Applying Learning Theories into Medical Education

Concept map on Learning theories and their Application
Theory Basis Application
Skinner’s Operant conditioning   This theory comes under the paradigms of behavior and its based on the idea that behaviors that are reinforced will continue, but behaviors that are followed by punishment will end. This theory proposed the concept of operant conditioning, which makes an attempt to change behavior by using positive and negative reinforcement; therefore, a person makes a link between a specific behavior and its consequence. To apply this theory in medical education, one way is to get a computerized system that combines tutorial programs with programs that monitor student performance and provide feedback to both student and teacher. A facilitator awards points to those students who took part actively so that students are encouraged to contribute more and their learning is improved.(Malala, Major, Maunez-Cuadra, & McCauley-Bell, 2007)  
Piaget’s theory of Cognitive development   This theory is based on studying the cognitive development of children and adolescents, in which Piaget identified four major stages sensorimotor, preoperational, concrete operational and formal operational. Piaget believed all children pass through these stages to advance to the next level of cognitive development. In each stage, children show new intellectual abilities and complex understanding of the world and may exhibit behaviors characteristic of more than one stage. (Strauss, 2000) An important application of Piaget’s theory is modifying the instructions according to the developmental level of learner. Use familiar examples to facilitate learning more complex ideas, such as story problems in clinical cases. We as facilitators can classify and group information with increasing complexity. We can also use outlines and hierarchies to assimilate new information with previous knowledge. This is significant in terms of developing instruction for medical students who are adults, but may be limited in their understanding of abstract concepts.
Vygotsky social development theory According to his theory life long process of development is dependent on social interaction. This phenomena is known as the Zone of Proximal Development (ZPD) which bridges the gap between what is known and what can be known. Vygotsky claimed that learning occurred in this zone. (Costley, 2012) In applying this theory a teacher should change his role from dictator to facilitator. The seating arrangement of class should be made in such manner that students sit in form of groups instead of audience. These groups should be selected in a way that each group should have a variety of students from low scorer to high achiever. The instructional design of material to be learned should be able to promote and encourage student interaction and collaboration. Thus the classroom becomes a community of learning. In other words, a student can perform a task under adult guidance or with peer collaboration that could not be achieved alone.
Self-Directed learning theory   Self-Directed learning is an informal process that primarily takes place outside the classroom. The learner makes decisions about content, methods, resources, and evaluation of the learning. Individuals take responsibility for their own learning process by determining their needs, setting goals, identifying resources, implementing a plan to meet their goals, and evaluating the outcomes.(Hiemstra & Brockett, 2012)   In order to make a student self-directed learner, the teacher should design an interactive lecture. First distribute a note taking guide which would contain key points, space for written notes, and two key multiple choice or “short answer” questions requiring higher level thinking, then stop twice during the lecture and ask the students to discuss their response to each question with their neighbors. A show of hands would determine the class responses to the question (checking for understanding) and you could then give the correct answer. Finally, assign a learning issue for the students to research in their own time.
Self-Determination Theory Self-determination theory is a macro theory of human motivation and personality concerned with supporting natural or intrinsic tendencies to identify and achieve goals.(Joo, Lim, Han, Ham, & Kang, 2013) To achieve the goals of self-regulation theory, students must be prepared to participate in planning for their future. The role of a facilitator in making his students self-directed learner cannot be ignored. Facilitator should design course curriculum with instructions in a way, which can help students achieve their long-term goals. Instructions should be provided to make students aware of their strengths and weaknesses, their needs and wants, communication skills and confidence to make their own decisions.
Self-Regulation theory This theory is based on the ability of a learner to understand and control his learning environment. It is a self directive process and set of behaviours where learners transform their mental abilities into skills and habits through a development process that emerges from guided practice and feedback.(Zumbrunn, Tadlock, & Roberts, 2011) In order to transform students into self regulated learners a facilitator should guide him to set short term goals, which allow them to take their progress to long term goals. Keeping the goal in mind learners considers time, strategies and resources they would need to get there. It is extremely important for the facilitator to keep in mind the developmental level of learners. Self regulated learners must clear their minds, pick the right tools for learning, know when to ask for help and should be able to monitor their performance through reflection.
Cognitive load theory Cognitive load theory assumes that the human cognitive system has a limited working memory that can hold no more than five to nine information elements and actively process no more than two to four elements simultaneously. It is able to deal with information for no more than a few seconds and almost all information is lost after about 20 seconds unless it is refreshed by rehearsal.(Bandura, 1986).   In medical teaching we can make our lectures interesting and decrease the cognitive load for students by explaining with pictures, mini and power point instead of texts. We can also show animations for complex processes or cycles. This proved to be the case when a condition with animation plus narration proved more effective than narration alone. Schemas can also reduce working memory load and aids the storage and organization of information in long-term memory and reduces working memory load. Another method to reduce cognitive load is with the help of concept maps.(Jiang & Perkins, 2013)  
Knowles adult learning principles It is based on characteristics of adults and their specific learning requirements. Adults are self- directed, motivated, goal-oriented, experienced and learn by doing.(Baskas, 2011) Students should be made aware of the traits of adult learners by the facilitator and different activities should be designed to gain main characteristics of adult learners. The facilitator should set a goal and convert theoretical learning to practical activities through giving students freedom to achieve this goal by applying their previous knowledge into new one and motivate them with relevance to real life problems. The activities they are engaged must directly contribute to achieve learning objectives. Once the learning objective is achieved their contribution should be acknowledged so in future they put in more effort and become more productive.
