Fostering ethical reasoning in medical pharmacology through role‐playing and digital tools
Authors: Pena‐Silva Ricardo A. , Velasco‐Castro Juanita M. , Zuluaga Linda , Cocoma Gonzalo , Jaramillo‐Rincon Sandra X. 
Published: May 2022

Introduction

Reflection on ethical behavior is undoubtedly one of the most important competencies required throughout a medical career, due to the series of dilemmas and difficult decisions that health professionals have to make when providing care to patients or communities, teaching other professionals, or conducting biomedical research. Given the complexity of the challenge, it is surprising that there is little literature about effective pedagogical strategies that enhance ethical reflection in medical students. The aim of this study is to evaluate new strategies for promoting ethical thinking and reflection, in a medical pharmacology course, using technologies that can be easily implemented in other courses and programs.

Methods

To promote ethical reflection, we developed a role‐playing game that was initially conducted face‐to‐face, but was quickly adapted to a digital environment, due to the changes in classroom interaction brought about by the COVID‐19 pandemic.

The academic exercise was conducted in several steps:

1) The course was divided into groups that were assigned an ethical dilemma or controversial situation in pharmacology. Examples of ethical dilemmas are equal access to expensive therapies, health disasters caused by drugs or toxic substances, research in humans without review by ethics committees, academic fraud in clinical or basic research studies.

2) Each group had to generate a 10‐minute newscast, in which they presented the dilemma in the form of a report, showing the point of view of the various actors involved (through the performance of the group members).

3) The newscast was shared through social networks with classmates, who reviewed the material asynchronously.

4) each expository group prepared an integration activity using, in a free way, digital tools (virtual boards, surveys and interactive quizzes, electronic forums, museum applications displayed on the Internet, etc) to seek to generate a deeper discussion about the assigned topic, in the classmates of the course.

5) the course mates and the teacher evaluated the quality of the elements of the activity by means of the mentimeter

6) at the end of the semester, an electronic survey with Likert‐type questions was applied to evaluate the students' perception of the effectiveness of the activity and their learning in 24 ethical competencies relevant to the course.

Results

During the two years of the innovation, the majority of students reported that the feedback provided by the professor (96%), group discussions (89%), role‐playing (79%), and opportunities for personal reflection (71%) were the activities that contributed most to their learning of ethics in pharmacology. Most students (96%) reported that the activities were helpful to them in achieving the competencies of ethical reasoning and reflection. Assessment of each competency, described in table 1, demonstrated gains in all domains.

Conclusions

The use of interaction and discussion tools, individually or in teams, in the framework of a role‐playing strategy, is an effective method to promote students' analysis of an ethical dilemma in medicine. Opening spaces for ethical discussion, in the midst of traditionally technical courses, helps students reflect more on the importance of course content and curricula, and how their learning will be useful for making better decisions as professionals.