Dissertation by Mustafa Volkan Kavas
TR
Bu tez ile, Türkiye biyoetik çevrelerine anlatısallık kuramı ve anlatısal etik yaklaşımının t... more TR
Bu tez ile, Türkiye biyoetik çevrelerine anlatısallık kuramı ve anlatısal etik yaklaşımının tanıtılması ve tıp etiği eğitiminin, “ölüm ve ölümcül hastaya yaklaşım” konusunda planlanan bölümünün verilmesinde anlatısal yöntemlerin etkililiğini sorgulamak hedeflenmiştir. Çalışmanın ilk bölümünde kapsamlı ve derleyici bir kuramsal inceleme yapılmıştır. İkinci bölümde ise, ilgili eğitim ile öngörülen bilgi, beceri ve tutumların oluşturulmasında anlatısal yöntemlerin, öteki yöntemlerle etkililik açısından karşılaştırıldığı bir araştırmanın raporu sunulmuştur.
Araştırma çerçevesinde, “ölüm ve ölümcül hastaya yaklaşım” konusunda tıp fakültesi lisans düzeyi öğrencilerinden oluşan küçük gruplara farklı yöntemler ile etik eğitimi verilmiştir. Çalışmaya 2007 yılı bahar döneminde, Ankara Üniversitesi Tıp Fakültesi’ndeki eğitimlerine devam eden 3., 4., 5. ve 6. sınıf öğrencileri dahil edilmişlerdir. Başvuran gönüllü öğrenciler, rasgelleme yöntemi ile eğitim verilecek üç gruba ayrılmışlardır. Buna göre, birinci grup “rol-oynama” yöntemi ile, ikinci grup “seminer oturumları” yöntemi ile, üçüncü grup ise “anlatısal yöntemler” ile seçilen konuda hazırlanmış bir tıp etiği eğitimi programına katılmışlardır. Uygulamanın öncesinde ve sonrasında, her gruptaki öğrencilerden, aldıkları eğitim ile kazandırılması öngörülen tutum değişiklerini ölçmeye yönelik hazırlanan “tutum ölçeği”ni doldurmaları istenmiştir (ön test ve son test).
Eğitimden sonra, hem süreç boyunca her bir grubun kendi içinde ne yönde değiştiği, hem de grupların birbirlerine göre farklılaşıp farklılaşmadığı, son test puanlarının hesaplanmasıyla ortaya konulmuştur. Rol oynama ve anlatısal yöntemleri, hedeflenen tutum değişikliğine ulaşmakta seminer yöntemine göre daha etkilidir. Bu sonuçlar her bir yöntemin etkililiği açısından tartışılmıştır. Anlatısal yöntemlerin, bir uygulamalı etik biçimi olan tıp etiği eğitiminde kayda değer bir etkiliğe sahip olduğu kanıtlanmıştır.
ENG
The purpose of this thesis study is to introduce narrative theory and narrative ethics approach to Turkish bioethics scholars and to question the efficacy of narrative methods in giving a structured part of “approach to death and dying” ethics education. In the first section a comprehensive theoretical review was presented. In the second section a research study was reported in which narrative methods were compared to other methods in terms of efficacy in educating and teaching the skills and attitudes to students.
Within the framework of this research, small groups of medical students were given ethics education on the topic of “approach to death and dying”. Students from Ankara University, School of Medicine were included in the study. These students were divided randomly into three groups. The first group attended an education program using the “role play” method, the second group was educated by the “seminar” method and the third group was exposed to “narrative” methods. Before and after the application of the education program, students from each group were asked to fill in the “attitude scale” which was prepared to measure the changes in the attitude (pre-test and post-test).
After the educational phase, both whether the groups had showed any difference in their attitudes and if so, in which direction each single group had changed were determined by calculating their post-test points. According to the results, role play method and narrative methods are more effective than seminar method in striving for the change of attitude towards a less thanatophobic approach to death and dying.
Papers by Mustafa Volkan Kavas
The main purpose of this study was to collect comprehensive data about the bioethics/medical ethi... more The main purpose of this study was to collect comprehensive data about the bioethics/medical ethics education programs at medical schools in Turkey. We designed a cross-sectional descriptive questionnaire survey which focuses on the content, teaching techniques, teaching years, assessment and evaluation methods, workforce and infrastructure. The data collection tool (Questionnaire of Inventory of Ethics Education Curricula in Turkish Medical Schools) was developed by the researchers specifically for this study. The questionnaire is comprised of three parts. The first part comprises 9 items about demographic information. In the second part, there are 7 parameters inquiring about the content of medical schools' bioethics/medical ethics curricula, teaching and training, and the assessment and evaluation methods they utilize, as well as the qualities of their substructures. The last part consists of 3 open-ended questions through which the participants may express their opinions about the strongest aspects of their bioethics/medical ethics education programs, areas for improvement within them, and the sources they use in teaching. <br>Initially, we conducted a literature survey to identify the main topics in contemporary bioethics/medical ethics. Among them, to begin with, we adopted the first volume of the Bioethics Core Curriculum book (Syllabus Bioethics Education Programme) as the basic framework. Afterwards, we enriched this content by comparing the initial topics with those covered in the Tomorrow's Doctors report published by the General Medical Council in the UK, the US-based The Accreditation Council for Graduate Medical Education's Outcome Project, and the National Core Curriculum developed and proposed by the Council of Medical Schools Deans as a guideline for medical educators in Turkey. We designed the questionnaire so that it included items that questioned not just which of the topics were embraced in the education programs of different institutions, but also how they were treated. Namely, per topic, [...]
Springer eBooks, Aug 30, 2013
ABSTRACT
Omega - Journal Of Death And Dying, Mar 2, 2017
Personal narratives are assumed to be primary sources of the essential meaning of lived experienc... more Personal narratives are assumed to be primary sources of the essential meaning of lived experiences of dying. In this study, I analyzed the personal diary of Miraç Fidan, a terminally ill adolescent with advanced cancer who kept a diary until her death at the age of 15. Miraç's Diary, also published as a book, was subjected to hermeneutic phenomenological narrative analysis. Inferences were drawn regarding the following basic elements: (a) The dynamics in which Miraç lived and (2) her perceptions of herself, her immediate environment, and her experiences. Suffering seems to be the main experience dominating Miraç's life, which I examined with regard to two dimensions: suffering caused by inevitable factors and suffering caused by preventable/changeable factors. The results suggest that if various causes among contextual factors are neutralized, then the quality of the existential experience determined by the inevitable factors would increase.