Maslow’s Hierarchy of needs Maslow’s hierarchy of needs is a motivational theory and represented by a pyramid with five levels. The lowest four levels comprising of physiological needs, safety, belongingness and esteem are considered deficiency or deprivation needs and abbreviated, as D needs. When D needs are obtained, the highest level, which is self-actualization, is attained and it is driven by one’s desire for personal growth and need to become all the things he is capable of.(Francis & Kritsonis, 2006) The teacher must know the physiological needs of students e.g. lunch and water break. Class room temperature should be good and a student should be allowed to go to restrooms. Next safety level should be achieved through accepting, fair and non-judgemental attitude from the teacher. To achieve the next level of belonging teacher should be approachable and create a learning environment in class through peer learning and group activities. To acquire self-esteem we should involve all students in class participation and responsibilities. To achieve self-actualization plan lessons those connect areas of learning and give students freedom to explore on their own.
Gagne’s instructional design Gagne’s model of instructional design is based on the information-processing model of the mental events that occur when adults are presented with various stimuli and focuses on the learning outcomes and how to arrange specific instructional events to achieve those outcomes. Gagne’s events of instruction consist of the following. Gaining attentionInforming the learner of the objectiveStimulating recall of prerequisite learningPresenting the stimulus materialProviding learning guidanceEliciting the performanceProviding feedbackAssessing the performanceEnhancing retention and transfer.(Martin, Klein, & Sullivan, 2004) In medical teaching we can capture attention of the students by providing an interesting picture regarding the topic or by stimulating learners curiosity with questions. Next we provide them all the learning objectives so they can get an overview of the topic. By associating new information with previous knowledge and personal experience and getting the learners to think about what they already know can facilitate the learning process e.g. by asking them to make concept maps. In lecture present information in a way, which is, clear, up-to-date and interesting to the audience. The information provided must have links and resources. Students should be assigned meaningful tasks with clear instructions. When students are performing the tasks, encouragement and feedback should be given. Allow students to reflect on their own learning. To enhance retention study groups should be assigned and students should coach and scaffold others.
Situativity theory It is based on the concept that students are more likely to learn by actively participating in their learning as opposed to listening to lectures. Situated learning means to have a thought and action which is used at right time and place. In this approach the content is learnt through doing activities. The situated model of learning is part of Lave and Wengers’s theory of communities of practice that states that learning should not be viewed as mere transmission of knowledge but as a distinctly embedded and active process.(Owen, 2006) We can apply this theory in medical teaching with problem solving programs (simulations) i.e. we can teach our students new information and skills and provide an opportunity to apply what was learned in a meaningful way. In this way students will be able to perform clinical skills that are not routinely practiced because of cost, physical danger, and time limitations.  
Ausubel’s meaningful learning Ausubel believes that learning of new knowledge depends on what we already know. It states that construction of knowledge starts with our observation and recognition of events and objects through concepts we already have. We learn by constructing a network of concepts and adding to them. (Kean & Kwe, 2014). Ausubel believed that understanding concepts, principles, and ideas are achieved through meaningful learning. Because meaningful learning involves recognition of the links between concepts, it has the privilege of being transferred to long-term memory. The most crucial element in meaningful learning is how the new information is integrated into the old knowledge to the extent that it can be related to what is already known.(Stalheim-Smith, 1998) We can apply this theory in our lectures by first asking the students to make concept map of the topic to be taught. In this way teacher can assess the prior knowledge of students regarding subject and also can identify the misconceptions among the students.(Novak, 2011)  
Brunner discovery learning According to this theory students construct their own new knowledge by organizing and categorizing information using a coding system. Bruner’s theory is a combination of content and strategies in which students discover their own coding system instead of being taught by the teacher. (Arifani, 2016). According to Brunner, personal experience and social interaction of a learner plays an important role in discovery learning.(Learning, 2000)     In medical settings, the role of the teacher should not be to teach information by rote learning, but instead to facilitate the learning process. This means that a good teacher will design lessons that help students discover the relationship between bits of information. To do this a teacher must give students the information they need, but without organizing for them. A teacher can also give his students a learning environment, an instructional guideline and ask them to explore a pre-determined problem. In this way students can construct new knowledge on their previous knowledge and solve a problem by discovering new information.(Castronova, 2002)  
Theory of communities of practice This theory is based on the notion that when a group of people who have common passion or interest in a subject or area integrate with each other, by sharing ideas and strategies, to solve problems over a period of time, they become a community. (Teeter et al., 2011) A facilitator can transform his classroom into a community of practice by designing a course that promotes learning through social interaction. Students are encouraged to form and work in groups, complete their assignments through a team effort, and interact with their peers’ through social media by posting their learning and experiences.
Atkinson-Shiffrin theory of information processing This is based on the fact that human memory could be broken into three different memory stores. Sensory memory takes in a lot of information through our senses, but majority of it cannot be processed due to limitations of our memory system and is lost within two seconds. The rest of the sensory memory enters the short term memory which is retainable up to eighteen seconds and can be converted into long term memory which is permanent through rehearsal.(Moore, Williams, North, Johri, & Paretti, 2015) To apply this memory model into teaching a facilitator should design his lecture in a way that can grab student attention till the end and his working memory can process information to the maximum potential. This can be achieved by adding metaphors, which can be either visuals or verbal information. The lecture slides should be minimum with emphasis on the relevant topic. During lecture by sharing a real life experience or a joke can help students to relate to the information later.

