Volume 4, Issue 2-1, April 2016, Page: 13-24
Ethics Education in Allied Health: A Systematic Review of Learning Outcomes for Entry-Level Students
Louise K. Wiles, International Centre for Allied Health Evidence, Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
Carolyn M. Murray, International Centre for Allied Health Evidence, Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
Amy Baker, International Centre for Allied Health Evidence, Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
Angela Berndt, International Centre for Allied Health Evidence, Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
Kobie Boshoff, International Centre for Allied Health Evidence, Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
Received: Dec. 21, 2015;       Accepted: Dec. 23, 2015;       Published: May 13, 2016
DOI: 10.11648/j.hss.s.2016040201.13      View  4978      Downloads  180
The complexities of modern healthcare pose a range of ethical issues for health professionals. In preparing student health professionals for these complexities, entry-level education must go beyond exposure to ethical theory, codes and standards. The aim of this systematic review was to determine the student learning outcomes reported in peer-reviewed allied health literature following ethics training. The review method included an a priori protocol, adherence to PRISMA statement, with critical appraisal via the Critical Appraisal Checklist for an Article on an Educational Intervention and The Critical Appraisal Skills Program (CASP) Qualitative Checklist. From a total of 1237 possible records published between 1991 and 2015, 11 studies of variable methodological quality met the inclusion criteria for final synthesis. Studies focused on teaching to occupational therapy, physiotherapy, pharmacy and dietetics students (n=588). Heterogeneity among studies precluded meta-analysis and data were synthesised qualitatively in a narrative format. A range of outcomes measures were used in the reviewed publications including the Structure of the Observed Learning Outcomes (SOLO), Defining Issues Test (DIT), Readiness for Interprofessional Learning Scale (RIPLS), Attitudes to Health Professionals Questionnaire (AHPQ), Student Development Task Lifestyle Inventory (SDTLI) and the Socio-moral Reflection Measure-short form (SRM-SF). Other studies surveyed students at the completion of the educational intervention using free text questions or Likert scales. The pedagogical approach used was varied, including transformative, constructivist, arts-based, inter-professional, problem-based or experiential learning approaches. The findings of this review suggest that given the current body of evidence, the teaching of ethics to and for allied health students should include the delivery of ethics focused content, be intensive in nature, link theory with real-life situations and practice, and expose students to multiple views using a variety of methods such as reflection and discussion of ambiguous, controversial topics. While the exact prescription of ethics training to maximise efficacy and uptake is unknown, there is some suggestion that immediate learning outcomes may follow a dose-response pattern, providing potential for future teaching models to incorporate repeated ethics exposure support for cumulative and sustained learning.
Entry-Level, Students, Education, Ethics, Moral, Systematic Review
To cite this article
Louise K. Wiles, Carolyn M. Murray, Amy Baker, Angela Berndt, Kobie Boshoff, Ethics Education in Allied Health: A Systematic Review of Learning Outcomes for Entry-Level Students, Humanities and Social Sciences. Special Issue: Ethical Sensitivity: A Multidisciplinary Approach. Vol. 4, No. 2-1, 2016, pp. 13-24. doi: 10.11648/j.hss.s.2016040201.13
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
B. J. Kenny, et al., Ethical perspective on quality of care: the nature of ethical dilemmas identified by new graduate and experienced speech pathologists. International journal of language & communication disorders, 2009. 44 (4): P. 421-439. doi: 10.1080/13682820902928711.
C. Carpenter, Moral distress in physical therapy practice. Physiotherapy theory and practice, 2010. 26 (2): P. 69-78. doi: 10.3109/09593980903387878.
S. J. Foye, et al., Ethical issues in rehabilitation: A qualitative analysis of dilemmas identified by occupational therapists. Topics in stroke rehabilitation, 2002. 9 (3): P. 89-101. doi: http://dx.doi.org.access.library.unisa.edu.au/10.1310/7824-1AE0-GFF0-KT55.
C. Grönlund, et al., Feeling trapped and being torn: Physicians' narratives about ethical dilemmas in hemodialysis care that evoke a troubled conscience. BMC Medical Ethics, 2011. 12 (1): P. 8. doi: 10.1186/1472-6939-12-8.
J. Holt and H. Convey, Ethical practice in nursing care. Nursing standard, 2012. 27 (13): P. 51-56. doi: http://dx.doi.org/10.7748/ns2012.
