The essential role of medical ethics education in achieving professionalism: The romanell report

Academic Medicine

Volumn 90, Issue 6, 2015, Pages 744-752

  Carrese, Joseph A ^a,b   Malek, Janet ^c   Watson, Katie ^d   Lehmann, Lisa Soleymani ^e   Green, Michael J ^f   Mccullough, Laurence B ^g   Geller, Gail ^a,b   Braddock, Clarence H ^h   Doukas, David J ⁱ  

^a University School of Medicine   (United States)

^b JOHNS HOPKINS UNIVERSITY   (United States)

^c EAST CAROLINA UNIVERSITY   (United States)

^d NORTHWESTERN UNIVERSITY   (United States)

^e BRIGHAM AND WOMEN S HOSPITAL   (United States)

^f PENN STATE COLLEGE OF MEDICINE   (United States)

^g BAYLOR COLLEGE OF MEDICINE   (United States)

^h UNIVERSITY OF CALIFORNIA   (United States)

ⁱ University of Louisville School of Medicine   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCREDITATION; CURRICULUM; EDUCATION; HUMAN; MEDICAL EDUCATION; MEDICAL ETHICS; PROCEDURES; PROFESSIONAL COMPETENCE; UNITED STATES;

ACCREDITATION; CURRICULUM; EDUCATION, MEDICAL, GRADUATE; EDUCATION, MEDICAL, UNDERGRADUATE; ETHICS, MEDICAL; HUMANS; PROFESSIONAL COMPETENCE; UNITED STATES;

EID: 84937929412     PISSN: 10402446     EISSN: 1938808X     Source Type: Journal    
DOI: 10.1097/ACM.0000000000000715     Document Type: Article

References (152)

