Ethics Education in Allied Health: A Systematic Review of Learning Outcomes for Entry-Level Students

The complexities of modern healthcare pose a range of ethical issues for health professionals. In preparing student health professionals for these complexities, entry-level education must go beyond exposure to ethical theory, codes and standards. The aim of this systematic review was to determine the student learning outcomes reported in peer-reviewed allied health literature following ethics training. The review method included an a priori protocol, adherence to PRISMA statement, with critical appraisal via the Critical Appraisal Checklist for an Article on an Educational Intervention and The Critical Appraisal Skills Program (CASP) Qualitative Checklist. From a total of 1237 possible records published between 1991 and 2015, 11 studies of variable methodological quality met the inclusion criteria for final synthesis. Studies focused on teaching to occupational therapy, physiotherapy, pharmacy and dietetics students (n=588). Heterogeneity among studies precluded metaanalysis and data were synthesised qualitatively in a narrative format. A range of outcomes measures were used in the reviewed publications including the Structure of the Observed Learning Outcomes (SOLO), Defining Issues Test (DIT), Readiness for Interprofessional Learning Scale (RIPLS), Attitudes to Health Professionals Questionnaire (AHPQ), Student Development Task Lifestyle Inventory (SDTLI) and the Socio-moral Reflection Measure-short form (SRM-SF). Other studies surveyed students at the completion of the educational intervention using free text questions or Likert scales. The pedagogical approach used was varied, including transformative, constructivist, arts-based, inter-professional, problem-based or experiential learning approaches. The findings of this review suggest that given the current body of evidence, the teaching of ethics to and for allied health students should include the delivery of ethics focused content, be intensive in nature, link theory with real-life situations and practice, and expose students to multiple views using a variety of methods such as reflection and discussion of ambiguous, controversial topics. While the exact prescription of ethics training to maximise efficacy and uptake is unknown, there is some suggestion that immediate learning outcomes may follow a dose-response pattern, providing potential for future teaching models to incorporate repeated ethics exposure support for cumulative and sustained learning.