Early Ethics Education and the Clinical Disconnect

July 15th, 2025

Ethics education in medical school typically begins with theoretical frameworks and hypothetical case studies in the early preclinical years. However, as clinical responsibilities increase, students often experience a decline in formal ethics instruction. Joelle Marie Robertson-Preidler, PhD, from the University of Texas Health Science Center at Houston, emphasizes that ethics education becomes even more critical during clinical training, when real-world patient interactions demand ethical reflection and decision-making.

Robertson-Preidler advocates for embedding ethics into everyday clinical practice. She suggests that methods such as ethics rounds or clinical ethics shadowing could integrate ethical reflection into routine patient care. Ideally, trainees would spend time with a clinical ethicist, though many teaching hospitals lack formal ethics services.

Barriers to Ethics Integration in Medical Curricula

At Creighton University School of Medicine in Omaha, NE, faculty recognized a gap in longitudinal ethics education. Although the curriculum included some group discussions on medical ethics topics like informed consent and end-of-life care, these were presented in isolation from foundational and clinical science content.

According to Cassie Eno, PhD, a faculty member at Creighton, the main challenge was the lack of dedicated time in an already crowded curriculum. Short or sporadic sessions were easier to implement, but failed to provide sustained ethical engagement. Eno emphasized the need for continuous, longitudinal integration of ethics and humanities into medical education.

New ERA Curriculum: A Longitudinal, Integrated Approach

In response, Creighton launched the New ERA curriculum (Experience, Reflection, Action) in fall 2019. It features three educational tracks:

• Blue Track: Basic sciences

• Green Track: Clinical skills

• Gold Track: Social context, clinical ethics, leadership, and professional development

The Gold Track aligns ethics topics with clinical themes from other tracks. For example, when students practice cardiovascular exams in the Green Track, they simultaneously explore ethical issues like end-of-life decisions related to heart failure in the Gold Track.

Assessing the Impact of the New Curriculum

Researchers evaluated the effects of New ERA by analyzing essays, interviews with 27 first-year medical students, and end-of-year survey data. Students reported a broader awareness of the social determinants of health and how patients' life circumstances shape clinical decisions.

Many students stated that ethics sessions helped promote empathy by encouraging them to consider diverse perspectives. These findings support the idea that integrated ethics instruction can counteract the ethical erosion and loss of empathy commonly observed during clinical training.

Students appreciated the presence of faculty facilitators to guide ethical discussions and help them navigate complex scenarios — particularly valuable given their limited clinical experience.

Conclusion

The New ERA curriculum demonstrates the value of integrating ethics and humanities into the medical education continuum. By aligning ethical discussions with concurrent clinical content and supporting student reflection, this model fosters professional identity development and ethical awareness. The approach offers a scalable model for reducing empathy decline and promoting ethical engagement throughout medical training.

To learn more about the New ERA curriculum trial, click here.