Turkiye Klinikleri Journal of Medical Ethics-Law and History, 2004
&amp;quot;ÖZET Kasım 2004te 10. kuruluş yıldönümü kutlanacak olan Türkiye Biyoetik Derneğinin... more &amp;quot;ÖZET Kasım 2004te 10. kuruluş yıldönümü kutlanacak olan Türkiye Biyoetik Derneğinin hangi amaçlarla kurulduğu, karar alma, etkinlik repertuarını ve ilgi alanlarını belirleme ve etkinlikte bulunma gibi işleyiş mekanizmalarının nasıl yapılandırıldığı, derneğin işlerliği / etkililiği ile ilgili ve etkinlikleri gerçekleştirirken hangi teorik yaklaşımları temel aldığı, bir örgütlenme olarak kendini nasıl tanımladığı gibi konular tarihsel olarak ele alınacaktır. Ülkemizde böylesi bir derneğin karar ve etkinliklerini nasıl değerlendirdiği ve hangi yaklaşımları neden önceleyerek eylem planlarını yapılandırması gerektiği tartışılmalıdır. Bu sayede, özellikle tıp etiği alanında söz sahibi olması beklenen bir derneğin varoluş nedenlerini sorgulaması, eleştirmesi mümkün olabilecektir. Derneğin geçmişte Türkiyede yaşanmış ve kamuoyunda yoğun biçimde tartışılmış kimi olaylara karşı hangi refleksleri gösterdiği, bu tartışmalara ne ölçüde dahil olduğu araştırılacaktır. Ortaya çıkacak veriler Türkiye Biyoetik Derneği ve benzeri örgütlenmelerin amaç, işlev ve etkililiğinin tartışılması ve yeniden yapılandırılmasında yol gösterici olabilir. ABSTRACT The Turkish Bioethics Associations10th anniversary will be celebrated in November 2004, and the goals it was founded for, its functioning mechanisms such as decision-making, interest and activity developing processes, its self-definition as a non-governmental organization and its theoretical approaches should be examined from a historical perspective. How such an association in our country evaluates its decisions and activities and how it should structure its operating plans according to which priorities should be discussed. By this, it might be possible for an associaton which is supposed to have an effect especially in biomedical ethics to question and criticize its raison detre. The reactions of the association towards previous ethical issues arosed and publicly discussed in Turkey will be studied and the extent of its participation will be searched. The collected data can be enlighting for the discussions about the goals, functions and efficacy of The Turkish Bioethics Association and can be useful for the reorganization of it and the similar organizations.&amp;quot;
Objective: To compare the efficacy of two teaching methods for thanatology education. Design: 60 ... more Objective: To compare the efficacy of two teaching methods for thanatology education. Design: 60 students were randomized in three groups. After “focus group sessions” with the participants, a validated attitude scale was applied to all. Group I continued with the regular program of the School of Medicine, without any interventions. Group II had seminar studies once every month for six months, each lasting 1.5 hours. Group III established a drama team under the direction of one of the researchers and made rehearsals with the aim of putting a play on the stage whose main theme is the relationships between the dying patients and their relatives. Six months later, the same attitude scale was applied once more in order to assess the difference between the efficacy of teaching methods. Results: There was a significant difference in each group between pre-test and post-test. Only Group II (the seminar group) showed significant decrease in their scores and became less thanatophobic. Conclusion: Students’ attitudes towards death and dying patients can be changed through education. According to our findings, seminar sessions and small group discussions are the most effective method for this education. Thanatology education through drama sessions needs further research. Our initial hypothesis was that about the drama technique would be more efficient in thanatology education, but our results did not support this hypothesis. On the contrary, although it was not statistically significant, post-test scores of Group III were indicating that they became more thanatophobic.
Bu tez ile, Turkiye biyoetik cevrelerine anlatisallik kurami ve anlatisal etik yaklasiminintaniti... more Bu tez ile, Turkiye biyoetik cevrelerine anlatisallik kurami ve anlatisal etik yaklasiminintanitilmasi ve tip etigi egitiminin, ?olum ve olumcul hastaya yaklasim? konusunda planlananbolumunun verilmesinde anlatisal yontemlerin etkililigini sorgulamak hedeflenmistir.Calismanin ilk bolumunde kapsamli ve derleyici bir kuramsal inceleme yapilmistir. Ikincibolumde ise, ilgili egitim ile ongorulen bilgi, beceri ve tutumlarin olusturulmasinda anlatisalyontemlerin, oteki yontemlerle etkililik acisindan karsilastirildigi bir arastirmanin raporusunulmustur. Burada amac, belirli bir baglamda da olsa anlatisal yontemlerin tip etigiegitimdeki yerine dair somut ve genellebilir veriler elde etmektir. Bunun yani sira, ikincil biramac olarak, ?olum ve olumcul hastaya yaklasim? konusunda ele alinan egitimyontemlerinin hangi acilardan basarili ya da basarisiz oldugunu saptanmaya calisilmistirArastirma cercevesinde, ?olum ve olumcul hastaya yaklasim? konusunda tip fakultesi lisansduzeyi ogrencilerinden olusan kucuk gruplara farkli yontemler ile etik egitimi verilmistir.Calismaya 2007 yili bahar doneminde, Ankara Universitesi Tip Fakultesi'ndeki egitimlerinedevam eden 3., 4., 5. ve 6. sinif ogrencileri dahil edilmislerdir. Basvuran gonullu ogrenciler,rasgelleme yontemi ile egitim verilecek uc gruba ayrilmislardir. Buna gore, birinci grup ?roloynama?yontemi ile, ikinci grup ?seminer oturumlari? yontemi ile, ucuncu grup ise?anlatisal yontemler? ile secilen konuda hazirlanmis bir tip etigi egitimi programinakatilmislardir. Dorduncu gruba ise, sadece bu grup icin gonullu olmak isteyen ogrencilerkatilmislardir. Bu son gruba herhangi bir egitim verilmemis, gruptaki ogrenciler kendiolagan tip egitimlerine mudahalesiz bir sekilde devam etmislerdir (kontrol grubu).Uygulamanin oncesinde ve sonrasinda, her gruptaki ogrencilerden, aldiklari egitim ilekazandirilmasi ongorulen tutum degisiklerini olcmeye yonelik hazirlanan ?tutum olcegi?nidoldurmalari istenmistir (on test ve son test).Egitimden sonra, hem surec boyunca her bir grubun kendi icinde ne yonde degistigi, hem degruplarin birbirlerine gore farklilasip farklilasmadigi, son test puanlarinin hesaplanmasiylaortaya konulmustur. Buna gore, rol oynama ve anlatisal yontemlerinin her ikisi de, olcekkapsaminda birer alt-olcek olan dort boyut (?olumcul hastalar ve yakinlari ile iletisim?,?bakim sorumlulugunu devretme?, ?olumcul hastadan kacinma? ve ?oz-yeterlilik algisi?)acisindan egitimle hedeflenen tutumun (daha az kacinici tutum) kazandirilmasinda etkilidir.Seminer yontemi ise bu boyutlardan sadece ikisi (?bakim sorumlulugunu devretme? ve?olumcul hastadan kacinma?) acisindan istenen yonde tutum degisikligi yaratabilmistir.Diger iki boyut (?olumcul hastalar ve yakinlari ile iletisim? ve ?oz-yeterlilik algisi?)acisindan grubun son test puanlari goz onune alindiginda Seminer Grubu'nun hedeflenentutum degisikligini gerceklestiremedigi soylenebilir. Rol oynama ve anlatisal yontemleri,acik ki, hedeflenen tutum degisikligine ulasmakta seminer yontemine gore daha etkilidir.Bu sonuclar her bir yontemin etkililigi acisindan tartisilmistir. Anlatisal yontemlerin, biruygulamali etik bicimi olan tip etigi egitiminde kayda deger bir etkilige sahip oldugukanitlanmistir.AbstractThe purpose of this thesis study is to introduce narrative theory and narrative ethics approachto Turkish bioethics scholars and to question the efficacy of narrative methods in giving astructured part of ?approach to death and dying? ethics education. In the first section acomprehensive theoretical review was presented. In the second section a research study wasreported in which narrative methods were compared to other methods in terms of efficacy ineducating and teaching the skills and attitudes to students. The objective of the research was,whether in some certain context, to obtain specific and generalizable data about the role ofnarrative methods in medical ethics education. In addition to that, the secondary objective isto determine in which aspects the applied methods succeeded or failed regarding the topic of?approach to death and dying?.Within the framework of this research, small groups of medical students were given ethicseducation on the topic of ?approach to death and dying?, however for each of them adifferent method was applied. Students from 3rd, 4th, 5th and 6th grades of Ankara University,School of Medicine were included in the study. These students, who applied voluntarily,were divided randomly into three groups. The first group attended an education programusing the ?role play? method, the second group was educated by the ?seminar? method andthe third group was exposed to ?narrative? methods. Students who specifically volunteeredwere included in the fourth group, where they were not given any education and theycontinued their usual medical education without any intervention (control group). Before andafter the application of the education program, students from each group were asked to fill inthe ?attitude…
Journal of Cancer Education, Feb 25, 2011
In recent decades growing efforts in Western countries in integrating end-of-life care issues int... more In recent decades growing efforts in Western countries in integrating end-of-life care issues into undergraduate medical education have been conspicuous. However, studies in this field are limited in Turkey. We aimed, therefore, as a first step, to develop an attitude scale in order to obtain objective data regarding medical students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; approaches to death and dying patients. After applying the scale on medical students and performing exploratory factor analysis, it was found out to be composed of a two-dimensional structure. Then the internal construct validity of these dimensions was subjected to Rasch analysis and the reliability of them was tested by internal consistency and person separation index. As a result of overall analyses, we suggest a new scale which is capable of making valid and reliable measurements.