T. Fortune, et al., Transition to practice in supercomplex environments: Are occupational therapy graduates adequately prepared? Australian occupational therapy journal, 2013. 60(3): P. 217-220. doi: 10.1111/1440-1630.12010.
E. Kinsella, et al., Through the eyes of students: Ethical tensions in occupational therapy practice. Canadian journal of occupational therapy, 2008. 75 (3): P. 176-183. doi: 10.1177/000841740807500309.
I. Edwards, et al., The development of moral judgement and organisation of ethical knowledge in final year physical therapy students. Physical therapy reviews, 2012. 17 (3): P. 157 - 166. doi: 10.1179/1743288X12Y.0000000001.
E. Kinsella, et al., An investigation of students’ perceptions of ethical practice: engaging a reflective dialogue about ethics education in the health professions. Advances in health sciences education, 2015. 20 (3): P. 781-801. doi: 10.1007/s10459-014-9566-9.
K. Dieruf, Ethical decision-making by students in physical and occupational therapy. Journal of allied health, 2004. 33(1): P. 24-30.
C. Freed, et al., Professional and ethical decision-making among health science students: A call to action about critical thinking. Medical science educator, 2012. 22 (1): P. 33-36. doi: 10.1007/BF03341750.
S. Parsons, et al., The teaching of health care ethics to students of nursing in the UK: A pilot study. Nursing ethics, 2001. 8(1): P. 45-56. doi: 10.1177/096973300100800106.
E. Kinsella and S. Bidinosti, ‘I now have a visual image in my mind and it is something I will never forget’: an analysis of an arts-informed approach to health professions ethics education. Advances in health sciences education, 2015: P. 1-20. doi: 10.1007/s10459-015-9628-7.
R. P. McNair, The case for educating health care students in professionalism as the core content of interprofessional education. Medical education, 2005. 39 (5): P. 456-464. doi: 10.1111/j.1365-2929.2005.02116.x.
S. Hanson, Teaching health care ethics: why we should teach nursing and medical students together. Nursing ethics, 2005. 12 (2): P. 167-176 doi: 10.1191/0969733005ne773oa.
P. W. Nolan and D. Markert, Ethical Reasoning Observed: a longitudinal study of nursing students. Nursing Ethics, 2002. 9 (3): P. 243-258 doi: 10.1191/0969733002ne507oa.
L. L. Hsu, Blended learning in ethics education: A survey of nursing students. Nursing ethics, 2011. 18 (3): P. 418-430. doi: 10.1177/0969733011398097.
A. Hudon, et al., What place for ethics? An overview of ethics teaching in occupational therapy and physiotherapy programs in Canada. Disability and rehabilitation, 2014. 36(9): P. 775-780. doi: 10.3109/09638288.2013.813082.
J. Higgs, et al., Professional practice and knowledge, in Practice knowledge and expertise in the health professions, J. Higgs and A. Titchen, Editors. 2001, Butterworth- Heinemann: Oxford. P. 3-9.
K. Mann, et al., Reflection and reflective practice in health professions education: a systematic review. Advances in health sciences education, 2009. 14(4): P. 595-621. doi: 10.1007/s10459-007-9090-2.
S. Verma, et al., Core competencies for health Care professionals: What medicine, nursing, occupational therapy, and physiotherapy share. Journal of allied health, 2006. 35 (2): P. 109-115.
K. Bushby, et al., Ethical tensions in occupational therapy practice: A scoping review. British Journal of Occupational Therapy, 2015. 78 (4): P. 212-221 doi: 10.1177/0308022614564770.
J. Goldie, Review of ethics curricula in undergraduate medical education. Medical education, 2000. 34 (2): P. 108-119. doi: 10.1046/j.1365-2923.2000.00607.x.
J. Higgs and H. Edwards, Education beginning practitioners: Challenges for health professional education. 1999, Oxford: Butterworth-Heinemann.
S. Wong, et al., Magnitude of change in outcomes following entry-level evidence-based practice training: a systematic review. International journal of medical education, 2013. 4: P. 107-114. doi: 10.5116/ijme.51a0.fd25.
C. Turnbull, et al., Allied, scientific and complementary health professionals: a new model for Australian allied health. Australian health review, 2009. 33 (1): P. 27-37. doi: 10.1071/AH090027 #sthash.XNtynr2E.dpuf.