1. Culver CM, Clouser KD, Gert B, Basic curricular goals in medical ethics. N Engl J Med 1985 312 253 256
2. Bickel J, Human values teaching program in the clinical education of medical students. J Med Educ 1987 62 369 378
3. Rabow MW, Remen RN, Parmelee DX, Inui TS, Professional formation: Extending medicine's lineage of service into the next century. Acad Med 2010 85 310 317
4. Eckles RE, Meslin EM, Gaffney M, Helft PR, Medical ethics education: Where are we? Where should we be going? A review. Acad Med 2005 80 1143 1152
5. Goldie J, Review of ethics curricula in undergraduate medical education. Med Educ 2000 34 108 119
6. Braddock C, Fryer-Edwards K, Task Force on Ethics and Humanities Education in Undergraduate Medical Programs Report on Ethics and Humanities Education in Undergraduate Medical Programs 2009 Chicago, Ill American Society for Bioethics and Humanities. http://www.asbh.org/publications/content/lcme.html. Accessed January 21, 2015
7. Persad GC, Elder L, Sedig L, Flores L, Emanuel EJ, The current state of medical school education in bioethics, health law, and health economics. J Law Med Ethics 2008 36 89 94
8. Lakhan SE, Hamlat E, McNamee T, Laird C, Time for a unified approach to medical ethics. Philos Ethics Humanit Med 2009 4 13
9. Lehmann LS, Kasoff WS, Koch P, Federman DD, A survey of medical ethics education at U.S. and Canadian medical schools. Acad Med 2004 79 682 689
10. DuBois JM, Burkemper J, Ethics education in US medical schools: A study of syllabi. Acad Med 2002 36 489 497
11. Perkins HS, Teaching medical ethics during residency. Acad Med 1989 64 262 266
12. Doukas DJ, McCullough LB, Wear S, Project to Rebalance and Integrate Medical Education (PRIME) Investigators Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Acad Med 2012 87 334 341
13. Doukas DJ, McCullough LB, Wear S, Project to Rebalance and Integrate Medical Education (PRIME) Investigators The challenge of promoting professionalism through medical ethics and humanities education. Acad Med 2013 88 1624 1629
14. Academy for Professionalism in Health Care Mission and Vision. http://innovatepedsgme.org/about/mission/index.cfm. Accessed February 24, 2015
15. Jonsen AR, Siegler M, Winslade WJ, Clinical Ethics 2002 5th ed. New York, NY McGraw-Hill Inc
16. Liaison Committee on Medical Education Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. degree. June 2013. https://www.lcme.org/publications/functions2013june.pdf. Accessed January 21, 2015
17. Accreditation Council for Graduate Medical Education ACGME Common Program Requirements. July 2013. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Accessed February 23, 2015
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19. ten Cate O, Scheele F, Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Acad Med 2007 82 542 547
20. Miles SH, Lane LW, Bickel J, Walker RM, Cassel CK, Medical ethics education: Coming of age. Acad Med 1989 64 705 714
21. Lehrmann JA, Hoop J, Hammond KG, Roberts LW, Medical students' affirmation of ethics education. Acad Psychiatry 2009 33 470 477
22. Manson H, The need for medical ethics education in family medicine training. Fam Med 2008 40 658 664
23. Favia A, Frank L, Gligorov N, A model for the assessment of medical students' competency in medical ethics. AJOB Prim Res 2013 4 68 83
24. Institute for the Study of Health and Illness The Healer's Art Course. http://www.ishiprograms.org/programs/medical-educators-students/course-description/Accessed February 3, 2015
25. Dyrbye LN, Massie FS, Eacker A, Relationship between burnout and professional conduct and attitudes among U.S. medical students. JAMA 2010 304 1173 1180
26. Spickard A Jr, Gabbe SG, Christensen JF, Mid-career burnout in generalist and specialist physicians. JAMA 2002 288 1447 1450
27. Haywood C Jr, Lanzkron S, Hughes MT, A video-intervention to improve clinician attitudes toward patients with sickle cell disease: The results of a randomized experiment. J Gen Intern Med 2011 26 518 523
28. Carrese JA, Rhodes LA, Bridging cultural differences in medical practice. The case of discussing negative information with Navajo patients. J Gen Intern Med 2000 15 92 96
29. Sharma RK, Khosla N, Tulsky JA, Carrese JA, Traditional expectations versus US realities: First- and second-generation Asian Indian perspectives on end-of-life care. J Gen Intern Med 2012 27 311 317
30. Tilburt J, Geller G, Viewpoint: The importance of worldviews for medical education. Acad Med 2007 82 819 822
31. Moon M, Taylor HA, McDonald EL, Hughes MT, Beach MC, Carrese JA, Analyzing reflective narratives to assess the ethical reasoning of pediatric residents. Narrat Inq Bioeth 2013 3 165 174