Reference

Arifani, Y. (2016). The Implementation of Team-Based Discovery Learning to Improve Students’ Ability in Writing Research Proposal. International Education Studies, 9(2), 111–119.

Bandura, A. (1986). Social Cognitive Theory Of Learning. Social Foundations of Thought and Action, 1–7.

Baskas, R. S. (2011). Applying Adult Learning and Development Theories to Educational Practice. Online Submission.

Castronova, J. (2002). Discovery learning for the 21st century: What is it and how does it compare to traditional learning in effectiveness in the 21st century. Action Research Exchange, 1(1), 1–12.

Costley, K. C. (2012). An Overview of the Life, Central Concepts, Including Classroom Applications of Lev Vygotsky. Online Submission.

Francis, N. H., & Kritsonis, W. A. (2006). A Brief Analysis of Abraham Maslow’s Original Writing of. Online Submission, 3(1).

Hiemstra, R., & Brockett, R. G. (2012). Reframing the Meaning of Self-Directed Learning: An Updated Model. In Proceedings of the 54th Annual Adult Education Research Conference (pp. 155–161).

Jiang, X., & Perkins, K. (2013). A Conceptual Paper on the Application of the Picture Word Inductive Model Using Bruner’s Constructivist View of Learning and the Cognitive Load Theory. Interdisciplinary Journal of Teaching and Learning, 3(1), 8–17.

Joo, Y. J., Lim, K. Y., Han, S. Y., Ham, Y. K., & Kang, A. (2013). The Effects of Self-Determination on Learning Outcomes in a Blended Learning. International Association for Development of the Information Society.