OMEGA - Journal of Death and Dying, 2017
Personal narratives are assumed to be primary sources of the essential meaning of lived experienc... more Personal narratives are assumed to be primary sources of the essential meaning of lived experiences of dying. In this study, I analyzed the personal diary of Miraç Fidan, a terminally ill adolescent with advanced cancer who kept a diary until her death at the age of 15. Miraç’s Diary, also published as a book, was subjected to hermeneutic phenomenological narrative analysis. Inferences were drawn regarding the following basic elements: (a) The dynamics in which Miraç lived and (2) her perceptions of herself, her immediate environment, and her experiences. Suffering seems to be the main experience dominating Miraç’s life, which I examined with regard to two dimensions: suffering caused by inevitable factors and suffering caused by preventable/changeable factors. The results suggest that if various causes among contextual factors are neutralized, then the quality of the existential experience determined by the inevitable factors would increase.
Cambridge Consortium of Bioethics Education established the “Turkey Working Group” in Paris on Ju... more Cambridge Consortium of Bioethics Education established the “Turkey Working Group” in Paris on June 21st, 2013. The Centre of this Group is Acibadem University School of Medicine, the Department of Medical History and Ethics, chaired by YIUlman. The Group functions as a collective of scholars, academics, experts who collaborate interdisciplinarily in bioethics education. The Group began to act by organizing workshops to assign its aims and strategies. The aims of the Group are to raise awareness in ethics education and moral decision making in the academy and at clinical setting; to work multiprofessionally in coordination with other healthcare professionals; to enhance advocacy of ethics teaching at university; to follow humanities perspective; to share ideas on curriculum development; to compare and learn mutually from the experiences; to choose topics for discussion on the issues of bioethics and societal issues; to structure multi-based research among countries. It is opening a ...
Background
Pay-for-performance system (P4P) has been in operation in the Turkish healthcare sect... more Background
Pay-for-performance system (P4P) has been in operation in the Turkish healthcare sector since 2004. While the government defended that it encouraged healthcare professionals’ job motivation, and improved patient satisfaction by increasing efficiency and service quality, healthcare professionals have emphasized the system’s negative effects on working conditions, physicians’ trustworthiness, and cost-quality outcomes. In this study, we investigated physicians’ accounts of current working conditions, their status as a moral agent, and their professional attitudes in the context of P4P’s perceived effects on their professional, social, private, and future lives.
Methods
First, we held 3 focus groups with 19 residents and 1 specialist regarding their lived experiences under P4P and thematically analyzed the transcripts. Second, we developed a questionnaire in order to assess how generalizable the qualitative findings are for a broader group of physicians. The tool has three parts questioning 1) demographic information, 2) working conditions, and 3) perceived consequences and effects of P4P. 2136 physicians responded to the survey. After refining the data, we conducted the statistical analysis over 1378 responses by using Spearman's correlation coefficient, exploratory factor analysis (EFA) for categorical data, and Kruskal-Wallis variance analysis.
Results
Thematic analysis revealed two dimensions: 1) factors leading to estrangement, and 2) manifestations of estrangement. As for the initial, participants thought that P4P affected relationships at work; family and social relationships; working conditions; quality of the specialty training; quality of healthcare services; and it caused healthcare system-related consequences . Concerning the latter, the following themes emerged: Estrangement of the physician ; damaging effects on physician’s psychology ; physician’s perception of their future life; and physician as a moral agent . According to EFA, a 5-factor structure was appropriate: F1) Estrangement; F2) adverse effects on the physician’s quality of life; F3) favorable consequences; F4) physicians becoming disreputable; F5) unfavorable consequences.
Conclusions
The findings suggest that under P4P, physicians have become more estranged towards their profession, their patients, and themselves. They suffer from deteriorating working conditions, lack of motivation, lack of work-related satisfaction, and hopelessness regarding their future. Furthermore, P4P impairs their ability to realize themselves as moral subjects practicing in alignment with professional values and principles.
Turkish Journal of Bioethics, 2015
Derleme/Review c a This article has been developed from the Report of the 3 rd Workshop of the Ca... more Derleme/Review c a This article has been developed from the Report of the 3 rd Workshop of the Cambridge Consortium of Bioethics Education Turkey Working Group held in Ankara on May 23rd, 2014. Outcomes of the Workshop have been drafted into an article by Mustafa Volkan Kavas, Kevser Vatansever, Yesim Isil Ulman, upon the unanimous decision of the Turkey Working Group at its 5 th Workshop on December 5, 2014. The participants of the Workshop have thankfully and rightly been cited in the Annex of this article.
BMC Public Health, 2021
Background: Human immunodeficiency virus (HIV) infection rates have been gradually increasing in ... more Background: Human immunodeficiency virus (HIV) infection rates have been gradually increasing in Istanbul, Turkey. Many people living with HIV (PLWH) here encounter difficulties, for example, in adapting to the chronic disease and obtaining continuous access to healthcare services. In this study, we aimed to explore the challenges PLWH face in their daily lives and understand their perceptions of themselves, healthcare professionals and services, and their social spheres via their expressed lived experiences in the healthcare setting. Method: Individual semi-structured in-depth interviews were conducted face-to-face with 20 PLWH in Istanbul. All the interviews were voice-recorded and transcribed verbatim except one, upon participant request, for which the interviewer took notes. These logs and the interviewer's notes were analyzed thematically using the inductive content analysis method. Results: The themes concerned experiences in three distinct contexts: 1) Interactions with healthcare providers; 2) Participants' responses to their HIV diagnosis; and 3) Interactions with their social networks. Firstly, the results highlighted that the participants perceived that healthcare professionals did not inform them about the diagnosis properly, failed to protect patients' confidentiality and exhibited discriminative behaviors towards them. Secondly, after the diagnosis the participants had difficulty in coping with their unsettled emotional state. While many ceased sexual activities and isolated themselves, some sought support. Lastly, living with HIV affected their relationships with their families and friends either positively or negatively. Moreover, they had to face the difficulties concerning spouse/partner notification issues about which many needed professional support.
Erciyes Medical Journal, 2021
Involuntary hospitalizations are commonly applied in the treatment of psychiatric disorders. Thes... more Involuntary hospitalizations are commonly applied in the treatment of psychiatric disorders. These practices have been controversial since they may pose morally questionable situations. This study aimed to reveal the clinical characteristics of patients who were involuntarily admitted to the psychiatry clinic as well as the reasons behind the involuntary admission decision and to examine the findings from an ethical point of view. Materials and Methods: Socio-demographic and clinical records of patients who had been involuntarily admitted to a university hospital between January-2013 and January-2019 were collected retrospectively. These data were compared with the variables of the voluntarily admitted patients who were matched with the involuntarily admitted study group in terms of admission year, sex, and age. Results: There was no significant difference between the two groups in terms of socio-demographic characteristics. The frequency of involuntary hospitalization was found to be higher in patients with psychotic disorders. These patients had a longer duration of hospitalization and were given long-acting antipsychotics more frequently. There was no significant difference between the groups in terms of risk of doing harm to oneself/others and treatment needs. Conclusion: Involuntary hospitalizations would contradict further with the principle of respect for patient's autonomy in comparison with those done due to the risk of doing harm to oneself/others. Prolonged hospitalization and long-acting drug choices in the absence of the risk of giving harm to oneself/others may contradict basic ethical principles, such as the right to choose one's treatment. Caution should be taken against potential ethical issues while considering involuntary hospitalization.
