Journal of Medical Ethics and History of Medicine 
 

 

 
 

 

 

 

Reform in medical ethics curriculum: a step by step approach based on 

available resources 

 
Fariba Asghari

1
, Azim Mirzazadeh

2*
, Aniseh Samadi

3
, Aliakbar Nejati Safa

4
, Ali Jafarian

5
, Ali 

Vasheghani Farahani
6
, Seyed Hasan Emami Razavi

7
 

 
1.Assistant Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. 

2.Assistant Professor, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 

3.Researcher, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. 

4.Associate Professor, Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran. 

5.Associate Professor, Department of General Surgery, Imam Khomeini Hospital Complex, School of Medicine, Tehran, University of Medical 

Sciences, Tehran, Iran. 

6.Assistant Professor, Department of Cardiology, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran. 

7.Professor, Department of General Surgery, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical 

Sciences, Tehran, Iran. 

 
 

*Corresponding author: 

Azim Mirzazadeh 

Address: Department of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.  

Postal Box: 14185-481 

Tel: (+98) 21 66 93 99 22 

E-mail: mirzazad@tums.ac.ir 

 

 
Received: 11 Nov 2010 

Accepted: 07 Aug 2011 

Published: 14 Aug 2011 
J Med Ethics Hist Med. 2011; 4:8. 
http://journals.tums.ac.ir/abs/19013 

 

© 2011 Fariba Asghari et al.; licensee Tehran Univ. Med. Sci. 

 

 

Abstract 
 

 
 

Keywords: Curriculum, Medical ethics, Undergraduate medical education. 

In this project, we aimed to revise the medical ethics curriculum at the School of Medicine, 

Tehran University of Medical Sciences, in order to promote the level of students’ ethical 

awareness and enable them to make ethical decisions. 

Ideal and long term educational objectives were set to determine directions for  future reforms 

and to provide a baseline for future evaluation of the project. However, based on limited 

available recourses, the first stage of the reform was planned and implemented with a 3 years 

scope. In revising the curriculum, which was done according to the Harden's ten 

questions, we focused on moral attitude and ethical reasoning skill in addition to academic 

knowledge base by using methods such as case discussions, portfolio, and clinical ethics 

rounds. The revised curriculum was implemented during the first semester of the 2006-2007 

academic year for the first time. 

The student feedback indicated that the new curriculum was successful in increasing the 

students’ awareness of ethical issues and enabled them to understand and accept their 

professional obligations. 

Revising the curriculum and its evaluation should be considered as an ongoing process. The 

present project was a successful experience that motivated faculty members to pursue the 

next steps of improving the curriculum on medical ethics and proved to be convincing for the 

authorities and policy makers to support it. 

http://journals.tums.ac.ir/abs/19013
http://journals.tums.ac.ir/abs/19013


J Med Ethics Hist Med 2011, 4:8 Fariba Asghari et al. 

 
 

Introduction 
 

Respecting professional obligations and mak- 

ing decisions in accordance to medical ethics are 

essential skills that must be built in physicians 

during their training as medical students (1). Any 

attempt aiming at improving medical ethics 

syllabus can  play an  important role in fostering 

those skills. 

Tehran University of Medical Sciences 

(TUMS), being the oldest and the largest medical 

university in Iran, plays a key role in medical 

education in the Islamic Republic of Iran. The 

proposal of the revision of medical ethics curricu- 

lum in Iran was put forward for the first time 

during the National Strategic Ethics Program in 

2002 (2). To address this issue, Medical Ethics and 

History of Medicine Research Center of TUMS in 

cooperation with the Medical Education Develop- 

ment Office of the TUMS, school of medicine 

planed to reform medical ethics education in 2004. 

This paper is intended to report the process and 

evaluation of the implementation of this reform. 

Prior to this reform, the Department of Foren- 

sic Medicine was in charge of medical ethics 

education for medical students at TUMS. Teaching 

was delivered by the means of formal lectures as a 

2-credit course in the fifth year of medical school. 

