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[Expositions 7.1 (2013) 72–87]  Expositions (online) ISSN: 1747–5376 

Educating for Ethical Engagement: Teaching Ethics to Graduate and 

Professional Students 
 

TOBY SCHONFELD 

Emory University 

 

 

I teach at an institution whose vision statement includes the term “ethically engaged.” Indeed, the 

goal is to engage in discourse in a way that fosters “openness and diversity of thought, 

experience, and culture”; to have scholars and students who “actively debate principles” with a 

commitment to “integrity and honor”; and to enhance the environment “through innovative 

stewardship” (Emory University). The commitment demonstrated by the administration to these 

principles should not be understated; without support at the top of an institution’s hierarchy, any 

effort to enforce policies or standards at the lower levels will inevitably fail. In addition, the 

culture of an organization is at least partly shaped by its leadership, and as a result having an 

administration dedicated to ethical action among its scholars and students helps generate a sense 

of positive energy toward “doing the right thing,” as it were. 

Yet it is at the level of direct interaction where ethical engagement is both developed and 

tested. We want graduate student researchers to use proper scientific methods, to respect 

individuals and populations who are partners with them in their research, and to craft research 

products that are both intellectually rigorous and useful to others. We want professional students 

to learn to conduct business transactions fairly; to honor the dignity and integrity of patients, 

clients, and colleagues; and to embrace diversity of cultures, traditions, and perspectives. And as 

these students become teachers themselves, we want them not only to model appropriate 

interaction and research processes, but also to learn to assess students’ progress with an eye 

towards justice and equality. 

In order to produce the professionals who embody these characteristics, faculty must teach by 

example, but not only this, for the skills, habits, and dispositions towards ethical action can be—

and must be—taught explicitly (Bird 1996, 783–86). Just as we would not expect a physician to 

know all that she needed about nephrology by inferring form and function from the surrounding 

systems, so too is it that we cannot anticipate graduate and professional students will be able to 

infer ethical engagement simply through “reading between the lines.” (In fact, explicit instruction 

in ethics is often required to combat precisely what the students do receive “between the lines”!) 

The job of graduate and professional educators includes preparing students to participate in an 

active citizenry, where scholars and professionals can both articulate and implement the 

foundations of ethical behavior both in their areas of specialty and in society more broadly. 

In this essay, I will describe the goals of ethics education for two main categories of post-

baccalaureate students: graduate students and professional students. I will then discuss how the 

goals of each educational endeavor ideally shape the curriculum that is developed. Next I will 

turn to discuss common content areas for ethics instruction (what one should teach), as well as to 

issues of ethics pedagogy (how one should teach). I conclude with a discussion of evaluation and 



73  Schonfeld 

 

 
 

assessment of ethics education for graduate and professional students, and demonstrate how 

these essential features ultimately cycle back to goal development and curricular design. 

 

Goals of ethics education  

As Ralph Tyler comments in his classic work on curriculum design, “[I]f an educational program 

is to be planned and if efforts for continued improvement are to be made, it is very necessary to 

have some conception of the goals that are being aimed at” (Tyler 1970, 3). That is, while it is 

true that some instructors can craft an effective course without first considering the goals of the 

curriculum, it is difficult to sustain such efforts without a more comprehensive view of learning 

outcomes. And while, broadly speaking, the goal of ethics education is to teach students to “act 

ethically,” more specific learning objectives will better ensure that the curriculum will enable 

students to achieve the desired outcome. 

 

Graduate education  

 

Most graduate education in ethics revolves around what is known as the responsible conduct 

of research (RCR), which refers to “overlapping concepts related to the discovery and 

dissemination of new knowledge: research, responsible science, scientific integrity, and 

responsible researchers” (Horner and Minifie 2011, S304). Given that the overall goal of 

graduate education is to produce the next generation of researchers, scholars, and teachers, 

effective RCR training lays a foundation from which these students can become effective 

purveyors of all aspects of their craft. 