Kean, A. C., & Kwe, N. M. (2014). Meaningful Learning in the Teaching of Culture: The Project Based Learning Approach. Journal of Education and Training Studies, 2(2), 189–197.

Learning, D. (2000). Jerome S. Bruner: Discovery Learning, 4173.

Malala, J., Major, A., Maunez-Cuadra, J., & McCauley-Bell, P. (2007). The Use of Rewards in Instructional Digital Games: An Application of Positive Reinforcement. Online Submission.

Martin, F., Klein, J., & Sullivan, H. (2004). Effects of Instructional Events in Computer-Based Instruction. Association for Educational Communications and Technology.

Moore, J., Williams, C. B., North, C., Johri, A., & Paretti, M. (2015). Effectiveness of Adaptive Concept Maps for Promoting Conceptual Understanding: Findings from a Design-Based Case Study of a Learner-Centered Tool. Advances in Engineering Education, 4(4).

Novak, J. D. (2011). A theory of education: Meaningful Learning Review, 1(2), 1–14.

Owen, S. (2006). Situated Researcher Reflections and Professional Learning Journeys. Australian Journal of Adult Learning, 46(1), 114–118.

Stalheim-Smith, A. (1998). Focusing on active meaningful learning.pdf. Idea Center, Kansas Sate University.

Strauss, S. (2000). Theories of Cognitive Development and Learning and Their Implications for Curriculum Development and Teaching.

Teeter, C., Fenton, N., Nicholson, K., Flynn, T., Kim, J., McKay, M., … Vajoczki, S. (2011). Using Communities of Practice to Foster Faculty Development in Higher Education. Collected Essays on Learning and Teaching, 4, 52–57.

Zumbrunn, S., Tadlock, J., & Roberts, E. D. (2011). Encouraging Self-Regulated Learning in the Classroom : A Review of the Literature, (October).

Medical Professionalism and Culturally Sensitive Issues

What does medical professionalism mean to you in the context of a doctor? How does the culture affect medical professionalism?

How can we teach culturally sensitive issues to our medical undergraduate students?

Truth be told, two years ago I was unaware of professionalism. I remember back in the first year of MBBS, during the white coat ceremony where I read the Hippocratic oaths that mention medical ethics and that was all.

Nonetheless; I will never forget that my teachers, whether they taught basic sciences or clinical sciences, who I had always admired were very professional, now that I look back and reflect upon it.

In my opinion, the main dilemma that the traditional medical curriculum face is that both the teachers and the students are preoccupied in covering the cognitive knowledge that they are unable to spare sometime to practice the necessary skills, behavior and attitude.

In the past decade much of the attention has been addressed towards medical professionalism. And now it has become a term that is commonly used among medical practioners and public.

With a purpose to define medical professionalism in the context of a doctor, I undertook a systematic review using PubMed, ERIC and Google scholar databases to identify the best evidence on core competencies of professionalism, the cultural affect and new teaching methods that are applicable to medical undergraduates in Pakistan. The inclusion criteria for systematic review was all the articles (whether original or reviewed) published between 2005 to 2017 on teaching culture and professionalism.

 I reviewed 25 articles and came to the conclusion that being professional has always been part of our culture, even if we go back to the Islamic history about thirteen centuries ago.

Accordingly, since the lifetime of the Prophet, ethical controls and principles have been established for medicine to guide physician’s behavior.

As quoted by Abu Na’eem: The Prophet, blessing and peace be upon him, says,

 “If a person who practices medicine while he is not known to be medically proficient, causes death or a lesser injury, he is held accountable.”

The Medical Professionalism Project launched by American Board of Internal Medicine Foundation, the American College of Physicians Foundation, and the European Federation of Internal Medicine in 2002 published a professionalism charter, that has been adopted by many major professional physician organizations.

The Professionalism charter defined three fundamental principles:

  1. The primacy of patient welfare:

This principle focusses on altruism, trust, and patient interest. The charter states:” Market forces, societal pressures, and administrative exigencies must not compromise this principle”

  • Patient autonomy:

This principle incorporates honesty with patients and the need to educate and empower patients to make appropriate medical decisions.