Except for a list of headings and subheadings for 

each session, there was no officially endorsed 

curriculum for this course, and students’ evaluation 

was solely based on a Multiple-Choice Question 

Examination. A survey was conducted among the 

final year medical students of the School of 

Medicine of TUMS to clarify their evaluation of 

ethics education in terms of its being successful in 

assisting them to deal with ethically challenging 

issues in clinical practice (a list of 23 ethical 

issues), and their opinions of the necessity of a 

change in the syllabus. The mean score given for 

the necessity of the course was 8.04 out of 10, 

while the mean score for the efficacy of the current 

ethics education in terms of enabling them to make 

accurate and sound decisions in the ethically 

difficult situations was 3.76 out  of 10 (3). It is 

noteworthy that even the director of the ethics 

course believed it necessary to revise the content of 

the course and its delivery methods. 

Based on this background, a team inclusive of 

faculty members of different departments of the 

school of medicine designed and implemented a 

reform project in 2005 in order to improve the 

quality of the medical ethics course. 

Description 
Initially, all former medical ethics lecturers 

and interested faculty members of different 

departments of the university were invited to 

participate  in  an  introductory  meeting.  In  this 

meeting which was held in winter 2005, the goals 

of revising ethics course and its suggested method- 

ology were explained. Fifteen out of the 17 

attendees, who will hereafter be referred to as the 

members of the Planning Committee, declared their 

support and expressed their interest in participating 

in the project. 

All members of the Planning Committee were 

invited to a training workshop (held in spring 2006) 

in which the proposed approach to revise the 

course based on Harden’s 10 questions was clearly 

explained. The domains that were expected to be 

covered in the new ethics course were discussed 

and a general agreement was reached. It was 

decided that the curriculum should include medical 

ethics, medical law, and professionalism. Also, the 

vision was discussed during the workshop, and 

although it was decided to set ultimate goals, the 

curriculum was initially developed with a 3-years 

scope based on the facilities that the university may 

offer for the implementation of the program. 

Meanwhile, minor revisions were decided to be 

made at the end of each semester, and major 

revisions at the end of each period of 3 academic 

years, so that the ultimate goals could be achieved. 

The 10 Harden's questions method was used 

to revise the medical ethics curriculum (4). To 

prepare a draft of the new curriculum, the 6- 

member committee, referred to as the Central 

Committee was formed in May 2006. The Central 

Committee prepared the draft of the course 

curriculum stage by stage during their regular 

weekly meetings and presented it to the Planning 

Committee for evaluation, potential modifications, 

and approval. This phase of the project took about 

four months. 

 

Curriculum Elements 

 

Needs assessment 

In this step, a review of literature on Iranian’s 

satisfaction of health care delivery related services 

(5-9), physicians’ professional challenges in Iran 

(10), prevalence of ethical conflicts (11), medical 

ethics curricula of medical schools in Iran  and 

other countries (12-15), and the evaluation of ethics 

education (16-18) was organized and carried out. 

Moreover, 5 professors of medicine with a great 

reputation in following the principles of medical 

ethics in their clinical practice were interviewed. 

Based on this needs assessment, it was concluded 

that it was of paramount importance to improve 

moral attitude, sensitize students to medical ethics 

issues, and develop ethical reasoning skills. 

 

 

 

 
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Objectives 
 

Based on the results of needs assessment 

studies, the goals and objectives of the course were 

identified as summarized in Table 1. 

 

These goals were set to provide the vision of 

the course, and no limit was considered for them 

during the first stage of the reform (the reform was 

planned within a 3-years scope). They were 

intended to serve as a baseline to evaluate the 

efficiency of the course and lead the future reforms. 

 

Content and its organizational framework 

Based on the needs assessment findings, 23 

topics were proposed and discussed. These topics 

were then evaluated and scored by the Central 

Committee, and, 15 topics with highest scores were 

selected as the content of the medical ethics 

curriculum. 

A number of subtopics were assigned to each 

topic (Table 2) so that to better represent the course 

contents. 

Each topic was assigned to one of the mem- 

bers of the Planning Committee to determine 

session contents and specific objectives. The 

members made suggestions based on literature 

review, general and intermediate  objectives,  and 

the available resources in the first step of the 

reform. The objectives  of each session were 

reviewed by 2 peers. 

