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Woodrow Wilson Fellow explores the trajectory of ethics through medical lens

By KATHERINE SIMEON | March 28, 2012

Pre-med students have a lot of things on their minds: taking an organic chemistry exam and studying the MCATs. Then, there's medical school: what schools will they apply to? Which one will they choose? What factor shape this decision?

One factor is curriculum. Medical schools are required to teach the same courses, but the area of ethics is slightly more fluid.

Senior Lindsey Hutzler sought to find what influences ethics curricula in medical schools in her Woodrow Wilson Project, The Rise of Ethics in the American Medical School Curriculum, which all started when Hutzler came across a New York Times article from 1986 about ethics in medical school.

She read that 112 out of 126 medical schools required students to take courses about doctor-patient relationships, communication skills, social and cultural issues and ethics. However, in the early 2000s, only nine medical institutions offered such training.

Other articles suggested that the Hopkins was one of the first institutions to implement ethics in their curriculum. Hopkins started ethics training at its medical institution in the 1930s, 50 years before requirement were introduced. The applicability of this topic to Hopkins also triggered Hutzler's curiosity.

"It's kind of twofold how we got to this," she said.

The project, looks at three different schools: the Hopkins School of Medicine, Weill Cornell Medical College and the Mount Sinai School of Medicine. Each carries different but comparably significant roles in the field of ethics as it applies to medical education.

Hutzler went to work searching the medical schools' archives, reading their course catalogs, other secondary literature and having extensive interviews with medical school professors, some who had initiated medical ethics training at their institutions. She found that ethics training in medical schools was of increasing importance, as medicine-related incidents enter the legislative spotlight and the use of informed consent became more prominent.

"The need for better communication skills between patients and physicians was kind of stressed," Hutzler commented, when discussing what she had learned about the training acquired for physician accreditation.

"We thought that several key factors might have attributed increasing this focus in the medical school curriculum," Hutzler said.

Hutzler predicted that an increase in informed consent, rise of managed care and publicity of ethical labs are some of these factors. Many of her predictions turned out to have evidence to support it, as her findings showed that these attributes and more, including geography, philosophy and the rise of technology are all bringing the focus to ethics training in medical education. Overall, the diverse origins of ethics training has caused it to become a subject taught with a lot of variance and subcategories.

As a public health major, Hutzler utilizes the Woodrow Wilson Fellowship as an opportunity to explore her field of study and link it to other disciplines, including history.

"I see it as a hybrid discipline and I also think that's reflective of our findings," Hutzler said. "I think it combines public health, it combines history and it combines history of medicine."

Hutzler, however, does not see her research as involved in concepts from the ethics discipline itself.

"I don't assess and I haven't been trained in how to evaluate an ethical dilemma and come to an appropriate conclusion," Hutzler said.

Hutzler became a Woodrow Wilson Fellow as a sophomore under the tutelage of Professor Melanie Shell-Weisf, a former member of Hopkins's Department of History. Although Hutzler still collaborates with her today, she also works with Graham Mooney from the Department of Epidemiology at the the School of Public Health and Institute of the History of Medicine.

With one year less than other Woodrow Wilson Fellows, Hutzler made strides to get her research done.

"This was a very crunched project because it changed many times. I would say this was the fifth or sixth revision on the project," Hutzler said.

The project shifted from looking at epidemiology and immigration to medical litigation. These changes, although time consuming, are worthwhile for Hutzler and part of the process.

"A lot of freshmen or even rising sophomores come in and think you have to stick with this idea," Hutzler said. "And a lot of times, you find that it doesn't work out. You find that your interests change as you take more courses in college or that there's not even available data on the project."

With an accomplished piece of research under her belt, Hutzler hopes to get her project published in an academic journal and maybe even use this project as a foundation for future research.

"It really is a journey and it's in a learning process," Hutzler said. "In a way, doing this project has taught me what I haven't learned in the classroom."


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