32. Tschudy MM, The sound of silence. Ambul Pediatr 2008 8 86
33. Watson K, Serious play: Teaching medical skills with improvisational theater techniques. Acad Med 2011 86 1260 1265
34. Green MJ, Myers KR, Graphic medicine: use of comics in medical education and patient care. BMJ 2010 340 c863
35. Charon R, Narrative medicine: A model for empathy, reflection, professionalism, and trust. JAMA 2011 286 1897 1902
36. Naghshineh S, Hafler JP, Miller AR, Formal art observation training improves medical students' visual diagnostic skills. J Gen Intern Med 2008 23 991 997
37. Dolev JC, Friedlaender LK, Braverman IM, Use of fine art to enhance visual diagnostic skills. JAMA 2001 286 1020 1021
38. Shapiro J, Rucker L, Beck J, Training the clinical eye and mind: Using the arts to develop medical students' observational and pattern recognition skills. Med Educ 2006 40 263 268
39. Hillary FG, Schultheis MT, Challis BH, Spacing of repetitions improves learning and memory after moderate and severe TBI. J Clin Exp Neuropsychol 2003 25 49 58
40. Singer PA, Robb A, Cohen R, Norman G, Turnbull J, Performance-based assessment of clinical ethics using an objective structured clinical examination. Acad Med 1996 71 495 498
41. Rosenbaum ME, Kreiter C, Teaching delivery of bad news using experiential sessions with standardized patients. Teach Learn Med 2002 14 144 149
42. Rinker B, Donnelly M, Vasconez HC, Teaching patient selection in aesthetic surgery: Use of the standardized patient. Ann Plast Surg 2008 61 127 131
43. Madan AK, Caruso BA, Lopes JE, Gracely EJ, Comparison of simulated patient and didactic methods of teaching HIV risk assessment to medical residents. Am J Prev Med 1998 15 114 119
44. Gisondi MA, Smith-Coggins R, Harter PM, Soltysik RC, Yarnold PR, Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas. Acad Emerg Med 2004 11 931 937
45. Tekian A, McGuire CH, WC McGaghie CH, Innovative Simulations for Assessing Professional Competence 1999 Chicago, Ill Department of Medical Education, University of Illinois at Chicago
46. University of Louisville James L. Stambaugh, Jr., Humanities in Medicine [lecture series]. https://itunes.apple.com/us/itunes-u/james-l.-stambaugh-jr.-humanities/id431433773?mt=10. Accessed February 23, 2015
47. Harvard University's Justice With Michael Sandel [online course]. http://www.justiceharvard.org/Accessed January 21, 2015
48. Knewton The Fipped Classroom: A New Method of Teaching Is Turning the Traditional Classroom on Its Head. http://www.knewton.com/flipped-classroom/Accessed January 21, 2015
49. Hayes RP, Stoudemire A, Kinlaw K, Dell ML, Loomis A, Qualitative outcome assessment of a medical ethics program for clinical clerkships: A pilot study. Gen Hosp Psychiatry 1999 21 284 295
50. Berseth CL, Durand R, Evaluating the effect of a human values seminar series on ethical attitudes toward resuscitation among pediatric residents. Mayo Clin Proc 1990 65 337 343
51. Schuh LA, Burdette DE, Initiation of an effective neurology resident ethics curriculum. Neurology 2004 62 1897 1898
52. Sulmasy DP, Geller G, Levine DM, Faden RR, A randomized trial of ethics education for medical house officers. J Med Ethics 1993 19 157 163
53. Elger BS, Harding TW, Terminally ill patients and Jehovah's Witnesses: Teaching acceptance of patients' refusals of vital treatments. Med Educ 2002 36 479 488
54. Self DJ, Olivarez M, Baldwin DC Jr., Clarifying the relationship of medical education and moral development. Acad Med 1998 73 517 520
55. International Training and Education Center for Health Writing Good Learning Objectives. I-TECH Technical Implementation Guide #4. January 2010. http://www.go2itech.org/resources/technical-implementation-guides/TIG4.WritingLrngObj.pdf/view. Accessed February 23, 2015
56. Welch M, Enhancing Awareness and Improving Cultural Competence in Health Care: A Partnership Guide for Teaching Diversity and Cross-Cultural Concepts in Health Professional Training 1998 San Francisco, Calif University of California at San Francisco
57. Pinsky LE, Fryer-Edwards K, Diving for PERLS: Working and performance portfolios for evaluation and reflection on learning. J Gen Intern Med 2004 19 5 pt 2 582 587
58. Robb A, Etchells E, Cusimano MD, Cohen R, Singer PA, McKneally M, A randomized trial of teaching bioethics to surgical residents. Am J Surg 2005 189 453 457
59. Lewin LO, Olson CA, Goodman KW, Kokotailo PK, UME-21 and teaching ethics: A step in the right direction. Fam Med 2004 36 suppl S36 S42
60. Arnold L, Assessing professional behavior: Yesterday, today, and tomorrow. Acad Med 2002 77 502 515
61. Savulescu J, Crisp R, Fulford KW, Hope T, Evaluating ethics competence in medical education. J Med Ethics 1999 25 367 374
