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Bioethics Teaching and Assessment:  My Experience of Three Institutes 
 
 
Zoheb Rafique 

Lecturer, Department of Biochemistry,  

Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro, Pakistan 

Email: dr_zohaib@hotmail.com 
 

 

Abstract: This paper describes my experience of teaching bioethics in different institutes and degree 

courses at undergraduate level. Bioethics is being taught to improve the understanding of the ethical 

issues in the field of medicine. The students are being trained in bioethics to recognize and resolve 

different ethical dilemmas and also to combat the situations where ethical analysis is needed. This paper 

also focuses on teaching and assessment methods for undergraduate courses.  

 

Key Words: bioethics, teaching, assessment 

 

Introduction: While few would deny the fact that some attention should be given to the ethical issues as 

part of a medical student's education, it has never been clear how this could be best achieved 
1
. Bioethics 

is a necessary component of medical curriculum nowadays and it is being taught all over the world. It is 

not only included in medical curriculum, but also in dental, physiotherapy, nursing, biotechnology, 

residency programs and PhD Programs etc. The Edinburgh Declaration of Medical Education approved in 

1988 requires that a future physician be trained as an attentive listener, a sensitive communicator, a 

careful observer and an effective clinician 
2
. The practice of medicine is intrinsically an ethical enterprise 

because patients are vulnerable and suffering and medical treatments are not merely technical, they often 

invade patients’ bodies and engage their consciences 
3
. Pellegrino argues that the ethical decisions are 

an integral and essential part of being a good physician. The better the students’ prior ethical education 

the better they can appreciate nuances and complexities of medical ethical choices. The less that prior 

education, the more the student needs instruction in ethics in the medical schools 
4
. From the developing 

world, countries such as Pakistan, Sri Lanka, India and Saudi Arabia have been slow to respond to this 

universal need 
5-7

. In Pakistan bioethics was started in 1998 at Aga Khan University (AKU) Karachi and 

was included in undergraduate curriculum of community health sciences 
8
. In our university Liaquat 

University of Medical and Health Sciences Jamshoro (LUMHS), bioethics teaching was started in 2007 

and was included in MBBS undergraduate curriculum. Bioethics is being taught in Lecture format only 

because of huge number of students and shortage of faculty, so we are not able to arrange problem 

based learning and small group discussions. I have been teaching bioethics to first year and second year 

MBBS Students since 2011. I have modified the curriculum and included more contemporary ethical 

issues and guidelines. Bioethics is not a separate subject in our MBBS program, but it a Tagged subject. 

mailto:dr_zohaib@hotmail.com


Bangladesh Journal of Bioethics 2014; 5(2):44-48 
 

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One of the affiliated institutes at our university IPRS (Institute of Physiotherapy and Rehabilitation 

Sciences) has also started bioethics in their BSc Physiotherapy program. They included bioethics as a 

separate subject in their final year. I am teaching in IPRS along with their faculty. There are very few 

medical institutes in our city Hyderabad and one of them is ISRA University. I am working as a visiting 

faculty member in ISRA University and I am involved in teaching bioethics. I am teaching bioethics to first 

year MBBS students and they have included bioethics as a minor subject. In this Paper I will discuss my 

experience of teaching bioethics in these three institutes and I will also discuss the assessment methods 

in the exam. 

 

How Do I Teach Bioethics: In our MBBS program at LUMHS, there are twelve lectures of bioethics in 

their curriculum. I use to take three lectures in each semester so I cover 12 lectures in the initial 4 

semesters of MBBS. The main subjects in the initial two years are Anatomy, Physiology and Biochemistry 

and some of the other subjects are included as Tagged subjects. They include Bioethics, Information 

Technology and Community Medicine. Community Medicine becomes major subject in 4th year MBBS. 

