysis of the enculturation of ethical concepts, metacognition, and thinking dispositions in this process.

In the concluding chapter, the elucidation of links and relationships operated through Chapter 6 leads to an analysis of the implications of Emmerich’s argument for medical ethics education and academic philosophy. In relation to the former, Emmerich stresses the role that medical ethics teaching has in ensuring that the “moral situations of medicine strike medical students” in a way that is similar for all students and coherent with the profession more broadly (p. 213); with regard to the latter, he calls for academic philosophy to develop an understanding of applied ethics in its practical dimensions (e.g. as applied in professional practice) as a social phenomenon. In suggesting that further research is necessary and desirable, Emmerich also underlines the wide transferability of the cognitive dimension of Bourdieu’s habitus he has developed and the possibility of wider application of the notion of cognitive apprenticeship.

An appendix traces the teaching career of Professor W. George Irwin, the first Chair of General Practice at Queen’s University Belfast (and only the fourth in the United Kingdom) and the links that connect the introduction of education in General Practice, the transformation of the curriculum, and the inclusion of medical ethics in the core structure of the curriculum. This dissertation offers exciting theoretical developments that cut across the fields of sociology, anthropology, philosophy, and professional education. As such, the conceptual tools it develops will be of interest to scholars in various areas of research, and in particular to those in the areas of medical ethics and medical education, applied ethics, and the sociology and philosophy of education.

Dr Sara Donetto
Florence Nightingale School of Nursing and Midwifery
King’s College London
sara.donetto@kcl.ac.uk

Primary Sources

Scholarly work in philosophy, sociology (including medical sociology and medical education sociology), and anthropology.
Medical education policy and guidance documents.

Dissertation Information

Queen’s University Belfast. 2011. 278 pp. Primary Advisor: Lindsay Prior.

 

Image:  Doctor with a stethoscope, Wikimedia Commons.