knowledge in the abstract, whether conceptually or factually. Context-rich questions will be directly related to a clinical situation, and test students in the weighing of information towards making a decision based on the relevant details. Extended-matching questions are context-rich and provide students with a sizeable list of concise and theoretically possible options within a defined category (such as a list of different diagnoses, or other decisional variables of ethico-legal significance), from which they have to match the most appropriate answer to a series of brief case vignettes. Another format is the key-feature approach where the case description is followed by a series of questions relating to essential decisions that are highly specific to contextual as well as medical details of the case (Schuwirth & van der Vleuten 2009). Decisions on key aspects of patient management may not necessarily be in terms of an established diagnosis and could relate, for example, to ethico-legal dimensions.
Assessing outcomes in ethics and law
Given that both the content and the form of assessment are bound up with the specification of course outcomes, care must be taken in how these are conceived. At the beginning of Chapter 2, it was noted briefly that learning outcomes in ethics and law might be framed in terms of Bloom’s taxonomic domains of the cognitive, the affective, and the psychomotor. However, Bebeau et al. (1999) explain that there is poor correlation within and poor intercorrelation between the three learning domains, especially with regard to our practices at an ethico-legal level, because “there are many types of cognitions, many types of affects, and many types of behaviors”. For example, the way we perceive a situation has a significant bearing on what we choose to do in that context. Also, the ability to demonstrate a given competency does not necessarily entail its transferability, as a metacompetency, to unexpected and unforeseen contexts (Barnett, 1994). If the primary goal of ethics and law in medical education is for students to attain performance outcomes in their practices, it matters that conation – the link between ethical reasoning and ethical doing – cannot be reduced to the simple product of knowledge and attitudes.
Rather than sustaining the tripartite model, with affect being separate from thoughts, cognition separate from feelings, and behaviours separate from them both, Rest (1986) proposes a model of functional psychological processes that is not predicated on components operating together logically, or linearly, or interactively, or deliberately. The processes he identifies are: ethical sensitivity (involving awareness and imagination); judgement (the process of deciding on ethically justified action); motivation (ordering ethical values above other values); and character (acting ethically despite hindrances). Thus, to take the cognitive domain, ethical knowledge involved in assessing the implications of an action is different from the knowing required to judge whether it is ethically justified, which is different again from the knowledge used to assign priority to ethical values, and which in turn is different from the knowledge necessary to act ethically when faced with obstacles (Bebeau et al., 1999).
Box 19 suggests possible assessment methods relating to ethico-legal sensitivity, judgement, motivation, and character. This is not to claim that the methods listed necessarily have either high specificity or sensitivity for
Guide 53: Ethics and Law in the Medical Curriculum 35
Given that both the content and the form of assessment are bound up with the specification of course outcomes, care must be taken in how these are conceived.
If the primary goal of ethics and law in medical education is for students to attain performance outcomes in their practices, it matters that conation – the link between ethical reasoning and ethical doing – cannot be reduced to the simple product of knowledge and attitudes.
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