 

Educational strategies 

Considering the available resources, it was 

decided that medical ethics course should be 

directed  towards  a  problem-based  and  student- 
1 

during  the  clinical  rotations  and  discuss  them 

from an ethical point of view. 

 Ethics rounds: On the last session of the course, 
students were divided into small groups based on 

the cases they had recorded in their portfolios. 

These cases were  then presented and ethically 

analyzed in the presence of a tutor who then 

provided her/him feedback on the presented cases 

and discussed them with other students. 

 
Assessment of the students 

This was performed through formative and 

summative approaches. In formative assessment, 

students were evaluated based on one of the cases 

they presented in ethics round session. In summa- 

tive assessment, grading was based on the attend- 

ance and active participation in group discussions 

(30% of the total grade), correct completion of their 

portfolio (20%), and their grade on the final written 

exam including case analyses and short answer 

questions (50%). 

 

Educator evaluation 

This was done formatively using the follow- 

ing methods: 

1. Evaluation forms which were filled out by 
students at every session and were returned to 

the educator. 

2. Observation of each session by a peer who was 
supposed to report to the faculty members 

through the course director. 

 

Course evaluation 

This was done every semester through the fol- 

lowing two methods: 
1. Course evaluation forms which were filled out 

centered  strategy  from  SPICES 0F strategies.  The by the students. 
following teaching methods were used for design- 
ing and implementing these strategies: 

 Case discussion in small  groups:  Our medical 
curriculum is a traditional one based on universi- 

ty lectures. Teaching through discussion in small 

groups of students in an organized manner was 

introduced in our curriculum for the first time and 

was considered a new experience for the school. 

Naturally, this raised concerns about the feasibil- 

ity of the method and students’ attitudes toward 

it. Students were divided into small groups and 

required to discuss educational cases in the 

presence of a tutor, report the group activity in 

class, and then the professor summarized the 

discussions and presented the session material. 

 Educational portfolio: Each student was required 
to  record  three  cases  she/he  has  encountered 

 
 

1 
S    Student-centred rather than Teacher-centred 

P    Problem-based rather than Information-gathering 
I    Integrated rather than Discipline-based 
C    Community-based rather than Hospital-based 
E   Electives rather than Standard Programme 
S   Systematic rather than Apprenticeship-based 

2. Focus group discussions which  required 
students to discuss the strengths and weakness- 

es of the course. 

Results of the evaluation were presented to 

the Planning Committee and used in the amend- 

ments of future courses. 

 

Communication of the new curriculum 

The study guide, containing  information 

about goals and objectives of each session, 

teaching-learning and evaluation methods, and 

course regulations (developed in September 2006) 

was distributed among students. These documents 

were revised every semester. The course time table 

was available  on the website  along with all 

sessions’ presentation slides, required readings for 

each session, and the news. 

 

Program management 

The members of the ethics course Planning 

Committee set up a virtual department consisting of 

the chair of department, a course director in charge 

of conducting and evaluating the course, and its 



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educators. These members hold regular monthly 

meetings and discussed and analyzed problems as 

well as potential changes in the course program in 

future. 

 

 

Evaluation 

 

The revised curriculum was first implemented 

in the first semester of the 2006-2007 academic 

years. In order to evaluate the quality of the first 

run of the new curriculum, a study was carried out 

to assess the students’ abilities in terms of ethical 

reasoning and their knowledge and skills in ethical 

analysis at the beginning and the end of the course; 

and, it also compared students’ abilities who were 

trained in the new and the old curriculum, the 

results is published separately (19). Here the result 

of students' survey of the curriculum success  is 

presented. 

 

Method and material 

The new curriculum was evaluated using a 

questionnaire by the means of which students’ 

opinions were asked regarding the new program, 

the educational methods, and its success in 

achieving its goals. In this questionnaire, some 

open-ended questions were used to encourage 

students to express their opinion of the strengths 

and weaknesses of the program and to offer their 

suggestions for its improvement. The question- 

naires were distributed during ethics rounds (the 

final session of the course) and completed forms 

were collected on the same session. 