Most RCR instruction aims at instilling a particular set of values in students from which 

ethical action should emerge. What are those values? Scholars have proposed a series of 

foundational principles, ranging from those specifically related to research involving human 

participants and codified in the Belmont Report (respect for persons, beneficence, and justice) to 

those seen as “fundamental to the scientific enterprise as a whole…: truthfulness, trust, …best 

interests, …carefulness, openness, freedom, credit, education, social responsibility, legality, 

opportunity, and mutual respect” (Horner and Minifie 2011, S305). 

While this work has gained prominence in the past few years in the STEM disciplines 

(science, technology, engineering, and math), the goal of producing scholars committed to the 

principles of ethical research transcends disciplinary lines. Indeed, some programs specifically 

aim at teaching skills that transfer beyond the discipline (see Weisblat and Sell 2012). Yet, 

consider the following definition:  “RCR refers to the commitment and integrity of researchers—

and all who participate in the research enterprise—to the norms of science, who—by engaging in 

systematic, responsible practices while proposing, performing, evaluating, and reporting 

research—contribute to an accurate, worthwhile, and enduring scientific record” (Horner and 

Minifie 2011, S304). Whether that “scientific record” is in chemistry, sociology, or art history, 

the goal of instilling core values within graduate education is relevant for all students. 

 



Educating for Ethical Engagement  74 

 

Professional education 

 

There are several reasons why training programs for professionals, especially health 

professionals, include ethics education. First, many hope that ethics education will enable the 

professional to recognize and effectively address ethical issues in clinical practice (Smith et al. 

2004; Eckles et al. 2005; Smith et al. 1994; Opel and Olson 2012), in policy development (Agee 

and Gimbel 2009), or in the clinical environment (Lin et al. 2013). Students will change both 

their behaviors and attitudes as a result of the ethics education in which they participate (Gross 

1999). Some programs aim at the moral development of students, most often measured in 

relation to Kohlberg’s schema (Dieruf 2004; Gross 1999; Self, Wolinsky, and Baldwin 1989; 

Bebeau and Thoma 1994; Quinn, Kinnison, and May 2012). Others aim at the “correction” of 

negative influences by powerful role models, sometimes referred to as the “hidden curriculum” 

(Wester, Willse, and Davis 2010; Lynoe, Lofmark, and Thulesius 2008; Kittmer et al. 2013). 

For both professional and graduate students, opportunities to participate in the global 

community create another set of educational goals. Students who are inadequately trained in 

ethics may in fact help to perpetuate some of the inequities that they hope to address (Lahey 

2012). Therefore, students must be prepared for the ethical complexities of research and 

professional practice in an international context. 

There is some evidence that explicitly teaching ethics to students is correlated with positive 

ethical behavior (Wester, Willse, and Davis 2010). This is true largely because ethics is 

“relational in nature,” and therefore attitudinal and behavioral shifts are particularly relevant 

(Milligan and Woodley 2009). For some, the goals of ethics education in the health professions 

is to enable “students to see ethics as a transformative, relational, and engaged endeavor in which 

their role is not to be an ethical ‘expert’ but rather to be informed and sensitive interlocutors 

within the multiple relationships of the health care setting” (Milligan and Woodley 2009, 133). 

 

How the goals shape curriculum design 

Despite a set of common goals, there is a variety of approaches to achieving successful ethics 

education for graduate and professional education (Lewin et al. 2004; Goldie 2000). Many 

curricula are practically focused, in the belief that attending to “real-world dilemmas” produces 

professionals who are equipped to address the ethical intricacies of clinical practice, scientific 

research, and a changing global environment (Roberts et al. 2005). Yet this may not be 

sufficient: one study comments that “embracing values and acquiring reasoning skills are not in 

fact sufficient to ensure ethical practice,” since organizational pressures for efficiency, among 

other pressures, may result in trainees’ inability to implement what they know is the right thing 

to do (McDougall 2009, 203–206). Therefore, good curriculum design must include not just the 

transfer of relevant knowledge, skills, and attitudes, but rather must also include practical 

strategies for the implementation of students’ new competencies given the reality of their future 

environments (McDougall 2009, 203–206). 



75  Schonfeld 

 

 
 

This is especially true if the goal of the curriculum is value inculcation and implementation. 