Death Studies, 2020
This qualitative study aims to reveal the effect of professional education on medical and nursing... more This qualitative study aims to reveal the effect of professional education on medical and nursing students’ attitudes toward death. The study was carried out with nursing and medical students (N = 197). Research data was collected through semi-structured interview questions and 23 focus group interviews. The data was assessed using thematic analysis method. The themes were evaluated within the context of perception of death, ethical dilemmas, and, death education. To achieve professional competency in attitudes toward death, it is imperative to form a common educational curriculum and practice that would help students develop a mutual language and value system about death.
BMC Medical Education, 2020
Background:
Ethics teaching is globally considered an essential part of medical education fosteri... more Background:
Ethics teaching is globally considered an essential part of medical education fostering professionalism. It does not only provide knowledge for good clinical conduct, but also trains medical students as virtuous practitioners. Although Turkey has had a considerable experience in ethics education of healthcare professionals, the general state of ethics curricula at medical schools in Turkey is unknown.
Methods:
The purpose of this study was to collect comprehensive data about the ethics education programs at medical schools in Turkey. To this aim, we designed a cross-sectional descriptive questionnaire survey which focuses on the content, teaching years, teaching, assessment and evaluation methodologies, workforce and infrastructure. We delivered the questionnaire to all medical schools in Turkey. Seventy-nine medical schools participated in this study (response rate: 78%).
Results:
Although most institutions had an undergraduate ethics curriculum (91.1%), the findings suggest deficiency of teaching personnel (34.2% had no instructors). Furthermore, the distribution and composition of the workforce was imbalanced. The content varies largely among institutions. Medical schools with an ethics department were more likely to diversify teaching topics. However, ethics education was largely based on the four-principle approach. The content was usually conveyed to students theoretically. Around 90% of schools had classroom lectures. It is the only method used at one-third of them. Clinical ethics education was mostly lacking. Multiple-choice tests were widely used to assess and evaluate student attainments (86.1%).
Conclusions:
Staff qualified to teach ethics and ethics education integrated into the six-year medical curriculum given by a multidisciplinary team are urgent necessities. Considering teaching, assessment and evaluation methodologies used, most medical schools seem to fall short of fostering students to develop ethical attitudes. Endeavors aiming for modern topics should be encouraged. As the organization of ethics education change continuously, we think that a platform for monitoring ethics education at medical schools in Turkey should be established. Such a body would help ethics instructors to network and find solutions to current problems and build shared wisdom.
Journal of Bioethical Inquiry, 2018
When accessing healthcare services, LGBT+ individuals are often exposed to segregating and margin... more When accessing healthcare services, LGBT+ individuals are often exposed to segregating and margin-alizing discourses. Knowledge about how such experiences are reflected in the moral world of LGBT+ individuals living in Turkey is limited. This study examined LGBT+ individuals' lived experiences when utilizing healthcare services. The findings are discussed in terms of moral discourses related to LGBT+ individuals' gender identity and sexual orientation. A qualitative field study was conducted using semi-structured interviews with fifty-five LGBT+ individuals from Turkish cities who were in contact with various non-governmental organizations that conduct studies on gender identity and sexual orientation. A questionnaire was administered with items on partici-pants' demographic information, experiences, behavioural patterns, and knowledge regarding healthcare services. The data were analysed thematically. The findings were evaluated within the framework of Baccess to healthcare service^ theme related to Bhealthcare service demand^ context. Additionally, the Binteraction with physicians^ theme was addressed in the context of Bphysician–pa-tient/counselee relationship.^ LGBT+ individuals state that they are exposed to stigmatizing and segregating discourses by healthcare professionals, which might pose an obstacle for adaptive health-seeking behaviours. These results suggest that physicians' professional approach has a considerable influence on LGBT+ individuals' capacity for utilizing healthcare services.
TR
GİRİŞ ve AMAÇ: İş sağlığı ve güvenliği uygulamaları, çalışanların yaşamını tehlikeye sokan, sa... more TR
GİRİŞ ve AMAÇ: İş sağlığı ve güvenliği uygulamaları, çalışanların yaşamını tehlikeye sokan, sağlığını tehdit eden, ekonomiye zarar veren, ‘iş kazası’ ve ‘meslek hastalığı’ denilen olayları önlemeyi amaçlar. İş sağlığı ve güvenliği uzmanlarının iş yerlerinde etik değerleri gözeterek denetim yapabilmeleri için mesleki bağımsızlığa sahip olmaları ve işlerinin temel öğesi olan sağlık ve güvenliği öncelik olmaktan çıkaracak herhangi bir zorunluluğa tabi olmamaları gerekmektedir. Bu çalışmada iş güvenliği uzmanının denetlenen kuruluşla kurdukları istihdam ve ücretlendirme ilişkisinin, uzmanların mesleki bağımsızlığı üzerindeki etkisi araştırılmaktadır.
YÖNTEM ve GEREÇLER: Çalışmada yarı yapılandırılmış derinlemesine görüşme tekniği kullanılmıştır. Ankara’da araştırmanın yapıldığı tarihte aktif olarak görev yapan ve en az 6 aylık tecrübe sahibi toplam 10 iş sağlığı ve güvenliği uzmanıyla görüşülmüştür. Ham veri tematik analize tabi tutulmuştur.
BULGULAR: “Mesleki motivasyon”, “meslek hayatında yaşanan sorunlar”, “ücretin denetlenen kuruluştan alınması” ve “görüşmecilerin çözüm önerileri” ana temalar olarak belirlenmiştir. Alt-temalar, bu boyutların sonuç ve işlevleri bakımından ayrıca gruplandırılmıştır. Çalışmamızda uzmanların, işsizlik kaygısı yaşadıkları, baskı altında çalıştıkları, taviz vermek zorunda kaldıkları, işlevsiz hissettikleri ve işlerine yabancılaştıkları temel bulgular olarak tespit edilmiştir.
TARTIŞMA ve SONUÇ: İşverenin tutumu ve tavrı iş sağlığı ve güvenliği uygulamalarının verimliliğini etkilemekte, uzmanların mesleki bağımsızlığı, işverenin inisiyatifine bırakılmaktadır. İş güvenliği uzmanı, işçinin sağlığını korumak ile kendi ev geçimini sağlamak arasında bir seçim yapmak zorunda kalmaktadır. İş güvenliği uzmanlarının görevlerini yerine getirirken, bilgileri ve vicdanları doğrultusunda bağımsız kararlar alarak uygulayabilmeleri ancak işverenle kurdukları istihdam ilişkisinin ortadan kalkmasıyla mümkün görünmektedir.
ENG
INTRODUCTION: The occupational health and safety practice, aims to prevent the events called “work accident” and “occupational disease,” which jeopardize the life and health of the employees and are harmful to the economy. To conduct inspections regarding the ethical values, it is necessary that the occupational health and safety (OHS) specialist is independent professionally and is not tied to any obligations that would take precedence over the main factors of their job; safety and health. In this study, the effect of the employment and charging relations between the OHS specialists and the inspected enterprise on the independence of OHS specialist is inquired.
METHODS: Semi-structured in-depth interview technique was used in this study. 10 OHS specialist were interviewed who were working actively at the time the data was collected and had at least 6 months job experience by then. The rough data were analyzed thematically.
RESULTS: “Professional motivation”, “professional problems”, “being paid by the inspected institution”, “solution offers of the interviewers” emerged as the main themes. The sub-themes were classified in the terms of the functions and outcomes of these dimensions. It is determined as the main findings that the OHS specialist feel unemployment anxiety, work under pressure, have to compromise with unpleasant conditions, feel useless and alienate to the work.
