doi: 10.56294/mw202342

REVIEW

The discipline of Medical Psychology in the ethical-humanistic education of medical students

La disciplina Psicología Médica en la formación ético-humanista del estudiante de la carrera Medicina

Yarabel Nápoles Prieto¹ *, Gladys Alejandra Rojas Sánchez¹ *, Arturo Puga García¹ *

¹Universidad de Ciencias Médicas de Sancti Spíritus. Sancti Spíritus, Cuba.

Cite as: Nápoles Prieto Y, Rojas Sánchez GA, Puga García A. The discipline of Medical Psychology in the ethical-humanistic education of medical students. Seminars in Medical Writing and Education 2023;2:42. https://doi.org/10.56294/mw202342

Submitted: 13-09-2023                   Revised: 20-11-2023                   Accepted: 28-12-2023                 Published: 29-12-2023

Editor: Dr. José Alejandro Rodríguez-Pérez

Tematic Editor: PhD. Carlos Singh Castillo

Note: Article presented at the IX International Conference on Ethics and Bioethics (ETHOS 2023).

ABSTRACT

Objective: to describe the current state of the ethical-humanistic training from the discipline of Medical Psychology, in the Faculty of Medical Sciences of Sancti Spíritus “Dr. Faustino Pérez Hernández”.

Methods: non-experimental, descriptive, cross-sectional, mixed approach study. Sample: non-probabilistic, by strata (10 professors, 8 directors, and 60 students).

Results: the diagnosis showed as strengths: the discipline of Medical Psychology is integrated to the transversality of the ethical-humanistic training in the curriculum of the Medicine career; the education of humanistic values is established as a priority methodological line; the medical-legal curricular strategy is developed; there is exemplarity in the professors of the discipline; the students recognize the importance of the formative process. Weaknesses were found in the direction of the ethical-humanist training from the discipline Medical Psychology and formative needs of the professors to fulfill the demands of the physician’s training model; there is still lack of integrative evaluations, with emphasis on skills and modes of action; as well as in the interrelation with the main integrative discipline.

Conclusions: the discipline Medical Psychology has potentialities to expand the ethical-humanistic training of the medical student; managers and students identified with the importance of the improvement of this formative process, however, it was found the lack of a pertinent methodology in its direction, according to the formative needs of teachers and students.

Keywords: Medical Education; Ethics; Humanism; Medical Psychology.

RESUMEN

Objetivo: describir el estado actual de la formación ético- humanista desde la disciplina Psicología Médica, en la Facultad de Ciencias Médicas de Sancti Spíritus “Dr. Faustino Pérez Hernández”.

Métodos: estudio No experimental, descriptivo, transversal, de enfoque mixto. Muestra: no probabilística, por estratos (10 profesores, 8 directivos, y 60 estudiantes).

Resultados: el diagnóstico evidenció como fortalezas: la disciplina Psicología Médica se integra a la transversalidad de la formación ético-humanista en el currículo de la carrera Medicina; se establece como línea metodológica prioritaria la educación de valores humanistas; se desarrolla la estrategia curricular médico-legal; hay ejemplaridad en el profesorado de la disciplina; los estudiantes reconocen la importancia del proceso formativo. Se constataron debilidades en el direccionamiento de la formación ético-humanista desde la disciplina Psicología Médica y necesidades formativas de los profesores para cumplimentar las exigencias del modelo de formación del médico; aún hay carencia de evaluaciones integradoras, con énfasis en habilidades y modos de actuación; así como en la interrelación con la disciplina principal integradora.

Conclusiones: la disciplina Psicología Médica tiene potencialidades para ampliar la formación ético-. humanista del estudiante de Medicina; los directivos y estudiantes se identificaron con la importancia del perfeccionamiento de este proceso formativo, sin embargo, se constató la carencia de una metodología pertinente en su direccionamiento, acorde a las necesidades formativas de docentes y estudiantes.

Palabras clave: Formación Médica; Ética; Humanismo; Psicología Médica.

