Extending ethics in medical education

Dr Andrew Papanikitas has used research, knowledge exchange and publications to strengthen the teaching of ethics in General Practice and other specialisms.

cover image of Handbook of Primary Care EthicsHandbook of Primary Care Ethics
Medical ethics and law (MEL) is a vital part of medical education. A strong foundation in MEL enables doctors to manage the professional dilemmas they face – within the law and with the confidence that they are doing the right thing.

A good understanding of ethics is particularly important in General Practice, the largest medical specialism and one where doctors are particularly likely to face ethical challenges without easy recourse to advice from colleagues.

Dr Papanikitas became aware of the need to strengthen MEL training as a GP trainee, finding the theoretical grounding he received as an undergraduate did not adequately prepare him for the dilemmas of day-to-day practice. As a practising GP he developed his interest with a PhD examining ethics education in General Practice, running a postgraduate diploma in Philosophy for Medicine, and involvement in the Royal College of GPs Ethics Committee.

Later, collaborating with Dr John Spicer, Head of Primary Care Education for Health Education England in South London, Papanikitas developed the Handbook of Primary Care Ethics, which offers insights from regulators, academics, clinicians and others on the range of dilemmas GPs may encounter.

Wendy Rogers, Professor of Clinical Ethics, Macquarie University, commented: ‘The Handbook of Primary Care offers something for everyone… guidance on duties in primary care, a framework for analysing a difficult consultation, insights into the voice of the patient, or an understanding of the economics of primary care.’ The book won a British Medical Association Book Award in 2018.

The award of a Knowledge Exchange Fellowship from The Oxford Research Centre for the Humanities in 2018-9 then allowed Dr Papanikitas to look beyond General Practice to explore post-graduate ethics education in other medical specialities. A pilot review of the Gerontology and Palliative Care curricula revealed huge differences in approach and content – and clear opportunities for knowledge exchange across medical specialities and between the profession and academia.

Working with Health Education England, the General Medical Council, the Royal Colleges and others through a series a knowledge exchange workshops, Papanikitas and Spicer have built a strong network of those interested in strengthening provision of ethics education after medical school. One output from this (with Knight, Hayhoe and other colleagues) is a pilot study of the needs of clinical commissioners with regard to ethics education. The paper is currently in press with the British Journal of General Practice.

Papanikitas is now seeking further funding to extend his review of post-graduate curricula and continue to promote robust MEL provision. He says: ‘Good ethics education equips doctors with the tools to manage the challenges they inevitably face in practice. Strengthening MEL is vital to preventing the stress and ‘moral distress’ we increasingly see in the profession, enabling doctors to practice with professionalism and confidence, and ensuring high-quality care for patients.’

Dr Andrew Papanikitas is an Oxford-based GP and a part-time Honorary Tutor at the Nuffield Department of Primary Health Care Sciences

Funders: The National Institute of Healthcare Research, The Institute of Medical Ethics, The Oxford Research Centre for the Humanities, The Collaborating Centre for Values Based Practice at St Catherine’s College Oxford, A Junior Research Fellowship at Harris Manchester College, Oxford.