Integrity can only be demonstrated through ethical action, so if there are institutional, 

hierarchical, social, or economic challenges to the implementation of core values, they must be 

included as part of the curriculum. Systemic pressures are not ancillary to educational design—

they are essential to it. 

Professional ethical education has often been communicated largely through the 

apprenticeship or mentoring model, but critics have attacked this methodology for both its lack 

of theoretical grounding and the impact of poor role models (Satterwhite, Satterwhite III, and 

Enarson 2000). Explicit education in ethics and professionalism provides students with the skill 

set necessary to apply fundamental value constructs in practice in a more comprehensive way 

than implicit modeling does. Students can learn about styles of implementation of core concepts 

from an apprenticeship model, but direct, longitudinal, and well-designed education in ethics and 

professionalism will make trainees more comfortable with and confident in topics in ethics. 

One important partner in curriculum design is often overlooked: the admissions committee. 

Since admissions committees assess fitness for success in a particular curriculum, they must 

work closely with the faculty responsible for curriculum to ensure a good match between 

curriculum design and student characteristics. To see what kind of impact this might have, 

consider that one scholar suggests that because effective teaching of ethics requires students be 

comfortable with fundamental concepts of ambiguity, admissions committees consider assessing 

“tolerance for ambiguity” as a criterion of selection (Geller 2013, 581–584). Regardless of the 

appropriate criteria, there is a necessary connection between goals, curriculum design, and 

student admissions.  

 

Integration of curriculum within larger framework 

 

Some argue that the best way to ensure that students are prepared to identify and address 

ethical issues as they arise is to establish “a curriculum that situates…ethical experiences to 

trainees in a more systematic fashion and within a structured format, thus allowing them to more 

explicitly build ethical reasoning skills” (Silverman et al. 2013, 58). Yet such a curriculum 

design could take many forms: discrete ethics courses as both required and elective elements of a 

training program, carefully-planned (and transparently communicated to students) integration of 

ethics topics throughout an overall curriculum, or a series of informal workshops and sessions 

that are interdisciplinary and broad-based. It is often the structure of the overall curriculum that 

constrains the design of the ethics piece: there is often a trade-off between devoting explicit time 

to professionalism topics and communicating “core” knowledge of the field. The variability of 

structures at institutions—and within programs at those institutions—makes it difficult to 

recommend a “one size fits all” structure for ethics instruction to graduate and professional 

students. Yet note that the organizational structure provides both opportunities and limitations 

for ethics instruction. 

 



Educating for Ethical Engagement  76 

 

Decisions about content: What to teach 

Content dictates form; that is, what one teaches ought to dictate how one teaches. Yet there is no 

consensus about either of these features in the ethics community. In what follows, I will describe 

some broad considerations that may assist designing ethics curricula for graduate and 

professional students, although I do not present these considerations as exhaustive. 

 

Professional and accrediting organizations 

 

Many professional organizations have either required ethics education as part of their 

accreditation requirements for curricula, or added licensing and continuing education 

requirements in ethics. The Office of Research Integrity (ORI) of the Department of Health and 

Human Services has identified nine core areas that are essential components of RCR education 

(Steneck 2007). Since the ORI is the oversight body responsible for Public Health Service 

research integrity activities, its broad purview adds influence and authority to its 

recommendations (Steneck 2007 p. v). Both the National Institutes of Health (NIH) and the 

National Science Foundation (NSF) have long required ethics training for those participating in 

grants that they fund. In addition to identifying general principles supporting ethics instruction, 

the NIH suggests a list of topics on which there is common agreement (National Institutes of 

Health 2011). Additionally, the Council of Graduate Schools (CGS) has pioneered several 

initiatives to encourage and facilitate instruction in these areas.[1] 

For health professions students, ethics and professionalism standards are essential components 

of medical education and training programs, as recognized by the two major accrediting bodies 

of Schools of Medicine: the Liaison Committee on Medical Education (LCME) and the 

Accreditation Council for Graduate Medical Education (ACGME). Programs in nursing and 

allied health professions also have accrediting and licensing agencies that specify ethics training. 