DISCUSSION AND CONCLUSION: The attitude of the employer effects the productivity of the occupational health and safety practices. The level of professional independence of the OHS specialist is dependent on the employer. The OHS specialist is usually obliged to prefer either protecting the employee’s health or sustaining his/her own means of living. The OHS specialist’s ability to make a judgment independently in accordance with his/her wise and consciences seems to be possible only when the employment and charging relations between the hirer and OHS specialist are removed.
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Dissertation by Mustafa Volkan Kavas
Bu tez ile, Türkiye biyoetik çevrelerine anlatısallık kuramı ve anlatısal etik yaklaşımının tanıtılması ve tıp etiği eğitiminin, “ölüm ve ölümcül hastaya yaklaşım” konusunda planlanan bölümünün verilmesinde anlatısal yöntemlerin etkililiğini sorgulamak hedeflenmiştir. Çalışmanın ilk bölümünde kapsamlı ve derleyici bir kuramsal inceleme yapılmıştır. İkinci bölümde ise, ilgili eğitim ile öngörülen bilgi, beceri ve tutumların oluşturulmasında anlatısal yöntemlerin, öteki yöntemlerle etkililik açısından karşılaştırıldığı bir araştırmanın raporu sunulmuştur.
Araştırma çerçevesinde, “ölüm ve ölümcül hastaya yaklaşım” konusunda tıp fakültesi lisans düzeyi öğrencilerinden oluşan küçük gruplara farklı yöntemler ile etik eğitimi verilmiştir. Çalışmaya 2007 yılı bahar döneminde, Ankara Üniversitesi Tıp Fakültesi’ndeki eğitimlerine devam eden 3., 4., 5. ve 6. sınıf öğrencileri dahil edilmişlerdir. Başvuran gönüllü öğrenciler, rasgelleme yöntemi ile eğitim verilecek üç gruba ayrılmışlardır. Buna göre, birinci grup “rol-oynama” yöntemi ile, ikinci grup “seminer oturumları” yöntemi ile, üçüncü grup ise “anlatısal yöntemler” ile seçilen konuda hazırlanmış bir tıp etiği eğitimi programına katılmışlardır. Uygulamanın öncesinde ve sonrasında, her gruptaki öğrencilerden, aldıkları eğitim ile kazandırılması öngörülen tutum değişiklerini ölçmeye yönelik hazırlanan “tutum ölçeği”ni doldurmaları istenmiştir (ön test ve son test).
Eğitimden sonra, hem süreç boyunca her bir grubun kendi içinde ne yönde değiştiği, hem de grupların birbirlerine göre farklılaşıp farklılaşmadığı, son test puanlarının hesaplanmasıyla ortaya konulmuştur. Rol oynama ve anlatısal yöntemleri, hedeflenen tutum değişikliğine ulaşmakta seminer yöntemine göre daha etkilidir. Bu sonuçlar her bir yöntemin etkililiği açısından tartışılmıştır. Anlatısal yöntemlerin, bir uygulamalı etik biçimi olan tıp etiği eğitiminde kayda değer bir etkiliğe sahip olduğu kanıtlanmıştır.
ENG
The purpose of this thesis study is to introduce narrative theory and narrative ethics approach to Turkish bioethics scholars and to question the efficacy of narrative methods in giving a structured part of “approach to death and dying” ethics education. In the first section a comprehensive theoretical review was presented. In the second section a research study was reported in which narrative methods were compared to other methods in terms of efficacy in educating and teaching the skills and attitudes to students.
Within the framework of this research, small groups of medical students were given ethics education on the topic of “approach to death and dying”. Students from Ankara University, School of Medicine were included in the study. These students were divided randomly into three groups. The first group attended an education program using the “role play” method, the second group was educated by the “seminar” method and the third group was exposed to “narrative” methods. Before and after the application of the education program, students from each group were asked to fill in the “attitude scale” which was prepared to measure the changes in the attitude (pre-test and post-test).
After the educational phase, both whether the groups had showed any difference in their attitudes and if so, in which direction each single group had changed were determined by calculating their post-test points. According to the results, role play method and narrative methods are more effective than seminar method in striving for the change of attitude towards a less thanatophobic approach to death and dying.
Papers by Mustafa Volkan Kavas
Pay-for-performance system (P4P) has been in operation in the Turkish healthcare sector since 2004. While the government defended that it encouraged healthcare professionals’ job motivation, and improved patient satisfaction by increasing efficiency and service quality, healthcare professionals have emphasized the system’s negative effects on working conditions, physicians’ trustworthiness, and cost-quality outcomes. In this study, we investigated physicians’ accounts of current working conditions, their status as a moral agent, and their professional attitudes in the context of P4P’s perceived effects on their professional, social, private, and future lives.
Methods
First, we held 3 focus groups with 19 residents and 1 specialist regarding their lived experiences under P4P and thematically analyzed the transcripts. Second, we developed a questionnaire in order to assess how generalizable the qualitative findings are for a broader group of physicians. The tool has three parts questioning 1) demographic information, 2) working conditions, and 3) perceived consequences and effects of P4P. 2136 physicians responded to the survey. After refining the data, we conducted the statistical analysis over 1378 responses by using Spearman's correlation coefficient, exploratory factor analysis (EFA) for categorical data, and Kruskal-Wallis variance analysis.
Results
Thematic analysis revealed two dimensions: 1) factors leading to estrangement, and 2) manifestations of estrangement. As for the initial, participants thought that P4P affected relationships at work; family and social relationships; working conditions; quality of the specialty training; quality of healthcare services; and it caused healthcare system-related consequences . Concerning the latter, the following themes emerged: Estrangement of the physician ; damaging effects on physician’s psychology ; physician’s perception of their future life; and physician as a moral agent . According to EFA, a 5-factor structure was appropriate: F1) Estrangement; F2) adverse effects on the physician’s quality of life; F3) favorable consequences; F4) physicians becoming disreputable; F5) unfavorable consequences.
Conclusions
The findings suggest that under P4P, physicians have become more estranged towards their profession, their patients, and themselves. They suffer from deteriorating working conditions, lack of motivation, lack of work-related satisfaction, and hopelessness regarding their future. Furthermore, P4P impairs their ability to realize themselves as moral subjects practicing in alignment with professional values and principles.
Ethics teaching is globally considered an essential part of medical education fostering professionalism. It does not only provide knowledge for good clinical conduct, but also trains medical students as virtuous practitioners. Although Turkey has had a considerable experience in ethics education of healthcare professionals, the general state of ethics curricula at medical schools in Turkey is unknown.
Methods:
The purpose of this study was to collect comprehensive data about the ethics education programs at medical schools in Turkey. To this aim, we designed a cross-sectional descriptive questionnaire survey which focuses on the content, teaching years, teaching, assessment and evaluation methodologies, workforce and infrastructure. We delivered the questionnaire to all medical schools in Turkey. Seventy-nine medical schools participated in this study (response rate: 78%).
Results:
Although most institutions had an undergraduate ethics curriculum (91.1%), the findings suggest deficiency of teaching personnel (34.2% had no instructors). Furthermore, the distribution and composition of the workforce was imbalanced. The content varies largely among institutions. Medical schools with an ethics department were more likely to diversify teaching topics. However, ethics education was largely based on the four-principle approach. The content was usually conveyed to students theoretically. Around 90% of schools had classroom lectures. It is the only method used at one-third of them. Clinical ethics education was mostly lacking. Multiple-choice tests were widely used to assess and evaluate student attainments (86.1%).
Conclusions:
Staff qualified to teach ethics and ethics education integrated into the six-year medical curriculum given by a multidisciplinary team are urgent necessities. Considering teaching, assessment and evaluation methodologies used, most medical schools seem to fall short of fostering students to develop ethical attitudes. Endeavors aiming for modern topics should be encouraged. As the organization of ethics education change continuously, we think that a platform for monitoring ethics education at medical schools in Turkey should be established. Such a body would help ethics instructors to network and find solutions to current problems and build shared wisdom.