Results 

A total of 113 completed questionnaires were 

returned (response rate = 82.5%). The students' 

views are summarized in Table 3. 

In evaluating the process of the course, 

74.0%, 74.3%, and 78.5% of students agreed or 

strongly agreed that the program had practical 

contents, the amount of information was enough 

and the program was well introduced at the 

beginning of the semester, respectively. According 

to students’ opinions, the program was mostly 

successful in terms of sensitizing them to ethical 

issues (more than 87.6% agreed), followed by 

giving them a better understanding and acceptance 

of their professional obligations, and humane and 

moral aspects of medical ethics (71.7%). However, 

it was mentioned that it fell short of significantly 

improving their ability to analyze medical ethical 

issues (51.3%). 

As regards evaluating the educational meth- 

ods, 80.8% and 78.8% of students believed that 

small group discussions and ethics rounds were 

good or excellent in terms of quality, the amount of 

transferred information, and its role in motivating 

them. Although our students had never experienced 

training in small groups, they not only accepted it 

quite well, but also rated it as a very advantageous 

method. 

Among the 40 written comments about the 

strengths, the most commonly mentioned ones 

were small group discussions followed by using 

interactive methods and being applicable to a 

clinical setting. One student stated “This course 

increases students’ senses of ethical judgment and 

reasoning, and broadens their horizon”. Another 

student expressed that "The strength of the course 

was the faculty members who were committed to 

medical ethics themselves, and no one recalled 

seeing any unethical behavior by them; this would 

make the material more acceptable.". In response 

to weaknesses, 43 comments were made, amongst 

which, the most important one was lack of an 

integrated reference for the course. Another student 

mentioned not using a roll call, and reported that 

some students were against the negative effect of 

absenteeism in group work on their final grade. 

Among the suggestions, one said “Ethics ed- 

ucation should be integrated into the  whole 

medical education period, if possible”. Another 

student suggested that feedbacks should be 

provided on all cases recorded in students’ portfo- 

lios. It was also suggested that a great emphasis 

should be put on ethics education in clinical wards 

as part of clinical rounds. 

Another method used for evaluating the pro- 

gram was holding a focus group discussion with 9 

students, 2 weeks after announcing the final exam 

results. Students were selected from both genders 

based on their grades on final exam, their interest 

in ethics course, and different entry years. Since the 

course evaluation questionnaire had been collected 

before the final exam and contained no items about 

the methods of assessment, a considerable propor- 

tion of the focus group discussion was spent on 

evaluating the students' assessment methods. The 

unanimous findings of the meeting indicated that 

there was insufficient time to complete the exami- 

nation. Students demanded to receive feedbacks on 

what they had written on their final exam, or at 

least be given the correct answers after the exam. 

The students believed that discussions in group 

works were very helpful, and they suggested that 

tutors should have a better command of the subject 

so that they can lead the discussions more effec- 

tively. 

 

Discussion 
 

Since a significant part of the course objec- 

tives were attitudinal, it was very difficult to 

convey them and there was no tool to accurately 

assess the achievements. The results of course 

evaluation however, indicated a significant 

improvement in the quality of the teaching meth- 

ods. In fact, the program proved to be attractive to 

the students and successful in raising their aware- 



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ness of ethical issues in their daily practice. 

However, we failed to fully achieve some of the 

course objectives. Since the assessment of achiev- 

ing the objective of adhering to professional 

obligation was only based on students’ answers, we 

could not envisage how well they would really 

practice it in future. 

In order to translate ethical sensitization into 

the ability of ethical reasoning and practice based 

on professional commitments, it seems imperative 

to review and amend the  curriculum repeatedly. 

The present program was planned with a 3-year 

scope. Evidently, the present course as a 2-credit 

block one can fail to effectively provide students 

with a solid base for their considering principles of 

medical ethics in clinical practice. 