  • Social justice:

This principle addresses physicians’ societal contract and distributive justice that is, considering the available resources and the needs of all patients while taking care of an individual patient.(Ludwig & Day, 2011)

After reviewing the three fundamental principles of professionalism, one can easily relate the similarities to the teachings of Islam and beautiful books written by Muslim physicians and scholars on ethics and professionalism.

An example is Al-Razi, who wrote a special book one thousand years ago under the title Akhlaaq al-tabeeb (Ethics of the physician). It has a note addressed to his students:

“A physician should be gentle with people, refrain from taking ill about them in their absence, and keep their secrets. A person may be afflicted with a disease which he keeps secret from the closest people to him such as his father, mother, and children. He hides it from them close to him and, out of necessity, reveals it to his doctor. If the physician treats one of a man’s women folk, girls, or boys, he should cast down his eyes and not look beyond the afflicted part of the body.”

In my own understanding of professionalism, it is not the work we do as doctors but the reason we do it and how well we do it. Patients consider physicians as healers, and put their trust in them. It is our role to protect this trust as we develop a covenant, a bond and a relationship that is unlike any other profession.(Cruess, Johnston, & Cruess, 2002)

This relationship of trust between a patient and a physician should be the guiding light of professionalism.

A physician needs to put emphasis on not only the premise of patient but also the welfare of patient in the context of

  • Evidence based care
  • Team based care
  • Appropriate use of resources.

As physicians, our obligations are not only giving our best, but also reflecting on everything we can do to regulate and monitor ourselves. We can also discuss with our colleagues, nurses, paramedics, pharmacist and hospital administration regarding further improvements in professionalism. (Al-Eraky, Donkers, Wajid, & Van Merrienboer, 2015)

How does the culture affect medical professionalism?

In order to propose an understanding of how culture affects professionalism, one must first have a clear understanding of Pakistani culture.

Pakistan is an Islamic state and has the second largest number of Muslims in the world. Then there are Hindus, Christians and other minorities. Religion is an integral part of culture that shapes symbols, beliefs, values, norms and even language.(Abdel-Razig et al., 2016) It inspires the way one thinks and considers issues such as morality, wellbeing, traditions and local practices. However, our culture is also framed with history, geography and the present policy. It can be explained very beautifully through five elements of culture as proposed by Edward B Tyler a well known anthropologist.

Symbol:        

In our society, how a person dresses up is a symbol of his social or professional status. As becoming a doctor is considered highly, we expect our physician to appear well groomed.

In the quest to appear good, most of the young doctors are going after materialistic things like expensive watches, smart phones or nice cars. And in doing so, some of them have to compromise their morality. This includes accepting gifts from patients, bribes from pharmaceutical companies and even doing illegal procedures, like organ trade in black market.

Five elements of culture

Language:

The relationship between communication skills and professionalism is very crucial.

In my country the official language is English, but the national language is Urdu. In our culture, people consider their physician as healer and expect him to listen to all their problems whether related to the diagnosis or not. Mostly patients also have difficulty in understanding medical terms so it is the duty of the doctor to explain the condition in layman term which he can understand. The same applies to taking consent and counseling of the patient and family. Doctors who are good at communication skills are considered competent, and the rest with fancy terms are not. There are a lot of examples where a doctor and patient’s family get into a conflict due to communication gap. (Humayun et al., 2008)

One cannot ignore the fact that every individual whether rich or poor, literate or illiterate, young or old has the right to know his medical condition and all possible treatment options.

Beliefs:

In our culture, there is a variety of belief systems. Two most notable are religious beliefs and mystic beliefs. Both doctors and patient believe that they are being watched over by Allah and whatever they do in this world they will be rewarded or punished in this world or hereafter.(Ho & Al-Eraky, 2016) We also have a strong belief on what goes around comes around. This aspect affect professionalism in a way that we do our duty and work for humanity with a view to be rewarded by Allah.

But the mystic beliefs accepted by patients that their disease is due to demons, black magic or the spell of evil eye are important part of our culture. There are also strong myths regarding side affects of medicine and complications of surgical procedures. And sometimes it becomes extremely difficult for doctors to deal with these concerns.