INTRODUCTION

Medical education in Cuba aims to train graduates with an ethical-humanistic education that enables them to fulfill their social role. The National Development Plan 2030 reflects the political commitment to improve the quality of education and promote distinctive attitudes of Cuban society.⁽¹⁾ The objectives of ethical-humanistic education align with the Constitution of the Republic by defining the country's educational policy and its foundations. This includes the progressive Cuban and universal pedagogical tradition, as well as the cultivation of ethical values in students.⁽²⁾

Ethical-humanistic education means that the student, through both curricular and extracurricular activities, adopts a comprehensive understanding of the nature of humanity and society. As a result, they will act in favor of human progress within historical and concrete conditions.⁽³⁾ This concept integrates humanistic education with ethics to assimilate norms of conduct that regulate human relations in a specific historical moment to create a system of universal and individual values.⁽⁴⁾

Since the 1990s, there has been an increase in studies on medical education focusing on the teaching of ethical principles and the humanistic conception in medical careers. The authors consider last years´ precedents from both international and Cuban contexts. 

In 2015, National University “Federico Villarreal”, Perù, conducted a study to analyze the ethical-humanistic formation process in the curriculum design of the Medicine career across different disciplines. Casaverde⁽⁵⁾, the author of the study, identifies limited influences to achieve the desired profile and advocates for ethical-humanistic education within a competency-based curriculum instead of isolated subjects.

In the Latin American context, a study conducted by a Chilean university (2018) titled “Cómo enseñar bioética en el pregrado” (How to teach bioethics in undergraduate studies) also examines the teaching of content related to bioethics, ethics, and medical humanism.  González et al.⁽⁶⁾ stress the need for ethical-humanistic education that is based on cross-disciplinary professional training. This should serve as a guiding principle for interpreting reality. They also promote the integration of this education into clinical and therapeutic decisions.

Another precedent is a study published in 2018 titled “Desarrollo de la formación ético-humanista en la asignatura Medicina Interna en la Universidad Mayor de San Simón” (Development of ethical-humanistic education in the Internal Medicine course at the University of San Simón). The study focused on medical education in Bolivia. According to Vargas⁽⁷⁾, although strategies were implemented for values education, ethical-humanistic content was not integrated or evaluated in a cross-disciplinary manner. Reports indicate a lack of extracurricular activities and little interest in this type of education. Both professors and students have a negative perception of ethical-humanistic education.

In 2022, the article “Medical Ethics in Medical Training” was published. The publication aimed to identify the impact of ethical content covered during medical education on professional practice at the Federal University of Paraná, Brazil. In the article, Barbosa et al.⁽⁸⁾ compared current ethical standards to previous ones and found a lack of ethical training in education, as well as a need for professional development.

In 2013, Hernández⁽⁴⁾ proposed a pedagogical approach to humanistic formation for students in the Medicine career at the University of Medical Sciences of Pinar del Río, Cuba. In 2015, Hernández and Ferro⁽⁹⁾ proposed a strategy for humanistic education and the physician´s practice. This proposal involves curricular actions in the discipline Philosophy and Society, and establishes a connection with the main integrating discipline.

“La formación ético-humanista en la dinamización del contenido de enseñanza-aprendizaje en la formación inicial médica” (Ethical-humanistic education in the dynamization of teaching-learning content in medical initial training) was also published in 2017 by professors from Santiago de Cuba ⁽¹⁰⁾. In 2019, Cedeño et al.⁽¹¹⁾, from the same institution, published a methodology for the socio-humanistic training of medical students. Both propose transforming the formative process within the career's disciplines.

Other precedents related to proposals for ethical-humanistic education in other health science careers were taken into consideration. In 2019, Alonso, et al.⁽¹²⁾ study humanistic and inclusive education in Health Technology as part of medical education. In 2020, Pérez, et al. ⁽¹³⁾ approach this process from the discipline Cuban History. 

In regards to systematic scientific production, it is recognized that ethical-humanistic education is a guiding principle in training. However, pedagogical technicalities can pose obstacles. Proposals for transforming the process are presented from different methodological, pedagogical, and didactic perspectives. Cross-sectional curriculum is taken into account, without declaring the articulation with disciplines, subjects and axiological contents. No proposal for improving ethical-humanistic education was accessed from the discipline Medical Psychology.