It is often argued that the current clinical edu- 

cational environment in Iran is incapable of 

promoting medical professionalism and moral 

values in students. It is argued that there exist 

several impediments in various clinical educational 

environments that make it inadequate for develop- 

ing moral values and this in turn may even cause 

erosion and desensitization (18, 20). Sophistication 

of medical decisions, heavy workload, difficult 

lessons, lack of time for relaxation and meditation, 

witnessing unethical behavior done by their 

superiors, insufficient support to confront stress, 

inability to discuss particular situations (e.g. when 

they had a dilemma, or unintentionally had to do 

something against their professional obligations) 

with others, seeing patients as mere  educational 

subjects rather than a human individual who should 

be respected, and also scolding patients as a way to 

vent workplace frustrations are all examples of 

those deficiencies. Obviously, we cannot expect a 

short course with a few credit points and limited 

time (over approximately 34 hours) on medical 

ethics to entail the desired attitude and the ability of 

ethical reasoning in medical students (21). Indeed, 

a supportive system committed to the promotion of 

appropriate professional behavior in all settings of 

the university and learning atmosphere is the key 

factor to facilitate and strengthen this culture (22, 

23). 

One of the most effective reforms suggested 

is the longitudinal integration of medical ethics and 

professionalism education in all phases of under- 

graduate medical education (16). Students' expo- 

sure to ethical aspects of clinical care during ward 

rounds, role models in clinical settings and their 

reflection on ethical dilemmas in such environ- 

ments seems to be of much more importance in 

comparison with attending large group lectures 

during a semester (22, 24). In other words, holding 

clinical ethics rounds at different wards appear to 

be more effective in making students’ learning 

more discernible and practical (22), and in helping 

them to maintain their ethical sensitivity in all 

difficult  clinical  circumstances  (21).  However, 

achieving this goal requires certain preparations, 

and this major reform seems currently elusive at 

our universities. 

In this study a number of different challeng- 

es were confronted with, and a variety of obstacles 

emerged. One of the most  important  challenges 

was shortage of full time faculty  members who 

wish to commit themselves exclusively to teaching 

medical ethics and improving the course teaching 

methods. All faculty members and project manag- 

ers involved in this project, had simultaneously 

several different responsibilities, they participated 

in teaching medical ethics as a secondary responsi- 

bility. This can jeopardize the consistency of the 

reform and hinder future improvement of the 

quality of this course. 

Another issue which should be considered as 

challenge is the lack of motivation among members 

of the faculty to get involved in the ethical aspects 

of medicine. We cannot expect the faculty mem- 

bers to pay attention to ethical issues in clinical 

practice and teach them to their students when their 

respect for these matters is not monitored and has 

no effect in their promotion. 

One of the limitations of this project was the 

lack of trained tutors to facilitate and lead discus- 

sions and debates in the small groups. Considering 

the successful results of group work in motivating 

students, to achieve a better outcome through this 

course, it seems quite necessary to train such tutors 

adequately so that they can better contribute to the 

overall improvement of the knowledge and skills of 

the students. 

Our experience showed that revising the 

course of medical ethics, even with limited 

resources, can result in significant improvements in 

the quality of the program. However, reforming the 

program should be an ongoing process and the 

curriculum should be continually  reviewed, 

revised, and adjusted to better achieve the course 

educational goals & objectives. To guarantee the 

success, the  directors of medical  schools should 

support the reform activities to motivate the faculty 

members and set proper conditions for the process. 

The favorable results of the presented project 

proved to be promising for designing and imple- 

menting further steps of reform and convincing the 

directors of medical school of the need for their 

more supportive role. 

 

Acknowledgements 

 

This study was conducted according to the 

project agreement number 132/3718 dated July 9, 

2006, and financially supported by Tehran Univer- 

sity of Medical Sciences. The authors wish to thank 

Drs Mahbubeh Haj Abdolbaqi, Farhad Shahi, 

Hamid Emadi, Ali Kazemian, Fakhroddin 

Taqadosinejad, Alireza Parsapour, Kiarash 

Aramesh, Ali Kazemi Saeed, Ahmad Kaviani, and 



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Seyed Morteza Karimian who assisted us in the 

design and implementation of the new ethics course 

as the members of the Planning Committee. Also, 

we would like to thank Drs Nazila Nikravan, 

Maryam Jessri, Fatemeh Shidfar, Samaneh Ansari, 

Saeedeh Sadeqi, and Somayeh Mahroozadeh who 

helped us in holding small group discussions as 

tutors. None of the authors had any conflict of 

interest. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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Table 1. The goals & objectives of TUMS ethics curriculum 
 

Goals: 
Students should be able to identify common ethical issues when providing health care, and make 

appropriate decisions. For this purpose, ethics education should: 

1. Enable students to understand and accept their professional obligations. 
2. Enable students to understand the humane and ethical aspects of the medical profession. 
3. Increase students’ awareness of ethical issues around them. 
4. Provide the required knowledge and skills background in students for ethical reasoning while 

considering legal issues. 