The twelve lectures covers almost all major topic of bioethics and they include, Introduction to Bioethics, 

in which fundamental principles of bioethics and why there is need of bioethics, definition of ethics and  

bioethics, history of medical ethics and components of medical ethics are covered. Physician-Patient 

Relationship is included in which all the doctor-patient approaches are covered such as consumerist, 

paternalistic, relationship of mutuality and finally default approach. One more important topic of bioethics 

Confidentiality is also being taught in which definition of confidentiality, ethical basis of confidentiality, 

circumstances of breach of confidentiality, exceptions to the requirement of confidentiality, confidentiality 

in Research i.e. Benefits of maintaining confidentiality in Research, how confidentiality can be maintained 

in the Research setting and what Researchers should do in this regard are covered. Informed Consent, its 

definition, five components, why informed consent is necessary, who cannot give consent and when proxy 

has to sign consent form, informed consent when doing Research, informed consent form in detail are 

included. Euthanasia, its definition, types, examples, case scenarios, Islamic Teachings regarding 

Euthanasia and end of life issues are covered. Brief account of organ donation and abortion are also 

included. Medical error and its types, doctor guilt after making errors and strategies of avoiding medical 

errors and reporting them are also covered. One topic includes breaking bad news and why it is difficult to 

do it, ABCDE Mnemonic of breaking bad news and what are the things to be avoided while breaking bad 

news are taught. Professional ethics is also taught and it covers definition of professional ethics, the dual 

role of physician and investigator, ethical guidelines for research involving human subjects and 

Nuremberg code. Ethical Dilemma, its definition, types, why does it exist and what are the steps for 

resolving ethical dilemmas are covered. Privacy and Veracity are also in the curriculum and they cover 

definition of privacy, privacy types, definition of veracity and arguments contributing to the justification of 

obligations of veracity. Theories of bioethics are also included in the course 
9
. One of the most important 

ethical issues which are often ignored is relationship of doctors/physicians with medical representatives of 



Bangladesh Journal of Bioethics 2014; 5(2):44-48 
 

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pharmaceutical companies and includes levels of interaction, promotions, various gifts from 

pharmaceutical companies, drug samples and its purpose in the eyes of patients, doctors and 

manufacturers. The curriculum at ISRA University is same as in LUMHS Jamshoro, but at ISRA University 

bioethics in being taught only in 2nd semester MBBS. Bioethics is major subject at IPRS LUMHS 

Jamshoro and it is being taught in their 7th and 8th semester (Final Year). I use to teach the same topics 

which I teach at MBBS level and they include all the topics from general ethics and they form the base of 

physiotherapy students. The IPRS have their own faculty also which is trained in ethics and they handle 

the ethical issues in the field of physiotherapy, organizational ethics and code of conduct in physiotherapy. 

We divided the topics into two and we cover them in both semesters (7th and 8th). As I earlier said in my 

paper that it is not possible for us to teach in any other format other than lectures, we do discuss case 

scenarios in our lectures and we make lectures interactive and we use power point presentations also in 

lectures. I always try to teach students the basic things so that they can learn and improve their future 

practices. The students do understand the ethical issues and they often ask questions regarding different 

ethical dilemmas.  

 

How Do I Assess In Exam: My Bioethics topics are same for the three institutes but the difference 

comes when doing final assessment. At the end of the semester classes and before exams, I give them 

handouts of all the topics covered in the lectures. The assessment tool is summative assessment (exam 

at the end of semester 
10

. In LUMHS MBBS Program there is no separate paper of bioethics, instead we 

give one compulsory short essay question in anatomy paper. Hence, anatomy paper consists of 95 marks 

and bioethics question contains 05 marks. If the students do not attempt the bioethics question they loss 

five marks because they don’t have any choice as it is compulsory question. Due to the question being 

compulsory the students do read the handouts before the exam and generally they do perform well in 

exam. At ISRA University the subject as I said earlier is minor, but they do have full paper. The marks of 

the paper are included in the semester exam but not in final annual exam, as ISRA have both patterns of 

exam i.e., semester followed by annual. There is single paper which contains bioethics as well as skill. 

The skill here refers to skill lab procedures, methods and concepts and it is taught by the ISRA faculty 

themselves and I use to teach bioethics as visiting faculty member. The paper comprises of 100 marks 

with 50 marks reserved for each component i.e. bioethics and skill. There are 60 SBQs (Single Best 

Questions) and 8 SEQs (Short Essay Questions). Each (BCQ) best choice question (contain one mark 

and each SEQ contain five marks. The students have to secure 50 marks out of 100 to pass the subject. 