The guiding documents of higher education establish goals for a humanistic education. Resolution 47/22 establishes humanistic education as a curricular strategy in the comprehensive training of professionals ⁽¹⁴⁾. “E”' curriculum plan for Medicine career requires that graduates have access to humanistic education through the curriculum.⁽¹⁵⁾
The curriculum plan for Medical Psychology must expand the model of the professional profile, as stated in the program's rationale.⁽¹⁵⁾

The discipline Medical Psychology consists of two subjects: General Psychology and Medical Psychology, which are studied in the fourth and fifth terms, respectively. Both subjects express professional model`s values and consider their contribution to the educational curriculum strategy. However, they do not mention their contribution to ethical-humanistic education. The discipline Medical Psychology addresses the medical-legal action strategy, which focuses on the relationship with patients, the legal procedures, and the medical record as a legal document.⁽¹⁵⁾

It is clear that even when Medical Psychology projects humanistic education, there is a contradiction between its conception and the methodological development to achieve it. According to the opinion of the discipline professors and previous works, there is a concern that students' ethical commitment is being compromised. This is leading to a lack of ethics in their relationships with patients, as well as iatrogenic effects through the psychological route. To address this issue, an institutional project was approved with the goal of proposing and validating scientific and pedagogical results that contribute to the improvement of the ethical -humanistic education process in the Medicine career, specifically through the discipline Medical Psychology. Diagnosing the current situation was identified as one of the scientific tasks.

Objective: To describe the current situation of ethical-humanistic training through the discipline Medical Psychology at the Faculty of Medical Sciences of Sancti Spíritus “Dr. Faustino Pérez Hernández.”

METHODS

Geographical and temporal context: Faculty of Medical Sciences of Sancti Spíritus “Dr. Faustino Pérez Hernández”. Years: 2022-2023.

Type of research: research-development with a non-experimental, descriptive, cross-sectional design using a mixed-methods approach.

General method: dialectical materialism.

Theoretical methods: historical-logical (background and evolution of the research object), analysis and synthesis (theoretical foundations and analysis of results), systematization (theoretical and practical bases), inductive-deductive (conclusions based on results).

Empirical methods: content analysis (systematization of bibliography contents), documentary analysis (information in guiding documents), interviews (criteria of participating subjects), focus groups (compilation of participants' experiences), scientific observation (evidence collection), expert criteria (instrument relevance), data triangulation (different methods and sources). Statistical-descriptive methods (descriptive and inferential statistics) were also used.

The study population was stratified. The study involved 10 psychology professors, 8 administrators of methodological work at various levels, and 276 third-year Medicine students.

A sample of 60 students was randomly selected from this stratum.

Research ethical principles were followed and the research was approved by both the institution's administration and participants. The information obtained met ethical requirements.

The analysis categories were established as follows:

· Cross-sectional dimension of ethical-humanist training (articulation of the ethical-humanist approach in a cross-sectional and multidisciplinary manner).

· Addressing ethical-humanistic education (projections, regulations, and methodological indications)

· Evaluation of ethical-humanistic education (contribution to ethical-humanistic education through professional model and evaluations)

· Influence of the professors 's role (performance of discipline professors)

· Influence on student motivation (assessment of motivation towards ethical-humanistic education)

· Student satisfaction with the ethical-humanistic education they receive

RESULTS

Twenty-two documents were reviewed and analyzed.

The “E” curriculum plan for Medicine career declares the cross-cutting nature of ethical-humanistic education and includes new curriculum units that contribute to this graduate profile. The curriculum plan is designed to include scientific and technical preparation, scientific thinking based on dialectical materialism, and a value system that provides an ethical framework for action.

The guiding documents of the discipline Medical Psychology establish the development of skills declared in the professional model. These skills include achieving effective communication, acting with independence and professional leadership, promoting humanism as an expression of empathy, trust, and respect towards the human being, as well as skills related to the legal and ethical aspects of the profession.

In terms of directing ethical-humanistic education from the discipline Medical Psychology, there is recognition of the need for improving the ethical-humanistic training emerging from the Methodological development plans at higher levels. Evidence of objectives, scientific-methodological work lines, as well as control actions towards ethical-humanistic education at different levels of methodological work (discipline collectives and subjects) is shown.

It was observed that educational and political-ideological work is given priority both in the curriculum and in extension activities. However, the work collectives at different levels do not provide explicit guidance on how to implement curricular strategies.

