UME-21 and teaching ethics: a step in the right direction.

BACKGROUND AND OBJECTIVES Ethics education for medical students has included a number of relatively vague descriptions of appropriate curricular objectives, but medical schools struggle with the general teaching of ethics, as well as with presenting the ethical dilemmas posed by managed care. This paper proposes some standards and uses them to analyze the general and managed care ethics content of the Undergraduate Medical Education for the 21st Century (UME-21) curricula. METHODS We analyzed progress and final reports from each school to define their learning objectives, content, teaching methods, and evaluation strategies in ethics. Each was evaluated using principles of adult learning and Rest's Four Component Model of Moral Development. Good examples of curricular elements from participating schools are described. RESULTS Ethics curricula varied widely among the schools. Goals and objectives were often stated in generalities. Teaching methods were diverse and innovative, and several new combinations of learning activities were created to highlight ethics topics. Content represented managed care and non-managed care topics in varying proportions. Student surveys of attitudes toward managed care and opinions of the ethics programs were the most commonly used as evaluation tools. Some schools were able to develop more direct means of evaluating student learning. The Four Component Model was not fully addressed in the programs developed by the participating schools. CONCLUSIONS We make recommendations about the objectives, teaching methods, content, and evaluation methods of an ideal medical school curriculum in ethics.