Journal of Medical Ethics and History of Medicine An innovative method of self-education through a bioethics group: the Ziauddin experience, Karachi, Pakistan Nausheen Saeed Assistant Professor, Department of Surgery, Ziauddin Hospital, Karachi, Pakistan. *Corresponding author: Nausheen Saeed Address: Ziauddin Hospital, Karachi, Pakistan. E-mail: minhalzay@yahoo.com Received: 31 May 2009 Accepted: 30 Aug 2009 Published: 14 Sep 2009 J Med Ethics Hist Med. 2009; 2:17. © 2009 Nausheen Saeed; licensee Tehran Univ. Med. Sci. Introduction World advancement in biotechnology has emerged as a challenge to humanity as well as physicians working in the community. With changing traditions and values, it is the need of the day to identify the ethical implications of our profession in order to deal with clinical dilemmas with a better understanding (1). The importance of bioethics teaching was overlooked till late 1990s in Pakistan and for the first time this subject gained recognition by Pakistan Medical and Dental Council (PMDC) in 2002 ( 2). As a result of this, all public and private medical colleges are bound to incorporate ethics as a subject in their curriculum. However, the young doctors who begin their career in university hospitals were not exposed to bioethics education; they feel the need of a formal training because they encounter problems in facing ethical dilemmas emerging from their clinical practice (3). In addition, they have to participate in undergraduate bioethics teaching. In order to meet these demands physicians have started showing their enthusiasm to educate themselves. The centre of biomedical ethics and culture (CBEC) introduced a one year postgraduate diploma (PGD) program in 2006. It is the only postgraduate-awarding degree program in biomedi- cal ethics in Pakistan. The focus of CBEC is to educate mid-career health care professionals particularly belonging to university hospitals throughout Pakistan (4). One of the mandatory requirements of this diploma course is to take up a project with an objective of disseminating bioethics education in different spheres of medical field. Ziauddin University started organizing bioeth- ics-related activities in its campus about seven years back. It is among one of the few private medical universities of the country which is forward looking and open to accept the challenges of new medical world. This institution recognized the need of teaching ethics even before its inclusion in PMDC code and started formal lectures for faculty by a consultant who had background in ethics. Ziauddin hospital comprises of three campuses based in Karachi. Keamari campus is a 110 bedded, low cost, tertiary care hospital which caters to a large population of Keamari (it is the main coastal town of Karachi situated in the central and western parts of the city) (5). The hospital includes special- ties like general medicine and allied, general surgery and allied, obstetrics and gynecology, eye, ear, nose and throat (ENT), pediatrics etc. The clinical teaching of the medical students has been divided into three campuses and this campus provides a great opportunity for third and fourth year students to gain knowledge and skills (6). The group coordinator has been working in the campus as an assistant professor in the department of general surgery and is actively involved in under-and post-graduate teaching. The majority faculty at this campus felt the requirement of initiating bioethics related activities. The need for starting bioethics education was raised because of a particular case of a woman J Med Ethics Hist Med 2009, 2:17 Nausheen Saeed Page 2 of 3 (page number not for citation purposes) having Down’s pregnancy. The ethical issues related to this pregnancy were discussed in a weekly multidisciplinary meeting in which the author was invited as she had background know- ledge of bioethics. This specific activity set a stage to develop a bioethics group that could address such issues. The author could sense the need for a forum and it was the opportune time to start a bioethics group as a project. Methodology A session was planned in order to sensitize the faculty members about bioethics in June 2008. As a result of this meeting, nine consultants from different specialties showed their interest in the subject. Therefore, it was decided to establish a bioethics group in the campus and its goals were defined. The primary objective of the group is self- education and capacity building of the faculty. The first meeting was called in August 2008 after taking approval from the administrative body. In its first meeting, a catchy acronym was agreed upon and hence BEGZ (Bioethics Group of Ziauddin) came into being. The terms of references including membership criteria, schedule of the meetings, keeping minutes were decided. Group coordinator (author) was responsible for arranging the meetings on monthly basis, and circulating the information of the meeting a week prior through email. Initially only physicians showed enthusiasm in joining the group although the forum was open to residents and nursing staff also. The interest in the group was disseminated through word of mouth and, as a result, three postgraduate residents and three nurses joined the group. With the passage of time, the number has grown from eleven to seventeen; the members belong to diverse special- ties like surgery, dermatology, psychiatry, medi- cine, obstetrics & gynecology, ophthalmology and ENT. Until now the discussions have been on a wide range of issues such as informed consent, patient- doctor relationship, abortion , pharma physician relationship, ethical dilemmas, religious and gender discrimination and environmental ethics. The format of the meeting is kept very flexible and simple which helps in maintaing the interest of the members. Multiple instructional modalities that have been used so far include movie clips, photographs, real life scenarios, poetry and literature in Urdu (national language) and role play. Out of these teaching tools, the role play has been an attention grabbing experience for the majority as this exercise is interesting and at the same time thought-provoking (7). It helps in improving the level of understanding and changing attitudes. It is one of the most effective teaching modality which is often overlooked in bioethics education, though it has been used for a long time in other fields. After completing six months of this activity a pretested self administered questionnaire was distributed and members were asked to give their opinions and suggestions regarding the improve- ment of BEGZ. Results There were fourteen members who filled up this proforma and shared their experiences. It was found that ten out of fourteen agreed that the capability of identifying ethical issues in their clinical practice has been enhanced. While eight out of fourteen were of the opinion that they could identify the ethical issues in their day to day life also. Eight out of twelve felt a change in their interaction with their patients, while four did not notice any change in their behavior. On inquiring about the most relevant topics discussed, the majority [9] agreed for discrimina- tion and pharma-physician interaction. The most often suggested topics for the upcoming sessions are research ethics, clinical ethics and beginning of life issues. Impression It is encouraging to note that BEGZ has made some headway (8). The number of members has increased from eleven to seventeen in just nine months. It is also important to note the diverse representation of the members. BEGZ comprises of not only physicians, but also postgraduate students and nurses. The inclusion of nurses may be a rarity if not the exception. The introduction of nurses in the bioethics group into the realm of biomedical ethics gives a sense of great accomplishment. Bioethics groups by themselves are few and far between in Pakistan. BEGZ activity started with some skepticism and apprehension among some faculty members but many of those fears have been allayed. This group activity appears to be sustaina- ble because of the continued interest of its partici- pants and innovative format of teaching. These preliminary experiences are being shared for the purpose of a better understanding of this distinctive way of learning. The effectiveness of this mode of education regarding awareness of bioethical issues and the perception/attitude of members will be reflected again after some time for further improvement. Acknowledgement I would like to thank Dr Tabinda Ashfaq and Dr Moinuddin Siddiqui for their support and assistance in writing this commentary. J Med Ethics Hist Med 2009, 2:17 Nausheen Saeed Page 3 of 3 (page number not for citation purposes) References 1. Van McCrary S. The role of bioethics in medical education: a crucial profession under threat. http://www.actionbioscience.org/biotech/mccrary.html#primer (accessed on Oct 2008) 2. Anonymous. 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