5. Enable students to make use of this knowledge and skills in ethical decision making. 
 

Intermediate objectives: 
Cognitive objectives. concern the transfer of knowledge in the following fields: 

 The principles of medical ethics and ethical theories 

 Professional obligations 

 Medical ethics issues (autonomy and informed consent, capacity and Surrogate decision making, 
physician patient relationship, confidentiality and truth telling, research ethics, end of life, resource 

allocation, medical errors, ethics in medical education, maternal-fetal conflict, conflict of interest, and 

professional relation with members of the health care team) 

Skill-wise objectives. concern ethical practice and the ability to make ethical decisions, which should 

include the following: 

1. Communicating with patients, their family members and other members of the medical com- 
munity concerning medical ethics issues. 

2. Encouraging patients and their family members to participate in medical decision making and 
effective interaction concerning medical ethics issues. 

3. Self evaluation and increased observation of professional obligations. 
4. Presenting and accepting constructive criticism. 
5. Required skills to fulfill professional obligations and ethical decisions despite limitations at 

workplaces 

Attitudinal objectives include the following: 

1. Ethical awareness in medical practice 
2. Respect, compassion, honesty, trustworthiness, and being responsive to patients’ and communi- 

ty’s needs where patients’ interests come first. 

3. Being responsible and accountable before the patients, society, law, and the medical profession, 
and commitment to Excellency. 

4. Commitment to justice and fairness in providing services. 
5. Respecting the role of the other members of the health care team. 
6. Respecting patients as human beings, and respecting differences in culture, religion, age, gender, 

and patients’ disabilities. 

7. Open to criticism, and self evaluation. 
8. Commitment to the health of one’s self and the other members of the medical community. 



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Table 2. TUMS medical ethics syllabus 

 

Professionalism 

 Concept of profession and professionalism 

 Medical Oats 

 Altruism 

 Responsibility 

 Duty 

 Integrity & honesty 

 Excellence 

 Challenges to professionalism 
 

Ethical theories 

 Meta ethics 

 Ethical theories: 

 Deontology 

 Utilitarianism theories 

 Virtue ethics 

 Islamic philosophy of ethics 

 Jurisprudence and medicine 
 

Principles of medical ethics and ethical tools 

 Autonomy 

 Beneficence 

 Non- maleficence 

 Justice 

 Approach to ethical issues 

 Matrices in ethical decision making 

 Physician–Patient Relationship 

 The  importance  of  a  proper  ethical  and 
clinical relationship with the patient 

 Respect   for   patient   beliefs,   religion,   and 
gender 

 Financial doctor-patient relationship 

 Compassion 

 Respect for patient’s privacy 

 

autonomy and informed consent 
 

 The right to autonomy and its importance 
(including the right to refuse medical treat- 

ment) 

 Criteria for valid informed consent 

 Amount  and  components  of  giving  infor- 
mation 

 Participation in decision making 

 Exceptions for informed consent 

 Criticism on informed consent 
 

determining capacity and substitutes for 

decision making 
 

 Definition of decision making capacity 

Physician relation with members of the health 

care team 
 

 Principles of professional relationship with 
peers (doctors and other members of the 

Health care team) 