Values:

Pakistan has a collectivist culture in which if someone deviates from the norm he is considered weak or bad. Kinship, family and community are extremely important. The extended family has significant influence, and the oldest male in the family is often the decision maker and spokesperson. The interests and honor of family are more important than those of individual family members. Women are respected but due to cultural gender discrimination, their opinion regarding treatment is often ignored.

It is also in the values of our culture to respect authority and not to question or challenge them. This leads to another professional problem in which junior doctors remain quiet and do not report medical errors of their seniors in order to avoid cold shoulder from the doctor community.

Norms:

Cultural norms are the standards we live by. they are the shared expectations and rules that guide behavior of people within social groups. Cultural norms are learnt and reinforced from parents, friends, teachers and others while growing up in a society.

The cultural norms are further classified into four categories.

1.Folkways: They are simply accepted customs e.g. shaking hands while greeting or leaving your seat for a senior or elderly.

2.More: This refers to the moral standards and their violation comes with a price. Sadly, in our culture due to poverty, illiteracy and injustice, loss of morality is very common. This culture affects professionalism in a very malignant way. Taking credit for others hard work whether clinically or academically is very common. One of the reasons for this behavior might be preference of quantity over quality. Young professionals look for shortcuts and in doing so they do a lot of things which is damaging to the profession and ethics.

3.Taboos: In our society, HIV, sexually transmitted diseases, drug addiction, homosexuality, psychiatric illnesses, physical and mental disabilities are considered absolute taboos. When it comes to dealing with these problems, we occasionally observe unprofessional behavior from health professionals.

4.Laws: The culture of following law is also very poor in our society due to corruption. This is the reason, a lot of malpractices ranging from medical negligence and quackery to organ smuggling and illegal abortions have become common.

How can we teach culturally sensitive issues to our medical undergraduate students? Explain with examples.

According to my best educated guess, some of the teaching methods which can help in teaching culturally sensitive issues are discussed as follows.

Brief introduction on orientation day:

During the white coat ceremony for first year, a formal address from the Dean, Principal or any other notable medical figure on culture, ethics and professionalism can be incorporated. This can help in establishing expectations and boundaries for acceptable behaviors in medical students throughout their journey. (Birden et al., 2013)

Build a code of conduct:

To teach cultural sensitivity and professionalism, a code of conduct must be built relevant to the societal needs, not downloaded. At the beginning of each academic year, the document should be revised and updated before distributing to faculty and students.

Professionalism curricula:

Whether a medical institute is following the traditional or the integrated curriculum, culturally sensitive issues can be taught through various methods. Some of the feasible methods are as follows:

                          

Fig 2: Teaching methods for professionalism.

Didactic lectures are an efficient method to teach cognitive base of professionalism to a large number of students. To make lectures more interactive, videos showing clinical scenarios followed by discussion from students can facilitate learning.(Steinert, Snell, Steinert, & Snell, 2015)

Example 1:

When teaching infectious diseases, we can show documentaries on patients of HIV, hepatitis or tuberculosis and their daily hardships.

Example 2:

In reproductive system, social issues regarding contraception, infertility, pregnancy in unmarried girls can be discussed.

Small group discussions e.g. PBL, CBL, tutorials and lab practical can be made very effective.

Example 1:

In PBL, taboos of addiction can be discussed.

Example 2:

In CBL, examination of female patient and cultural issues regarding privacy and exposure can be critically analyzed.

Example 3:

While doing lab work, communication skills and professional attitude towards paramedics and helping staff can be taught to students.

Role Modelling:

Students learn a lot from role models who have clinical competence, excellent teaching skills and desirable personal qualities.(Passi, Doug, Peile, Thistlethwaite, & Johnson, 2010)

Example 1:

In OPD or clinics, how medical teachers interact with patients from low socioeconomic status, including their queries related to their medical condition, is considered an excellent approach.

Example 2:

In clinical clerkship, students watch and learn the professional attitude of their teachers, when offered gifts or foreign trips by pharmaceutical companies.

Role play:

In role play, we can give students a scenario and ask two or three of them to act, while the remaining class can observe and later discuss among themselves.