GİRİŞ ve AMAÇ: İş sağlığı ve güvenliği uygulamaları, çalışanların yaşamını tehlikeye sokan, sağlığını tehdit eden, ekonomiye zarar veren, ‘iş kazası’ ve ‘meslek hastalığı’ denilen olayları önlemeyi amaçlar. İş sağlığı ve güvenliği uzmanlarının iş yerlerinde etik değerleri gözeterek denetim yapabilmeleri için mesleki bağımsızlığa sahip olmaları ve işlerinin temel öğesi olan sağlık ve güvenliği öncelik olmaktan çıkaracak herhangi bir zorunluluğa tabi olmamaları gerekmektedir. Bu çalışmada iş güvenliği uzmanının denetlenen kuruluşla kurdukları istihdam ve ücretlendirme ilişkisinin, uzmanların mesleki bağımsızlığı üzerindeki etkisi araştırılmaktadır.
YÖNTEM ve GEREÇLER: Çalışmada yarı yapılandırılmış derinlemesine görüşme tekniği kullanılmıştır. Ankara’da araştırmanın yapıldığı tarihte aktif olarak görev yapan ve en az 6 aylık tecrübe sahibi toplam 10 iş sağlığı ve güvenliği uzmanıyla görüşülmüştür. Ham veri tematik analize tabi tutulmuştur.
BULGULAR: “Mesleki motivasyon”, “meslek hayatında yaşanan sorunlar”, “ücretin denetlenen kuruluştan alınması” ve “görüşmecilerin çözüm önerileri” ana temalar olarak belirlenmiştir. Alt-temalar, bu boyutların sonuç ve işlevleri bakımından ayrıca gruplandırılmıştır. Çalışmamızda uzmanların, işsizlik kaygısı yaşadıkları, baskı altında çalıştıkları, taviz vermek zorunda kaldıkları, işlevsiz hissettikleri ve işlerine yabancılaştıkları temel bulgular olarak tespit edilmiştir.
TARTIŞMA ve SONUÇ: İşverenin tutumu ve tavrı iş sağlığı ve güvenliği uygulamalarının verimliliğini etkilemekte, uzmanların mesleki bağımsızlığı, işverenin inisiyatifine bırakılmaktadır. İş güvenliği uzmanı, işçinin sağlığını korumak ile kendi ev geçimini sağlamak arasında bir seçim yapmak zorunda kalmaktadır. İş güvenliği uzmanlarının görevlerini yerine getirirken, bilgileri ve vicdanları doğrultusunda bağımsız kararlar alarak uygulayabilmeleri ancak işverenle kurdukları istihdam ilişkisinin ortadan kalkmasıyla mümkün görünmektedir.
ENG
INTRODUCTION: The occupational health and safety practice, aims to prevent the events called “work accident” and “occupational disease,” which jeopardize the life and health of the employees and are harmful to the economy. To conduct inspections regarding the ethical values, it is necessary that the occupational health and safety (OHS) specialist is independent professionally and is not tied to any obligations that would take precedence over the main factors of their job; safety and health. In this study, the effect of the employment and charging relations between the OHS specialists and the inspected enterprise on the independence of OHS specialist is inquired.
METHODS: Semi-structured in-depth interview technique was used in this study. 10 OHS specialist were interviewed who were working actively at the time the data was collected and had at least 6 months job experience by then. The rough data were analyzed thematically.
RESULTS: “Professional motivation”, “professional problems”, “being paid by the inspected institution”, “solution offers of the interviewers” emerged as the main themes. The sub-themes were classified in the terms of the functions and outcomes of these dimensions. It is determined as the main findings that the OHS specialist feel unemployment anxiety, work under pressure, have to compromise with unpleasant conditions, feel useless and alienate to the work.
DISCUSSION AND CONCLUSION: The attitude of the employer effects the productivity of the occupational health and safety practices. The level of professional independence of the OHS specialist is dependent on the employer. The OHS specialist is usually obliged to prefer either protecting the employee’s health or sustaining his/her own means of living. The OHS specialist’s ability to make a judgment independently in accordance with his/her wise and consciences seems to be possible only when the employment and charging relations between the hirer and OHS specialist are removed.
Bu tez ile, Türkiye biyoetik çevrelerine anlatısallık kuramı ve anlatısal etik yaklaşımının tanıtılması ve tıp etiği eğitiminin, “ölüm ve ölümcül hastaya yaklaşım” konusunda planlanan bölümünün verilmesinde anlatısal yöntemlerin etkililiğini sorgulamak hedeflenmiştir. Çalışmanın ilk bölümünde kapsamlı ve derleyici bir kuramsal inceleme yapılmıştır. İkinci bölümde ise, ilgili eğitim ile öngörülen bilgi, beceri ve tutumların oluşturulmasında anlatısal yöntemlerin, öteki yöntemlerle etkililik açısından karşılaştırıldığı bir araştırmanın raporu sunulmuştur.
Araştırma çerçevesinde, “ölüm ve ölümcül hastaya yaklaşım” konusunda tıp fakültesi lisans düzeyi öğrencilerinden oluşan küçük gruplara farklı yöntemler ile etik eğitimi verilmiştir. Çalışmaya 2007 yılı bahar döneminde, Ankara Üniversitesi Tıp Fakültesi’ndeki eğitimlerine devam eden 3., 4., 5. ve 6. sınıf öğrencileri dahil edilmişlerdir. Başvuran gönüllü öğrenciler, rasgelleme yöntemi ile eğitim verilecek üç gruba ayrılmışlardır. Buna göre, birinci grup “rol-oynama” yöntemi ile, ikinci grup “seminer oturumları” yöntemi ile, üçüncü grup ise “anlatısal yöntemler” ile seçilen konuda hazırlanmış bir tıp etiği eğitimi programına katılmışlardır. Uygulamanın öncesinde ve sonrasında, her gruptaki öğrencilerden, aldıkları eğitim ile kazandırılması öngörülen tutum değişiklerini ölçmeye yönelik hazırlanan “tutum ölçeği”ni doldurmaları istenmiştir (ön test ve son test).
Eğitimden sonra, hem süreç boyunca her bir grubun kendi içinde ne yönde değiştiği, hem de grupların birbirlerine göre farklılaşıp farklılaşmadığı, son test puanlarının hesaplanmasıyla ortaya konulmuştur. Rol oynama ve anlatısal yöntemleri, hedeflenen tutum değişikliğine ulaşmakta seminer yöntemine göre daha etkilidir. Bu sonuçlar her bir yöntemin etkililiği açısından tartışılmıştır. Anlatısal yöntemlerin, bir uygulamalı etik biçimi olan tıp etiği eğitiminde kayda değer bir etkiliğe sahip olduğu kanıtlanmıştır.
ENG
The purpose of this thesis study is to introduce narrative theory and narrative ethics approach to Turkish bioethics scholars and to question the efficacy of narrative methods in giving a structured part of “approach to death and dying” ethics education. In the first section a comprehensive theoretical review was presented. In the second section a research study was reported in which narrative methods were compared to other methods in terms of efficacy in educating and teaching the skills and attitudes to students.
Within the framework of this research, small groups of medical students were given ethics education on the topic of “approach to death and dying”. Students from Ankara University, School of Medicine were included in the study. These students were divided randomly into three groups. The first group attended an education program using the “role play” method, the second group was educated by the “seminar” method and the third group was exposed to “narrative” methods. Before and after the application of the education program, students from each group were asked to fill in the “attitude scale” which was prepared to measure the changes in the attitude (pre-test and post-test).
After the educational phase, both whether the groups had showed any difference in their attitudes and if so, in which direction each single group had changed were determined by calculating their post-test points. According to the results, role play method and narrative methods are more effective than seminar method in striving for the change of attitude towards a less thanatophobic approach to death and dying.