Methodological training activities have been developed to educate in value formation. However, a strategy covering all the planned dimensions has not been developed for the program called “Director de valores” that governs Cuban educational institutions.

The professors of the discipline conducted scientific-methodological research and proposed a system of activities for humanistic education, which was validated. The activities were designed for group work with the coordination of a Psychology professor, but they can be applied to other disciplines.

The discipline Medical Psychology should establish interdisciplinary connections, but the programs lack explicit methodological guidance. There are no ethical-humanistic education strategies in the year collectives to achieve interdisciplinary integration with the main discipline.

In this sense, the relationship with Legal Medicine is established for topics related to Medical History and iatrogenesis resulting from ethical violations. The discipline collective has developed a program to introduce the communication of bad news as an elective course.

Professors of this discipline do not believe that the current methodological activities are sufficient for effectively developing humanistic education and the relationship with the professional's contextual level of action. In professors training, appropriate methods for humanistic education development are mastered (problematic cases, simulations, role playing, video debates, presentation of lived experiences, among others); however, their use predominates only in assessment activities.

The importance of conducting integrated assessments, with a focus on evaluating ethical-humanistic skills and behavior, is acknowledged. The discipline Medical Psychology is integrated into the main integrating discipline for the evaluation of independent work. Yet it is not established in systematic evaluation forms. A more effective way to introduce ethical aspects in the final evaluation integrative works in both subjects is evident.

Exemplary behavior is an aspect evaluated in professors. The discipline's professors are expected to serve as examples of ethical behavior, which contributes to the humanistic education of students. They also perform well as lead professors, so they have the potential to exert their influence through the comprehensive educational work plans.

As for the students, it is not observed that ethical-humanistic education as a guiding principle of their professional preparation constitutes a motivation. Students acknowledge that ethical-humanistic aspects are addressed in the discipline Medical Psychology and preceding ones, but express a need for further improvement in this area.

Based on the results, the strengths and weaknesses of the research object can be established. 

Some strengths include:

· The discipline Medical Psychology is integrated into the interdisciplinary and ethical education provided in the Medicine program's curriculum.

· Priority is given to the methodological approach to values education.

· The curricular strategy of medical-legal education is proposed.

· Professors serve as role model. Scientific-methodological results related to humanistic education are observed from an educational perspective.

· Both professors and students recognize the significance of improving the educational process.

The following weaknesses are clear:

· Deficiencies in the methodological direction of ethical-humanistic education are acknowledged.

· There is a poor interrelationship with the main integrating discipline.

· Professors perceive a need for training to meet the requirements of the medical training model. 

· There is a lack of integrated assessments that emphasize skills and behavior.

· While professors demonstrate mastery of developmental teaching methods, they are used primarily in evaluative teaching activities.

DISCUSSION

Medical Psychology is a quintessential humanistic discipline. Medical educators generally agree that Humanities disciplines should be included in curricula, despite the current emphasis on scientific and technological development.⁽¹⁶⁾ However, their course loads are not considered sufficient. As a result, they have limited time to deal with humanistic issues ⁽¹⁷⁾. The current “E” curriculum plan for Medicine program⁽¹⁵⁾ includes the discipline Medical Psychology. Nevertheless, the number of hours dedicated to topics related to doctor-patient relationship, which is of great importance for ethical-humanistic education, is considered insufficient.

In this context, there is evidence of a contradiction in educational practice between the projected profile of Medicine program graduates and the ethical commitment demonstrated by the students. They engage in breaches of medical ethics, such as causing iatrogenic psychological effects, which can lead to persistent patient dissatisfaction with the care they receive. The causes identified include a poor doctor-patient relationship, deficits in communication skills, violations of ethical principles, and humanistic values.^{(18, 19)} The discipline of Medical Psychology addresses these aspects. Therefore, to intentionally impact the curricular dimension of ethical-humanistic education from within the discipline, a different methodological approach must be taken.