In BS Physiotherapy, the bioethics is compulsory subject and students have to pass the subject to clear 

their semesters. There is no annual system in IPRS so students have to clear bioethics in both 7th and 

8th semesters. There are 100 marks in bioethics paper and paper contains my component and other from 

the faculty of IPRS. We have again divided our portions and we teach in the ratio of 75:25. In 7th 

semester I teach 75 percent of the course and the IPRS faculty 25 percent. It is because the topics from 

general ethics helps the students and are like first step to understand ethical issues in physiotherapy in 



Bangladesh Journal of Bioethics 2014; 5(2):44-48 
 

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the coming lectures. In 8th semester the ratio inverses and I teach 25 percent of the curriculum and they 

teach 75 percent.  The Physiotherapy component is mainly covered in 8th semester. There are 35 BCQs 

in the semester paper and contains 70 marks, while 30 marks are reserved for SEQs and students have 

to attempt 6 questions out of 8 and each question carries 05 marks. We have the paper distribution also 

in the ratio of 75:25, in which 6 SEQs and 27 BCQs are given to 75 percent weightage component and 2 

SEQs and 08 BCQs are reserved for 25 percent component and vice versa in other semester. In BCQs 

we include some case scenarios also which are discussed in the lectures. Those students who get less 

than 50 percent marks are declared fail and they have to appear in Re-sit exam. The performance of 

Physiotherapy students is better than MBBS Students in the exam. This is because bioethics is included 

in their final year and they are already familiar with the clinical subjects and clinical ward postings and 

being final year students their maturity and cognitive level is also higher than 1st year MBBS Students. 

The other reason is that they have compulsory subject of bioethics and they have to pass it at any cost to 

get the degree. The time allotted for papers is 2 hours in physiotherapy paper and 2 and half hours in 

MBBS paper at ISRA University and LUMHS Anatomy paper is also of 2 hours where one compulsory 

question of bioethics is included. There is no OSPE or OSCE exam included to assess the students. The 

students’ attendance is merged and counted in overall attendance with other major subjects and those 

students who have less than 75 percent attendance are not allowed to appear in exam. This rule applies 

to all three institutes uniformly. Some students take bioethics seriously and try to understand the concepts 

and contemporary issues in the field, while other just tries to pass the exam and show superficial interest. 

 

Conclusion: A good physician is one who is not only technically sound, but also ethically well-grounded. 

Medical institutes in Pakistan are providing technical training, but largely neglecting the ethical 

component. Given the challenging environment of developing countries, it is imperative that structured 

education in bioethics with a proper evaluation and feedback system is developed. Bioethics is currently 

being taught in almost all major medical institutes of our country and the smaller and newer institutes 

should also adopt this strategy. My current experience of almost 2 and half years of teaching bioethics is 

satisfactory and I hope the future generation of the doctors will practice their medicine in ethical way and 

they will implement bioethics in their clinical practices and research, whether it is informed consent or 

keeping confidentiality of the patient and the research subjects or avoiding unethical relationship with the 

representatives of the pharmaceutical companies. 

 

References: 

1. D J Weatherall. Teaching ethics to medical students. Journal of medical ethics.1995 21: 133-134 

2. The Edinburgh Declaration. The world conference on medical education. 1988 August 7–12. 

Edinburgh, Scotland: World Federation for Medical Education. 

3. Dubois JM, Burkemper J. Ethics education in US medical schools: A study of syllabi. Acad Med. 2002 

77:432–437. 



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4. Pellegrino ED. Teaching medical ethics: Some persistent questions and some responses. Acad Med. 

1989 64:701–703. 

5. Al-Shehri MY. Medical curriculum in Saudi medical colleges: Current and future perspectives. Ann 

Saudi Med. 2001 21:320–323. 

6. Shiraz B, Shamim MS, Shamim MS, Ahmed A. Medical ethics in surgical wards: Knowledge, attitude 

and practice of surgical team members in Karachi. Indian J Med Ethics. 2005 2:94–96. 

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tomorrow’s physicians: An aspect of coverage in the formal curriculum. Med Teach. 2006 28:182–184. 

8. KULSOOM GHIAS, SYEDA KAUSER ALI, KAUSAR S. KHAN, ROBYNA KHAN, MURAD M. KHAN, 

ARSHI FAROOQUI & PARVEZ NAYANI.  How we developed a bioethics theme in an undergraduate 

medical curriculum. Med Teach. 2011 33: 974–977. 

9. Tom L. Beauchamp, James F. Childress. Principles of Biomedical Ethics. 2001; 5th edition, Oxford 

University Press. 

10. K Mattick, J Bingh. Teaching and assessing medical ethics: where are we now? J. Med. Ethics. 2006 

32:181-185. 

 

 

 Conflict of interest: There is no conflict of interest. 
 

 

  

  