Pay-for-performance system (P4P) has been in operation in the Turkish healthcare sector since 2004. While the government defended that it encouraged healthcare professionals’ job motivation, and improved patient satisfaction by increasing efficiency and service quality, healthcare professionals have emphasized the system’s negative effects on working conditions, physicians’ trustworthiness, and cost-quality outcomes. In this study, we investigated physicians’ accounts of current working conditions, their status as a moral agent, and their professional attitudes in the context of P4P’s perceived effects on their professional, social, private, and future lives.
Methods
First, we held 3 focus groups with 19 residents and 1 specialist regarding their lived experiences under P4P and thematically analyzed the transcripts. Second, we developed a questionnaire in order to assess how generalizable the qualitative findings are for a broader group of physicians. The tool has three parts questioning 1) demographic information, 2) working conditions, and 3) perceived consequences and effects of P4P. 2136 physicians responded to the survey. After refining the data, we conducted the statistical analysis over 1378 responses by using Spearman's correlation coefficient, exploratory factor analysis (EFA) for categorical data, and Kruskal-Wallis variance analysis.
Results
Thematic analysis revealed two dimensions: 1) factors leading to estrangement, and 2) manifestations of estrangement. As for the initial, participants thought that P4P affected relationships at work; family and social relationships; working conditions; quality of the specialty training; quality of healthcare services; and it caused healthcare system-related consequences . Concerning the latter, the following themes emerged: Estrangement of the physician ; damaging effects on physician’s psychology ; physician’s perception of their future life; and physician as a moral agent . According to EFA, a 5-factor structure was appropriate: F1) Estrangement; F2) adverse effects on the physician’s quality of life; F3) favorable consequences; F4) physicians becoming disreputable; F5) unfavorable consequences.
Conclusions
The findings suggest that under P4P, physicians have become more estranged towards their profession, their patients, and themselves. They suffer from deteriorating working conditions, lack of motivation, lack of work-related satisfaction, and hopelessness regarding their future. Furthermore, P4P impairs their ability to realize themselves as moral subjects practicing in alignment with professional values and principles.
Ethics teaching is globally considered an essential part of medical education fostering professionalism. It does not only provide knowledge for good clinical conduct, but also trains medical students as virtuous practitioners. Although Turkey has had a considerable experience in ethics education of healthcare professionals, the general state of ethics curricula at medical schools in Turkey is unknown.
Methods:
The purpose of this study was to collect comprehensive data about the ethics education programs at medical schools in Turkey. To this aim, we designed a cross-sectional descriptive questionnaire survey which focuses on the content, teaching years, teaching, assessment and evaluation methodologies, workforce and infrastructure. We delivered the questionnaire to all medical schools in Turkey. Seventy-nine medical schools participated in this study (response rate: 78%).
Results:
Although most institutions had an undergraduate ethics curriculum (91.1%), the findings suggest deficiency of teaching personnel (34.2% had no instructors). Furthermore, the distribution and composition of the workforce was imbalanced. The content varies largely among institutions. Medical schools with an ethics department were more likely to diversify teaching topics. However, ethics education was largely based on the four-principle approach. The content was usually conveyed to students theoretically. Around 90% of schools had classroom lectures. It is the only method used at one-third of them. Clinical ethics education was mostly lacking. Multiple-choice tests were widely used to assess and evaluate student attainments (86.1%).
Conclusions:
Staff qualified to teach ethics and ethics education integrated into the six-year medical curriculum given by a multidisciplinary team are urgent necessities. Considering teaching, assessment and evaluation methodologies used, most medical schools seem to fall short of fostering students to develop ethical attitudes. Endeavors aiming for modern topics should be encouraged. As the organization of ethics education change continuously, we think that a platform for monitoring ethics education at medical schools in Turkey should be established. Such a body would help ethics instructors to network and find solutions to current problems and build shared wisdom.
GİRİŞ ve AMAÇ: İş sağlığı ve güvenliği uygulamaları, çalışanların yaşamını tehlikeye sokan, sağlığını tehdit eden, ekonomiye zarar veren, ‘iş kazası’ ve ‘meslek hastalığı’ denilen olayları önlemeyi amaçlar. İş sağlığı ve güvenliği uzmanlarının iş yerlerinde etik değerleri gözeterek denetim yapabilmeleri için mesleki bağımsızlığa sahip olmaları ve işlerinin temel öğesi olan sağlık ve güvenliği öncelik olmaktan çıkaracak herhangi bir zorunluluğa tabi olmamaları gerekmektedir. Bu çalışmada iş güvenliği uzmanının denetlenen kuruluşla kurdukları istihdam ve ücretlendirme ilişkisinin, uzmanların mesleki bağımsızlığı üzerindeki etkisi araştırılmaktadır.
YÖNTEM ve GEREÇLER: Çalışmada yarı yapılandırılmış derinlemesine görüşme tekniği kullanılmıştır. Ankara’da araştırmanın yapıldığı tarihte aktif olarak görev yapan ve en az 6 aylık tecrübe sahibi toplam 10 iş sağlığı ve güvenliği uzmanıyla görüşülmüştür. Ham veri tematik analize tabi tutulmuştur.
BULGULAR: “Mesleki motivasyon”, “meslek hayatında yaşanan sorunlar”, “ücretin denetlenen kuruluştan alınması” ve “görüşmecilerin çözüm önerileri” ana temalar olarak belirlenmiştir. Alt-temalar, bu boyutların sonuç ve işlevleri bakımından ayrıca gruplandırılmıştır. Çalışmamızda uzmanların, işsizlik kaygısı yaşadıkları, baskı altında çalıştıkları, taviz vermek zorunda kaldıkları, işlevsiz hissettikleri ve işlerine yabancılaştıkları temel bulgular olarak tespit edilmiştir.
TARTIŞMA ve SONUÇ: İşverenin tutumu ve tavrı iş sağlığı ve güvenliği uygulamalarının verimliliğini etkilemekte, uzmanların mesleki bağımsızlığı, işverenin inisiyatifine bırakılmaktadır. İş güvenliği uzmanı, işçinin sağlığını korumak ile kendi ev geçimini sağlamak arasında bir seçim yapmak zorunda kalmaktadır. İş güvenliği uzmanlarının görevlerini yerine getirirken, bilgileri ve vicdanları doğrultusunda bağımsız kararlar alarak uygulayabilmeleri ancak işverenle kurdukları istihdam ilişkisinin ortadan kalkmasıyla mümkün görünmektedir.
ENG
INTRODUCTION: The occupational health and safety practice, aims to prevent the events called “work accident” and “occupational disease,” which jeopardize the life and health of the employees and are harmful to the economy. To conduct inspections regarding the ethical values, it is necessary that the occupational health and safety (OHS) specialist is independent professionally and is not tied to any obligations that would take precedence over the main factors of their job; safety and health. In this study, the effect of the employment and charging relations between the OHS specialists and the inspected enterprise on the independence of OHS specialist is inquired.
METHODS: Semi-structured in-depth interview technique was used in this study. 10 OHS specialist were interviewed who were working actively at the time the data was collected and had at least 6 months job experience by then. The rough data were analyzed thematically.
RESULTS: “Professional motivation”, “professional problems”, “being paid by the inspected institution”, “solution offers of the interviewers” emerged as the main themes. The sub-themes were classified in the terms of the functions and outcomes of these dimensions. It is determined as the main findings that the OHS specialist feel unemployment anxiety, work under pressure, have to compromise with unpleasant conditions, feel useless and alienate to the work.
DISCUSSION AND CONCLUSION: The attitude of the employer effects the productivity of the occupational health and safety practices. The level of professional independence of the OHS specialist is dependent on the employer. The OHS specialist is usually obliged to prefer either protecting the employee’s health or sustaining his/her own means of living. The OHS specialist’s ability to make a judgment independently in accordance with his/her wise and consciences seems to be possible only when the employment and charging relations between the hirer and OHS specialist are removed.
