Simulation-based learning in healthcare ethics education

Abstract

The dissertation presents an argument for the use of a nontraditional teaching method – simulation – in ethics curricula in medical and undergraduate nursing programs. It reveals the soundness of simulation as an educational approach in light of its pedagogy of engagement and formation and its appropriateness in teaching problem solving in complex and uncertain situations that center on relationships. Simulation offers a holistic approach to teaching ethics that addresses the cognitive, practical and moral apprenticeships that comprise the signature pedagogy of medicine and nursing as characterized by Shulman. When used with the traditional methods of ethics instruction, simulation is well suited to assist in the development of the ethical practitioner by its inclusion of practice, feedback and reflection that encourages development and habituation of the professional virtues, including prudential reasoning. The dissertation includes the relevant literature on goals and methods of ethics education, virtue ethics, quality of care, and simulation. It responds to the virtue/skill dichotomy that is apparent in ethics curricula in medicine and nursing and argues for a balanced approach to ethics education. It engages the healthcare literature on virtue ethics to support the need to emphasize educational goals that prepare healthcare practitioners who exercise virtue as well as clinical ethics skills, such as ethical analysis and decision making skills. In addition, the dissertation shows that while ethics education has many nonexclusive goals, an important and often overlooked goal of ethics education is improved quality of care for patients. The dissertation makes explicit the relationship between ethics education and the quality of care for patients and demonstrates the contribution of professional virtues and attributes to the patient perspective of quality care as measured by respect, empathy and satisfaction. It also shares an ethical imperative for the adoption of simulation in ethics education. The dissertation concludes that simulation meets the goals of ethics education: the development of ethically-sensitive, reflective and ethically competent healthcare practitioners, with the potential, ultimately, to lead to improved quality of patient care. When used with traditional teaching methods, simulation allows the educator to better meet the ethics education goals by explicitly introducing specific virtues and values into learning experiences and providing essential practice opportunities for habituation and formation of professional virtues and skills. Suggestions for the inclusion of ethics simulations are provided. Although the focus of the scholarly research is limited to medical students and baccalaureate nursing students, the results may be applicable to healthcare students and professionals in related disciplines.