The discipline should enhance students' critical and reflective thinking skills, as well as their ethical commitment. During this stage of life, student's personality undergoes transformation throughout the educational process.  Students develop their own set of values, which can lead to conflicts between their ideals and the daily clinical practice ⁽²⁰⁾. The obtained results highlight the significance of the educators' role. Students' value judgment of the healthcare team's performance is higher in terms of expectations but lower in terms of the actual quality of the professionals.⁽²¹⁾

Administrators, professors, and students acknowledge that scientific education is crucial but not enough. Physicians must rely on intuition and empirical experience in their daily work. Therefore, it is essential to introduce Ethics and Bioethics content applied to clinical practice.^(22,23) Medical Psychology should be better integrated into workplace training to promote ethics in clinical and therapeutic decision making, and respectful treatment of patients and their families. This is a clear example of the need for such integration.⁽²⁴⁾

It is also deemed necessary for Medical Psychology to impact on the relationship between its content and the moral and deontological requirements of the medical profession. They indicate that students should display emotional skills, including effective communication, sociability, and empathy. These humanistic qualities are reflected in the practice of the profession through altruism and the rejection of maleficence, unequal treatment, and injustice.^(25,26,27)

Medical humanism is the combination of medical science and art, reflecting a par excellence humanistic attitude resulting from learning and methodology.⁽²⁸⁾

To achieve ethical-humanistic education, it is necessary to prepare professors to assess ethical dilemmas that arise from current technological developments in healthcare. The resolution of these dilemmas requires a process of teaching and learning that facilitates the development of the educational context, enhancing both content and methods.^(29,30,31) The ethical conduct of professors is essential in shaping fairer and socially involved citizens. This requires that professors be evaluated from a humanistic perspective.⁽³²⁾

Regarding the assessment of professional performance from the discipline Medical Psychology, there is alignment with Oseguera⁽³³⁾ in highlighting that evaluations typically focus on cognitive aspects and skills, while humanistic qualities and ethical-social commitment are often overlooked. While ethics and humanistic perspective are now included in the curriculum, methods for evaluating students' values and attitudes towards clinical practice problems have not advanced at the same pace.⁽³³⁾

The curricular limitations identified in this study are consistent with the deficiencies noted by Cañizares and Sarasa ⁽³⁴⁾ in their analysis of the teaching of ethical and moral values in the Cuban educational system. Authors observed that the teaching of ethical and moral aspects of the profession presents a curriculum gap between the actual and desired outcomes; the content evaluation lacks systematics, formality, and adequate documentation.

Medical Psychology provides a comprehensive approach to the health-disease process and a humanistic model of health care. Medical Psychology takes a comprehensive approach to the health-disease process and follows a humanistic model of healthcare. It also has the potential to structure developmental and relevant methods for building values that promote internal contradictions in students that serve as driving forces for personality development. Thus, it is justified to transform ethical-humanistic education from this discipline in accordance with the contributions of educational research and scientific results in this field. To this end, an approach to the teaching-learning process is needed that, within the humanistic paradigm, promotes reflective thinking and meaningful learning of ethical principles and humanistic values.

CONCLUSIONS

The ethical-humanistic education projected from the discipline of Medical Psychology at the Faculty of Medical Sciences of Sancti Spíritus “Dr. Faustino Pérez Hernández.” is not yet meeting the requirements of the Medicine training model. To improve the process, faculty training needs were identified. The administrators, professors, and students recognized the need for ethical-humanistic education, and the possibilities for its improvement were demonstrated in the curricular, pedagogical, and extension dimensions.

RECOMMENDATIONS

Propose a methodology for broader studies as a scientific result that contributes to the improvement of ethical-humanistic education in the discipline Medical Psychology. This consideration arises from the potential to enhance the ethical-humanistic education process, starting from the current situation under investigation and moving towards the projected training model.

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FINANCING

None.

CONFLICT OF INTEREST

None.

AUTHORSHIP CONTRIBUTION

Conceptualization: Yarabel Nápoles Prieto, Gladys Alejandra Rojas Sánchez, Arturo Puga García.

Research: Yarabel Nápoles Prieto, Gladys Alejandra Rojas Sánchez, Arturo Puga García.

Methodology: Yarabel Nápoles Prieto, Gladys Alejandra Rojas Sánchez, Arturo Puga García.

Writing - original draft: Yarabel Nápoles Prieto, Gladys Alejandra Rojas Sánchez, Arturo Puga García.

Writing - revision and editing: Yarabel Nápoles Prieto, Gladys Alejandra Rojas Sánchez, Arturo Puga García.