Finally, the national bioethics association, the American Society for Bioethics and Humanities 

(ASBH), has developed a document that outlines the core competencies necessary for bioethics 

clinical consultants, as well as a companion piece that serves as an education guide for achieving 

the objectives outlined in the core competencies document. 

 

General content considerations 

 

Because ethics education is multi-faceted, considerations of content are not limited to simply 

a list of subjects worth discussing, but instead must also include processes of skill development 

and mastery of appropriate attitudes. Much of curriculum design in ethics, then, involves 

identifying relevant knowledge, skills, and attitudes (KSAs). One group at Georgetown 

University has identified the central topics for RCR training that reflects not just the mastery of 

content knowledge, but also skill and attitude development (Tractenberg and FitzGerald 2012). 

In addition, health care educators are increasingly expected to instruct students not only on 

clinical competencies, but also critical thinking and professional partnering skills, technological 



77  Schonfeld 

 

 
 

aptitude, computer competence, and informatics (Litchfield et al. 2000, and Hayward and Cairns, 

2001). 

Yet even knowing that “content” is a broad consideration in ethics does not guarantee 

consensus in instruction. Two surveys revealed the breadth of methods and topics used in ethics 

education at U.S. and Canadian medical schools (DuBois and Burkemper 2002, 432–437; 

Lehmann et al. 2004, 682–689). Authors of both studies agree that a “common core curriculum” 

does not exist, and that a significant gap remains between ideal and real curricula. Similar 

findings have been confirmed in parts of Europe (Mijaljica 2013). 

A recent paper describes a novel, alternative approach to ethics education. Rather than listing 

specific topics, McCammon and Brody argue for teaching virtue ethics as a methodology to 

medical professionals. They claim that this approach provides at least three advantages: (1) 

deliberately teaching medical virtues can produce trainees who exhibit professional behavior 

regardless of the aptitude with which they entered the profession; (2) viewing virtue formation as 

a life-long process emphasizes the continual development of professional identity rather than 

presenting it as something whose competency can be mastered; and (3) recognizing moral 

distress as an inevitable byproduct of the virtuous professional’s actions promotes an open, 

transparent discussion of morally troubling features of professional life (McCammon and Brody 

2012, 257–272). 

 

Decisions about pedagogy: How to teach 

Ethics instruction, especially to an audience of professionals or soon-to-be professionals, carries 

with it its own set of challenges and opportunities. A good review of what makes ethics 

education different, and difficult, to teach was produced by Felicia Cohn (Cohn 2012, 164–171). 

The overall goal is to view students as partners in education, not as passive recipients of 

knowledge (Milligan and Woodley 2009, 131–139). This means detailing a structure that enables 

students to engage meaningfully with the work, which can be time consuming and intensive for 

both students and faculty alike. 

 

Using cases well 

 

In ethics, cases are often seen as the primary pedagogical vehicle for delivering relevant 

knowledge, developing skills, and effecting change in attitude, at least partly by recognizing the 

value of narrative medicine (Charon 2012, 342–347; Foreman, Hark, and DeLisser 2012, 29–37; 

Garrison et al. 2011, 85–89; Jawaid et al. 2011, 66–70; Stephens et al. 2012, 26–30). One study 

investigated the type of case that is likely to be most effective in promoting learning and found 

that cases that include social context details are more effective (Bagdasarov et al. 2012b), as well 

as those cases with a simple causal structure (Johnson et al. 2012, 63–77). Another study that 

compared the effectiveness of case-based instruction on learning, retention, and ethical decision-

making found that well-structured cases and assignments led to greater effectiveness in 

instruction (Bagdasarov et al. 2012a, 79–86). In addition, “reflection” as an exercise is neither 



Educating for Ethical Engagement  78 

 

one clearly defined process nor easy to teach to novice learners; as a result, faculty incorporating 

reflective writing into a curriculum must consider carefully the meaning, structure, and desired 

outcomes for the exercise (Wald and Reis 2010, 746–749; Cohn et al. 2009, 587–596; Wear et al. 

2012, 603–609). 