Example 1:

Speaking up against an impaired colleague or reporting a medical negligence by a senior are some of the culturally sensitive issues, which can be recognized through role play.

Reflective Writing:

After interacting with patients, we can ask our students to reflect on their experience and write down what went well and what could have been done better.(Aronson, 2011)

Example 1:

A conflict occurs between a surgeon and a patient’s husband regarding consent for hysterectomy.

Example 2:

Delivering sad and unexpected news to the patient and family.

Environment of Institute:

Finally, to achieve our goals we need to seek institutional support. The environment of the institute must be ready for change in policies. The hidden curriculum (that influences structure, function and culture of an institute) must be in harmony with the formal curriculum.(Yelon, Ford, & Anderson, 2014)

                      Fig 3: Steps for teaching culturally sensitive issues

Limitations:

In my humble opinion, teaching culturally sensitive issues is a domain beyond the scope of this assignment due to the following limitations:

  1. Culture of our region is changing constantly.
  2. Designing methods for teaching sensitive issues is easy but implementing them is very difficult.
  3. Assessment of students regarding learning and attitude is a time consuming process and can be only assessed during real clinical situations.

Despite the limitations, an initiative has to be taken, to make our graduates professional and community oriented.

References

Abdel-Razig, S., Ibrahim, H., Alameri, H., Hamdy, H., Haleeqa, K. A., Qayed, K. I., … Falahi, S. Z. Al. (2016). Creating a Framework for Medical Professionalism: An Initial Consensus Statement From an Arab Nation. Journal of Graduate Medical Education, 8(2), 165–172. https://doi.org/10.4300/JGME-D-15-00310.1

Al-Eraky, M. M., Donkers, J., Wajid, G., & Van Merrienboer, J. J. G. (2015). Faculty development for learning and teaching of medical professionalism. Medical Teacher, 37 Suppl 1(November), S40-6. https://doi.org/10.3109/0142159X.2015.1006604

Aronson, L. (2011). Twelve tips for teaching reflection at all levels of medical education. Medical Teacher, 33(3), 200–205. https://doi.org/10.3109/0142159X.2010.507714

Birden, H., Glass, N., Wilson, I., Harrison, M., Usherwood, T., & Nass, D. (2013). Teaching professionalism in medical education: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25. Medical Teacher, 35(7), e1252-66. https://doi.org/10.3109/0142159X.2013.789132

Cruess, S. R., Johnston, S., & Cruess, R. L. (2002). Professionalism for medicine: Opportunities and obligations. Medical Journal of Australia, 177(4), 208–211.

Ho, M., & Al-Eraky, M. (2016). Professionalism in Context: Insights From the United Arab Emirates and Beyond. Graduate Medical Education, 8(2), 268–270. https://doi.org/10.4300/JGME-D-16-00103.1

Humayun, A., Fatima, N., Naqqash, S., Hussain, S., Rasheed, A., Imtiaz, H., & Imam, S. Z. (2008). Patients’ perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore. BMC Medical Ethics, 9, 14. https://doi.org/10.1186/1472-6939-9-14

Ludwig, S., & Day, S. (2011). New Standards for Resident Professionalism: Discussion and Justification. In Ehancing Quality of Care, Supervision, and Resident Professional Development (pp. 47–51). Retrieved from https://www.acgme.org/Portals/0/PDFs/jgme-11-00-47-51%5B1%5D.pdf

Passi, V., Doug, M., Peile, E., Thistlethwaite, J., & Johnson, N. (2010). Developing medical professionalism in future doctors: a systematic review. International Journal of Medical Education, 1, 19–29. https://doi.org/10.5116/ijme.4bda.ca2a

Steinert, Y., Snell, L. S., Steinert, Y., & Snell, L. S. (2015). Interactive lecturing : strategies for increasing participation in large group presentations Interactive lecturing : strategies for increasing participation in large group presentations, 21(November). https://doi.org/10.1080/01421599980011

Yelon, S. L., Ford, J. K., & Anderson, W. a. (2014). Twelve tips for increasing transfer of training from faculty development programs. Medical Teacher, (November), 1–6. https://doi.org/10.3109/0142159X.2014.929098

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