62. Rees C, Shepherd M, The acceptability of 360-degree judgements as a method of assessing undergraduate medical students' personal and professional behaviours. Med Educ 2005 39 49 57
63. Ginsburg S, Regehr G, Mylopoulos M, From behaviours to attributions: Further concerns regarding the evaluation of professionalism. Med Educ 2009 43 414 425
64. McCammon SD, Brody H, How virtue ethics informs medical professionalism. HEC Forum 2012 24 257 272
65. Ginsburg S, Regehr G, Lingard L, Basing the evaluation of professionalism on observable behaviors: A cautionary tale. Acad Med 2004 79 10 suppl S1 S4
66. Hafferty FW, Franks R, The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 1994 69 861 871
67. Hojat M, Vergare MJ, Maxwell K, The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009 84 1182 1191
68. Shochet RB, Colbert-Getz JM, Wright SM, The Johns Hopkins Learning Environment Scale: Measuring medical students' perceptions of the processes supporting professional formation. Acad Med 2015 90 810 818
69. Doukas DJ, Charting a course of reform in medical ethics and humanities. May 21, 2011 Presented at: Project to Rebalance and Integrate Medical Education (PRIME) Workshop II Louisville, Ky
70. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS, Physicians' empathy and clinical outcomes for diabetic patients. Acad Med 2011 86 359 364
71. Misch DA, Evaluating physicians' professionalism and humanism: The case for humanism connoisseurs. Acad Med 2002 77 489 495
72. Wald HS, Borkan JM, Taylor JS, Anthony D, Reis SP, Fostering and evaluating reflective capacity in medical education: Developing the REFLECT rubric for assessing reflective writing. Acad Med 2012 87 41 50
73. Myers MF, Herb A, Ethical dilemmas in clerkship rotations. Acad Med 2013 88 1609 1611
74. Berger JT, Moral distress in medical education and training. J Gen Intern Med 2014 29 395 398
75. Wiener CM, Thomas PA, Goodspeed E, Valle D, Nichols DG, Genes to society-the logic and process of the new curriculum for the Johns Hopkins University School of Medicine. Acad Med 2010 85 498 506
76. Charon R, Deep structures, or how our work improves the care of the sick. May 10, 2012 Presented at: Project to Rebalance and Integrate Medical Education (PRIME) 2012 National Conference Louisville, Ky
77. Culver CM, Clouser KD, Gert B, Basic curricular goals in medical ethics. N Engl J Med 1985 312 253 256
78. Bickel J, Human values teaching program in the clinical education of medical students. J Med Educ 1987 62 369 378
79. Rabow MW, Remen RN, Parmelee DX, Inui TS, Professional formation: Extending medicine's lineage of service into the next century. Acad Med 2010 85 310 317
80. Eckles RE, Meslin EM, Gaffney M, Helft PR, Medical ethics education: Where are we? Where should we be going? A review. Acad Med 2005 80 1143 1152
81. Goldie J, Review of ethics curricula in undergraduate medical education. Med Educ 2000 34 108 119
82. Braddock C, Fryer-Edwards K, Task Force on Ethics and Humanities Education in Undergraduate Medical Programs Report on Ethics and Humanities Education in Undergraduate Medical Programs 2009 Chicago, Ill American Society for Bioethics and Humanities. http://www.asbh.org/publications/content/lcme.html. Accessed January 21, 2015
83. Persad GC, Elder L, Sedig L, Flores L, Emanuel EJ, The current state of medical school education in bioethics, health law, and health economics. J Law Med Ethics 2008 36 89 94
84. Lakhan SE, Hamlat E, McNamee T, Laird C, Time for a unified approach to medical ethics. Philos Ethics Humanit Med 2009 4 13
85. Lehmann LS, Kasoff WS, Koch P, Federman DD, A survey of medical ethics education at U.S. and Canadian medical schools. Acad Med 2004 79 682 689
86. DuBois JM, Burkemper J, Ethics education in US medical schools: A study of syllabi. Acad Med 2002 36 489 497
87. Perkins HS, Teaching medical ethics during residency. Acad Med 1989 64 262 266
88. Doukas DJ, McCullough LB, Wear S, Project to Rebalance and Integrate Medical Education (PRIME) Investigators Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Acad Med 2012 87 334 341
89. Doukas DJ, McCullough LB, Wear S, Project to Rebalance and Integrate Medical Education (PRIME) Investigators The challenge of promoting professionalism through medical ethics and humanities education. Acad Med 2013 88 1624 1629
90. Academy for Professionalism in Health Care Mission and Vision. http://innovatepedsgme.org/about/mission/index.cfm. Accessed February 24, 2015
91. Jonsen AR, Siegler M, Winslade WJ, Clinical Ethics 2002 5th ed. New York, NY McGraw-Hill Inc
92. Liaison Committee on Medical Education Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. degree. June 2013. https://www.lcme.org/publications/functions2013june.pdf. Accessed January 21, 2015