Building on the successes of incorporating reflective writing into medical education generally, 

one study compared two teaching methods—written case analyses and written case analyses with 

group discussion—to determine the effectiveness of each method on enhancing students’ ability 

to identify and assess ethical issues (Smith et al. 2004, 265–271). Not surprisingly, the 

investigators concluded that group discussion of the cases added educational value; students’ 

ability to identify and assess ethical issues improved after a structured, facilitated discussion 

session (Smith et al. 2004, 265–271). 

Not all case-based pedagogy is equal. Some scholars criticize the “distilling” of cases down to 

their essential features on the grounds that critically important contextual details get lost in 

translation; as a result, students end up with an impoverished array of possible resolutions to a 

case (Milligan and Woodley 2009, 131–139). In order to address this fear, some programs use 

“creative expressive” exercises to teach students how to recognize and capture important 

contextual features of situations (Milligan and Woodley 2009, 131–139). 

Relevant case scenarios may be effective in graduate education (Wester 2007, 199–211). Yet 

whether for graduate or professional education, it may not be ideal to present only cases that 

result in moral distress or that highlight systematic failures. Indeed,  the “tragic” case method of 

teaching ethics may not be sufficient because it fails to prepare trainees both for the more 

common, mundane ethical issues and for their likely role in the identification and resolution of 

an ethical issue (Opel and Olson 2012, 370–373). Rather, a more effective method may be to 

have students generate their own cases based on ethical quandaries they have experienced in 

their own research or practice (Opel and Olson 2012, 370–373; Fard, Asghari, and Mirzazadeh 

2010, 723–730). 

 

Assessment and Evaluation 

Regardless of the approach to teaching ethics, assessment of learning remains a challenge. The 

goal of higher education is no longer simply the acquisition of knowledge in a particular area, 

but also the creation of a community of learners who have developed “problem-solving skills, 

professional skills, and authentic learning, i.e. learning in real-life contexts” (Dochy, Segers, and 

Sluijsmans 1999, 332). As a result, assessment must go beyond simply measuring the 

“reproduction of knowledge” (Dochy, Segers, and Sluijsmans 1999, 331–350) and attend to 

these additional skill sets as well. However, the measurement of such skill sets remains a 

challenge. 

One study compared three approaches to ethics education in graduate social work programs: a 

discrete course in ethics, an integrated ethics model, and a mixed-model approach. Investigators 

found that students in the discrete ethics course (which focused on principles of common 

morality) demonstrated a greater improvement in moral judgment and ethical sensitivity than did 



79  Schonfeld 

 

 
 

students in either of the other two groups (Sanders and Hoffman 2010, 7–22). Another study 

demonstrated evidence that even a short lecture focused on an area of research misconduct can 

be helpful in raising students’ awareness of the problem and how to avoid it (Brkic et al. 2012, 

570–574). 

Whatever the method of instruction chosen, assessment areas must be dictated by the goals of 

ethics education. Therefore, part of the early stages of curriculum design must include 

considerations of the measurement of goals when students complete the training program. As 

Tyler states: “many variables make it impossible to guarantee that the actual learning 

experiences provided are precisely those that are outlined in the learning units. Hence, it is 

important to make a more inclusive check as to whether these plans for learning experiences 

actually function to guide the teacher in producing the sort of outcomes desired” (Tyler 1970, 

104). In addition to evaluating the specific coursework, well-designed assessments will “check 

the validity of the basic hypotheses upon which the instructional program has been designed and 

developed” (Tyler 1970, 105). 

 

Quantitative vs. qualitative measures 

 

There are efforts to measure students’ ethics mastery via quantitative measures. One study 

describes a multiple choice pre-test/post-test design, where students’ scores increased 

significantly after a 15-week pre-clinical bioethics course (Fernandes, Borges, and Rodabaugh 

2012, 92–97). Others have devised a quantitative instrument to measure “dimensions of 

ethicality” among graduate students that has validity across the four dimensions of data 

management, study conduct, professional practices, and business practices (Mumford et al. 2006, 

319–345). Qualitative measures are often seen as a better way of capturing ethical mastery, as it 

is only through the application of knowledge and skills that competence is apparent. Yet it is 

often difficult to achieve inter-rater reliability on these measures in ethics, which compromises 

the validity of the findings of a study (Lohfeld et al. 2012, 635–642). 