B. Berman, et al., Physicians’ attitudes toward complementary or alternative medicine: A regional survey. Journal of the American Board of Family Practice, 1995. 8: P. 361-366. doi: 10.3122/jabfm.8.5.361.
A. Vickers, Recent advances in complementary medicine. British medical journal, 2000. 321 (7262): P. 683-686.
J. Denison and Z. Avner, Positive coaching: Ethical practices for athlete development. Quest, 2011. 63 (2): P. 209-227. doi: 10.1080/00336297.2011.10483677.
J. Henretty and H. Levitt, The role of therapist self-disclosure in psychotherapy: A qualitative review. Clinical psychology review, 2010. 30 (1): P. 63-77 doi: 10.1016/j.cpr.2009.09.004.
A. Pasini, How to make good choices? Ethical perspectives guiding social workers moral reasoning. Social work education, 2015: P. 1-10 doi: 10.1080/02615479.2015.1081679.
Department of General Practice at University of Glasgow. Critical appraisal checklist for an article on an educational intervention. 2006 Accessed 30th November, 2015; Available from: http://www.gla.ac.uk/media/media_64040_en.pdf.
CASP international network. Critical appraisal skills programme: making sense of the evidence. 2010 Accessed 30th November 2015; Available from: http://www.casp-uk.net/about-casp/.
D. Moher, et al., Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine, 2009. 151(4): P. 264 doi: 10.1016/j.ijsu.2010.02.007.
P. DeMars, et al., Ethics across the occupational therapy curriculum. The american journal of occupational therapy, 1991. 45(9): P. 782-787.doi: 10.5014/ajot.45.9.782.
L. Swisher, et al., Evaluating moral reasoning outcomes in physical therapy ethics education: stage, schema, phase, and type. Physical therapy reviews, 2012. 17 (3): P. 167-175. doi: 10.1179/1743288X12Y.0000000011.
M. Jones, et al., Cognitive maps and the structure of observed learning outcome assessment of physiotherapy students’ ethical reasoning knowledge. Assessment & evaluation in higher education, 2014. 39 (1): P. 1-20 doi: 10.1080/02602938.2013.772951.
P. Solomon and E. L. Geddes, Influences on physiotherapy students' choices to pursue learning related to ethics in a problem-based curriculum. Physiotherapy Canada, 2000 (Fall): P. 279-285.
E. L. Geddes, et al., Does moral judgement improve in occupational therapy and physiotherapy students over the course of their pre-licensure training? Learning in health & social care, 2009. 8(2): P. 92-102. doi: 10.1111/j.1473-6861.2008.00205.x.
D. Greene, The use of service learning in client environments To enhance ethical reasoning in students. The American journal of occupational therapy, 1997. 51 (10): P. 844-852. doi: 10.5014/ajot.51.10.844.
K. Whelan, et al., Interprofessional education in undergraduate healthcare programmes: the reaction of student dietitians. Journal of human nutritian and dietetics, 2005. 18: P. 461-466. doi: 10.1111/j.1365-277X.2005.00650.x.
J. Strawbridge, et al., Interprofessional ethics and professionalism debates: findings from a study involving physiotherapy and pharmacy students. Journal of interprofessional care, , 2014. 28 (1): P. 64-65 http://dx.doi.org/10.3109/13561820.2013.829423.
D. A. Cook, et al., Method and reporting quality in health professions education research: a systematic review. Medical education, 2011. 45 (3): P. 227-238 doi: 10.1111/j.1365-2923.2010.03890.x.
S. C. Kitto, et al., Quality in qualitative research. Medical journal of Australia, 2008. 188 (4): P. 243.
D. Poff, Reflections on the relationship of research integrity to research ethics in publishing. Journal of academic ethics, 2010 (8): P. 259-263. doi: 10.1007/s10805-010-9126-8.
J. E. Thistlethwaite, et al., The effectiveness of casebased learning in health professional education. A BEME systematic review: BEME Guide No. 23. Medical Teacher, 2012. 34 (6): P. e421-e444. doi: 10.3109/0142159X.2012.680939.
V. Murrell, The failure of medical education to develop moral reasoning in medical students. International journal of medical education, 2014. 5: P. 219-225 doi: 10.5116/ijme.547c.e2d1.
H. Brody and D. Doukas, Professionalism: a framework to guide medical education. Medical education, 2014. 48: P. 980-987. doi: 10.1111/medu.12520.
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