93. Accreditation Council for Graduate Medical Education ACGME Common Program Requirements. July 2013. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Accessed February 23, 2015
94. Carraccio C, Burke AE, Beyond competencies and milestones: Adding meaning through context. J Grad Med Educ 2010 2 419 422
95. ten Cate O, Scheele F, Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Acad Med 2007 82 542 547
96. Miles SH, Lane LW, Bickel J, Walker RM, Cassel CK, Medical ethics education: Coming of age. Acad Med 1989 64 705 714
97. Lehrmann JA, Hoop J, Hammond KG, Roberts LW, Medical students' affirmation of ethics education. Acad Psychiatry 2009 33 470 477
98. Manson H, The need for medical ethics education in family medicine training. Fam Med 2008 40 658 664
99. Favia A, Frank L, Gligorov N, A model for the assessment of medical students' competency in medical ethics. AJOB Prim Res 2013 4 68 83
100. Institute for the Study of Health and Illness The Healer's Art Course. http://www.ishiprograms.org/programs/medical-educators-students/course-description/Accessed February 3, 2015
101. Dyrbye LN, Massie FS, Eacker A, Relationship between burnout and professional conduct and attitudes among U.S. medical students. JAMA 2010 304 1173 1180
102. Spickard A Jr, Gabbe SG, Christensen JF, Mid-career burnout in generalist and specialist physicians. JAMA 2002 288 1447 1450
103. Haywood C Jr, Lanzkron S, Hughes MT, A video-intervention to improve clinician attitudes toward patients with sickle cell disease: The results of a randomized experiment. J Gen Intern Med 2011 26 518 523
104. Carrese JA, Rhodes LA, Bridging cultural differences in medical practice. The case of discussing negative information with Navajo patients. J Gen Intern Med 2000 15 92 96
105. Sharma RK, Khosla N, Tulsky JA, Carrese JA, Traditional expectations versus US realities: First- and second-generation Asian Indian perspectives on end-of-life care. J Gen Intern Med 2012 27 311 317
106. Tilburt J, Geller G, Viewpoint: The importance of worldviews for medical education. Acad Med 2007 82 819 822
107. Moon M, Taylor HA, McDonald EL, Hughes MT, Beach MC, Carrese JA, Analyzing reflective narratives to assess the ethical reasoning of pediatric residents. Narrat Inq Bioeth 2013 3 165 174
108. Tschudy MM, The sound of silence. Ambul Pediatr 2008 8 86
109. Watson K, Serious play: Teaching medical skills with improvisational theater techniques. Acad Med 2011 86 1260 1265
110. Green MJ, Myers KR, Graphic medicine: use of comics in medical education and patient care. BMJ 2010 340 c863
111. Charon R, Narrative medicine: A model for empathy, reflection, professionalism, and trust. JAMA 2011 286 1897 1902
112. Naghshineh S, Hafler JP, Miller AR, Formal art observation training improves medical students' visual diagnostic skills. J Gen Intern Med 2008 23 991 997
113. Dolev JC, Friedlaender LK, Braverman IM, Use of fine art to enhance visual diagnostic skills. JAMA 2001 286 1020 1021
114. Shapiro J, Rucker L, Beck J, Training the clinical eye and mind: Using the arts to develop medical students' observational and pattern recognition skills. Med Educ 2006 40 263 268
115. Hillary FG, Schultheis MT, Challis BH, Spacing of repetitions improves learning and memory after moderate and severe TBI. J Clin Exp Neuropsychol 2003 25 49 58
116. Singer PA, Robb A, Cohen R, Norman G, Turnbull J, Performance-based assessment of clinical ethics using an objective structured clinical examination. Acad Med 1996 71 495 498
117. Rosenbaum ME, Kreiter C, Teaching delivery of bad news using experiential sessions with standardized patients. Teach Learn Med 2002 14 144 149
118. Rinker B, Donnelly M, Vasconez HC, Teaching patient selection in aesthetic surgery: Use of the standardized patient. Ann Plast Surg 2008 61 127 131
119. Madan AK, Caruso BA, Lopes JE, Gracely EJ, Comparison of simulated patient and didactic methods of teaching HIV risk assessment to medical residents. Am J Prev Med 1998 15 114 119
120. Gisondi MA, Smith-Coggins R, Harter PM, Soltysik RC, Yarnold PR, Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas. Acad Emerg Med 2004 11 931 937
121. Tekian A, McGuire CH, WC McGaghie CH, Innovative Simulations for Assessing Professional Competence 1999 Chicago, Ill Department of Medical Education, University of Illinois at Chicago
122. University of Louisville James L. Stambaugh, Jr., Humanities in Medicine [lecture series]. https://itunes.apple.com/us/itunes-u/james-l.-stambaugh-jr.-humanities/id431433773?mt=10. Accessed February 23, 2015
123. Harvard University's Justice With Michael Sandel [online course]. http://www.justiceharvard.org/Accessed January 21, 2015