 Approach to breach of professional behavior 
by peers 

 Approach to peer error 

 Consultation and its role in decision making 
 

Medical liability and medical error 
 

 Definition of medical error 

 Necessity   of   disclosing   medical   error   to 
patient 

 How to disclose errors 

 Medical liability 

 Medical negligence 

 How to deal with medical negligence 
 

Ethics in medical education 
 

 Patient consent 

 Practicing   on   comatose   and   newly   dead 
patients 

 Maintaining quality services to patients while 
training students 

 The role of students in confronting errors by 
the medical community 

 

conflict of interest 
 

 Definition of conflict of interest 

 Self-referral 

 Vendor relationships 

 Conflict of interest in research 

 Conflict of interest in educational centers 

 Management of conflict of interest 

 

Resource Allocation 
 

 Medical resources 

 Concept of Justice 

 Levels of resource allocation 

 Avoiding discrimination in giving services 

 Approach to requests of inappropriate 
treatment 

 Distribution of resources in disasters and war 

 

ethics in research 
 

 Informed consent 



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Table 2. TUMS medical ethics syllabus 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 Methods of determining capacity 

 Selecting a substitute 

 Informed   consent   in   cases   of   unstable 
capacity 

 Principles of decision making on the behalf of 
incompetent people 

 

confidentiality and truth telling 
 

 Necessity of confidentiality 

 Terms for breaching confidentiality 

 Necessity of truthfulness 

 Breaking bad news 

 Responsibility  of  telling  the  truth  in  the 
medical team 

 Ethical issues in treating with placebo 

 Confidentiality 

 Risk / benefit evaluation 

 Justice 

 Research in vulnerable groups 
 

Maternal-fetal conflict 
 

 Different approaches to fetal right to life 

 Conflict of maternal independence with fetal 
life or wellbeing 

 Conflict of maternal health with fetal heath 

 Rule  and  regulations  on  abortion  in  the 
Islamic Republic of Iran 

 

ethical issues in end of life 
 

 Decision making for terminal ill patient 

 Ethical aspect of a non-resuscitation order 

 Euthanasia 

 Indications of withdrawing life support 

 Brain death 



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Table 3. Students’ evaluation (%) after the first run of the revised curriculum 
 

Process 
Strongly 

Agree agree Neutral Disagree 
Strongly 

Disagree 

The course introduction gave students was 

informative 
21.4 57.1 14.3 6.3 0.9 

Sufficient information was transferred to the 

students. 
15.0 59.3 18.6 6.2 0.9 

Course contents were practical for interns 23.1 50.9 13.9 11.1 0.9 

Interactive educational methods were used 

appropriately 
15.2 48.2 18.8 17.0 0 

Course contents were scheduled 

appropriately 
14.3 44.6 18.8 21.4 0.9 

Students evaluation methods were 

acceptable 
6.7 30.5 43.8 15.2 3.8 

Management performance in terms of access 

to resources and information was acceptable 
8.9 36.6 33.9 18.8 1.8 

Amount and contents of assignments were 

appropriate 
18.6 50.4 18.6 10.6 1.8 



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Table 3. Students’ evaluation (%) after the first run of the revised curriculum 
 

 

outcome 
Strongly 

Agree agree Neutral Disagree 
Strongly 

Disagree 

The course enabled students to realize and 

accept their professional obligations 
12.4 59.3 15.0 13.3 0 

The course enabled students to understand 

the human and moral aspects of their 

profession 

 

11.5 
 

54.9 
 

20.4 
 

12.4 
 

0.9 

The course increased students attention to 

ethical issues around them 
34.5 53.1 9.7 2.7 0 

The course provided adequate primary skills 

and knowledge for appropriate ethical 

decision making while considering legal 

matters 

 

8.8 

 

46.0 

 

26.5 

 

16.8 

 

1.8 

The course enabled students to use the 

acquired knowledge and skills in ethical 

decision making 

 

7.1 
 

44.2 
 

27.4 
 

16.8 
 

4.4 

Teaching methods 
Strongl

y Agree 
agree Neutral Disagree 

Strongly 

Disagree 

Small discussion groups 30.3 50.5 14.7 2.8 1.8 

Lectures 6.4 40.4 42.2 9.2 1.8 

Case presentation on final ethics rounds 31.7 47.1 17.3 3.8 0 

Use of interactive methods 22.9 45.0 24.8 6.4 0.9 

portfolio 12.1 39.3 32.7 12.1 3.7 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



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