However, given that ethics is fundamentally relational, it can be difficult to assess students’ 

skills and attitudes effectively by using quantitative measures alone. Qualitative or mixed 

method techniques facilitate the evaluation of a question involving many (and sometimes 

unknown) variables and enables the researcher to consider both emergent themes and the role 

and influence of the investigator on the subject studied (Creswell 2003). This is particularly 

valuable in ethics education, where the perspectives of the teacher may have significant influence 

on the development of the learner. Trainees quickly learn which approaches to an ethics problem 

the teacher prefers and may quickly shape their habits based on the approach of the instructor. 

Similarly, listening to a trusted teacher or mentor offer a perspective on an issue is likely to have 

a significant impact on the way a trainee approaches the problem. And yet we rarely account for 

these features in curricular assessment; rather, we simply concentrate on whether or not the 

students seemed to perform adequately according to our objectives. Qualitative measures, 

however, enable us to probe for these additional features, and to recognize and address them 



Educating for Ethical Engagement  80 

 

when they emerge unexpectedly from analysis. Common techniques for eliciting such 

information come from focus groups or interviews, but even a careful analysis of a case study 

(whether in a pre-test/post-test format or individually) can provide insight into the intended and 

unintended influences on students’ learning. 

Qualitative assessments of ethics teaching abound in the literature. One approach builds on 

general work on the utility of reflective writing in medicine as a way of enhancing insight into 

personal and professional values, connecting to and processing cases that are emotionally 

engaging for practitioners, and managing moral conflicts that may arise in clinical practice 

(Abildsnes, Flottorp, and Stensland 2012; Cohn et al. 2009; Cayley, Schilling, and Suechting 

2007; Chretien, Goldman, and Faselis 2008,; Devlin et al. 2010,; Plack et al. 2007; Song and 

Stewart 2012; Thiel et al. 2011). Studies have demonstrated the utility of reflective writing in 

ethics for specific institutions and curricula (Fischer et al. 2011, 166–175), but may not be 

generalizable (Cohn et al. 2009, 587–596; Chretien et al. 2012, 42–48). Other studies compare 

written case analysis with and without group discussion (Smith et al. 2004, 265–271), while yet 

others use a pre-test/post-test model to identify success in achieving learning outcomes 

(Schonfeld, Dahlke, and Longo 2011, 273–290). Regardless, the assessment method must be 

dictated by the research questions asked. 

 

Evaluation of curriculum 

 

Many of the aforementioned instruments are designed to measure the effectiveness of a 

particular course or educational intervention. Yet entire curricula must also be assessed for 

adequacy of achieving objectives, and such assessment cannot simply consist in aggregating the 

data from individual courses. To be done well, program-level assessments often require 

significant investment of faculty, student, and administrator time, and a variety of dimensions of 

the content, process, and logistics of the curriculum must be considered (Goldman et al. 2012, 

300–307). The most successful approaches consider assessment as part of the initial curriculum 

design, and therefore any instruments (surveys, vignettes, reflections) or processes (focus groups, 

structured interviews, pre-tests/post-tests) are prepared and planned well ahead of the time for 

assessment. 

 

Conclusion 

As students transition to the professional workforce, they will encounter emergent ethical issues 

not covered by their training. Indeed, such issues may arise from a myriad of sources, including 

from engagement with social media and public perceptions of the professional enterprise based 

on journalistic accounts of misdeeds (Farnan et al. 2013, 620–627; Anderson and Giordano 2013, 

58) . The only realistic way to prepare students to anticipate and address emergent issues is by 

providing them with the tools to reason through issues as they develop. 

 



81  Schonfeld 

 

 
 

 

Notes 

1. Full disclosure: Emory University has been the recipient of two recent grants from the 

Council of Graduate Schools, which were used to create and refine the Program on 

Scholarly Integrity that I direct. 

 

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