124. Knewton The Fipped Classroom: A New Method of Teaching Is Turning the Traditional Classroom on Its Head. http://www.knewton.com/flipped-classroom/Accessed January 21, 2015
125. Hayes RP, Stoudemire A, Kinlaw K, Dell ML, Loomis A, Qualitative outcome assessment of a medical ethics program for clinical clerkships: A pilot study. Gen Hosp Psychiatry 1999 21 284 295
126. Berseth CL, Durand R, Evaluating the effect of a human values seminar series on ethical attitudes toward resuscitation among pediatric residents. Mayo Clin Proc 1990 65 337 343
127. Schuh LA, Burdette DE, Initiation of an effective neurology resident ethics curriculum. Neurology 2004 62 1897 1898
128. Sulmasy DP, Geller G, Levine DM, Faden RR, A randomized trial of ethics education for medical house officers. J Med Ethics 1993 19 157 163
129. Elger BS, Harding TW, Terminally ill patients and Jehovah's Witnesses: Teaching acceptance of patients' refusals of vital treatments. Med Educ 2002 36 479 488
130. Self DJ, Olivarez M, Baldwin DC Jr., Clarifying the relationship of medical education and moral development. Acad Med 1998 73 517 520
131. International Training and Education Center for Health Writing Good Learning Objectives. I-TECH Technical Implementation Guide #4. January 2010. http://www.go2itech.org/resources/technical-implementation-guides/TIG4.WritingLrngObj.pdf/view. Accessed February 23, 2015
132. Welch M, Enhancing Awareness and Improving Cultural Competence in Health Care: A Partnership Guide for Teaching Diversity and Cross-Cultural Concepts in Health Professional Training 1998 San Francisco, Calif University of California at San Francisco
133. Pinsky LE, Fryer-Edwards K, Diving for PERLS: Working and performance portfolios for evaluation and reflection on learning. J Gen Intern Med 2004 19 5 pt 2 582 587
134. Robb A, Etchells E, Cusimano MD, Cohen R, Singer PA, McKneally M, A randomized trial of teaching bioethics to surgical residents. Am J Surg 2005 189 453 457
135. Lewin LO, Olson CA, Goodman KW, Kokotailo PK, UME-21 and teaching ethics: A step in the right direction. Fam Med 2004 36 suppl S36 S42
136. Arnold L, Assessing professional behavior: Yesterday, today, and tomorrow. Acad Med 2002 77 502 515
137. Savulescu J, Crisp R, Fulford KW, Hope T, Evaluating ethics competence in medical education. J Med Ethics 1999 25 367 374
138. Rees C, Shepherd M, The acceptability of 360-degree judgements as a method of assessing undergraduate medical students' personal and professional behaviours. Med Educ 2005 39 49 57
139. Ginsburg S, Regehr G, Mylopoulos M, From behaviours to attributions: Further concerns regarding the evaluation of professionalism. Med Educ 2009 43 414 425
140. McCammon SD, Brody H, How virtue ethics informs medical professionalism. HEC Forum 2012 24 257 272
141. Ginsburg S, Regehr G, Lingard L, Basing the evaluation of professionalism on observable behaviors: A cautionary tale. Acad Med 2004 79 10 suppl S1 S4
142. Hafferty FW, Franks R, The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 1994 69 861 871
143. Hojat M, Vergare MJ, Maxwell K, The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009 84 1182 1191
144. Shochet RB, Colbert-Getz JM, Wright SM, The Johns Hopkins Learning Environment Scale: Measuring medical students' perceptions of the processes supporting professional formation. Acad Med 2015 90 810 818
145. Doukas DJ, Charting a course of reform in medical ethics and humanities. May 21, 2011 Presented at: Project to Rebalance and Integrate Medical Education (PRIME) Workshop II Louisville, Ky
146. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS, Physicians' empathy and clinical outcomes for diabetic patients. Acad Med 2011 86 359 364
147. Misch DA, Evaluating physicians' professionalism and humanism: The case for humanism connoisseurs. Acad Med 2002 77 489 495
148. Wald HS, Borkan JM, Taylor JS, Anthony D, Reis SP, Fostering and evaluating reflective capacity in medical education: Developing the REFLECT rubric for assessing reflective writing. Acad Med 2012 87 41 50
149. Myers MF, Herb A, Ethical dilemmas in clerkship rotations. Acad Med 2013 88 1609 1611
150. Berger JT, Moral distress in medical education and training. J Gen Intern Med 2014 29 395 398
151. Wiener CM, Thomas PA, Goodspeed E, Valle D, Nichols DG, Genes to society-the logic and process of the new curriculum for the Johns Hopkins University School of Medicine. Acad Med 2010 85 498 506
152. Charon R, Deep structures, or how our work improves the care of the sick. May 10, 2012 Presented at: Project to Rebalance and Integrate Medical Education (PRIME) 2012 National Conference Louisville, Ky