Amaç: Ankara Üniversitesi Tıp Fakültesi Dönem-3 öğrencilerine yönelik olarak geliștirilen ve 2004’den beri
sürdürülmekte olan “Uygulamalı Aydınlatılmıș Onam Alma Becerisi (UAOAB)” eğitim programı yıllar içinde
özellikle 2012 yılı sonrasında olmak üzere bazı yapısal değișikliklere uğramıștır. Bu çalıșma, öğrencilerin
program hakkındaki düșüncelerinin, bu değișikliklere paralel olarak zaman içinde farklılık gösterip göstermediğini
ortaya koymak amacıyla tasarlanmıștır.
Gereç ve Yöntem: 2010-14 yılları arasında UAOAB eğitimi kapsamında gerçekleștirilen uygulama oturumlarına
katılan öğrencilerden, ilgili eğitim çalıșmasına ilișkin bir değerlendirme anketi doldurmaları istenmiștir.
Elde edilen veriler istatistiksel olarak analiz edilmiș ve ulașılan bulgular yorumlanmıștır.
Bulgular: Öğrencilerin büyük bölümü “aydınlatılmıș onam” konusunu mesleki yașamları açısından önemli
bulmakta ancak konu ile ilgili bilgi ve becerilerinin yeterli olmadığını düșünmektedir. Öğrenciler, genel
olarak UAOAB eğitiminden memnundurlar (ort. %81,3). Programın mesleki sorumluluk kazandırma ve iletișim
becerilerinin öğretilmesi açısından etkili olduğunu düșünen öğrencilerin oranı 2012-14 yılları arasında
önceki yıllara göre anlamlı olarak daha fazladır.
Sonuç: Öğrenciler, “aydınlatılmıș onam” ve ilgili konular hakkında bilgi ve beceri kazanmaya gereksinim
duymaktadırlar. Öğrencilerin UAOAB eğitim programı hakkındaki olumlu kanılara sahip olması, programın
geliștirilerek sürdürülmesi yönündeki çabaları destekleyici bir bulgudur. Zaman içindeki değișimi gösteren
sonuçlar, standardize hastalar ve simülasyon tekniklerinin etkin kullanımının programı daha etkili kıldığını
düșündürmektedir.
ENG
Aim: Applied education program on “Obtaining Informed Consent Skill (UAOAB)”, which was developed for
Ankara University Faculty of Medicine Grade-3 students and has been continuing since 2004, underwent
some structural changes over the years especially after 2012. This study was designed to reveal whether
students’ thoughts on the program differ parallel to these changes through time.
Material and Method: Students who attended practice sessions as a part of the UAOAB education between
the years of 2010-14 were asked to fill out an evaluation questionnaire about this education study. The data
collected were statistically analyzed and findings were interpreted.
Findings: The great majority of the students consider “informed consent” an important issue with respect to
their professional lives; however, they think that their knowledge and skills are insufficient. They are generally
satisfied with the UAOAB education (mean 81.3%). The ratio of students, who think that the program is
efficient in terms of professional responsibility acquisition and teaching communication skills, is significantly
higher between the years of 2012-14 than previous years.
Results: Students are in need of acquiring knowledge and skills about “informed consent” and related issues.
The finding that students have positive opinions regarding UAOAB education program supports endeavors
to continue the program by developing it progressively. Results showing the change over time
suggest that the use of standardized patients and simulation techniques lead to a more efficient program.
EACME in Barcelona: Bioethics in crisis
The theme of this year’s EACME Conference in Barcelona was “Justice in Healthcare – Values in Conflict.” Given the current status of our era of humanitarian crises and increasing injustice throughout the globe, and taken into consideration their direct projections on the healthcare delivery, eg. as is seen in the case of asylum seekers fleeing to Europe, the rationale behind picking it is perfectly understandable. Nevertheless, it is difficult to claim that the content of the conference satisfactorily corresponds to this crucial topic. Although many issues in the field were covered with a variety of interesting studies, the majority of those fell into the areas of concerns of so called the first world countries. Physician assisted suicide, palliative care, big data, and increasing the quality of ethic support in clinics might be of some examples to such subjects. The conference functioned as a platform to discuss, for instance, advanced guidelines on setting limits in end-of-life care in wealthy societies; it might well be the case that many other countries do not even have structured services called as such. This observation does not rely on that presentations from “developing” countries were scarce, but the fact that even studies submitted from countries with fragile economies focused on similar topics as if they do not have more substantial problems. Besides, how one issue is treated is equally important as what is chosen to be studied. In this respect, the conference gave the impression that real causes underlying increasing injustice in healthcare delivery were rarely touched upon. Most studies focused on seeking better and just ways of organizing healthcare on the micro level and almost none had a say about power relations and their impact on practice. This whole picture of the conference demonstrates current streams in bioethics that seems to be in a meaning-making crisis.
ECEN Open Forum Day: A promising initiative
Prior the EACME, the 4th European Clinical Ethics Network (ECEN) Open Forum Day was held. The program composed of clinical ethics support or consultation practices from a variety of countries such as Sweden, Italy, Czech Republic, Romania, The Netherlands, Chile and Turkey. Delegates of the network seemed quite impressed with the diversity of experiences of which strong points and pitfalls were jointly reflected on. Nevertheless, they also emphasized the urgent need for a better collaboration to be able to develop projects that would help lead every party’s expertise and experience towards a common goal. Among suggestions worth mentioning were organizing a summer school, writing a European project, creating theme discussion groups, involving PhD students, writing collaborative papers and a establishing pre-submission peer review system. The network posed to be a promising initiative.
The Turkey Working Group realized its third workshop on the theme “How can ethics be taught in health sciences?" to discuss developing an approach towards the current challenges of methodology of ethics education in the context of healthcare professionals’ moral development. By answering this question, the Workshop aimed to emancipate educators, professionals from clichés by encouraging them to seek ways for innovative educational methods, by giving emphasis on the importance of collaboration and interaction. We think the systematical review of the themes referred by the Group in this workshop, would be a useful initial structural ground for further discussions and implementations.
The learning environment of medical education has both negative and positive influences on students’ acquisition of ethics-related skills, as well as professional skills, knowledge and attitudes. Considering the recent trend in medical education towards more student-centered and professional values-oriented curricula, one should expect that today graduates are more humanistic and virtuous. On the other hand, students are generally idealistic and compassionate when they start the journey to become doctors. However, despite students’ good intentions and medical schools’ struggle for improving teaching of ethics, related skills and attitudes, cynicism emerges eventually in most of the students while they are becoming healthcare professionals. The Cambridge Bioethics Education Turkey Group proposes that a student-centered and professional values-oriented curriculum can help to raise more humanistic and virtuous students. Despite the barriers in the current structure of modern medicine and medical education, there are effective student-centered teaching methods and various strategies to overcome negative influences of the hidden curricula, which in the end help us produce better equipped healthcare professionals in terms ethical competency, moral awareness and reflective skills.
Key Words: Medical Education, Ethics, Professional Values, Professionalism, Team Working, Collective Action
“How can ethics be taught in Health Sciences?”, Ankara, 23 May 2014
CAMBRIDGE BIOETHICS EDUCATION TURKEY WORKING GROUP,
III. WORKSHOP REPORT
“How can ethics be taught in Health Sciences?”
Ankara, 23 May 2014
Workshop Group I Report
By answering the question above, while creating new ones in search of answers to them, this Workshop aims to emancipate ourselves from clichées and stereotyped thoughts and applications; it intends to emphasize the importance of collaboration and interaction.
Discussing the feasibility of teaching bioethics, noticing the positive and negative effects of learning environment over ethical values and ethical decision-making will help to be aware, to understand, to solve the problems in this process. During medical education, the dynamics at macro level are to determine particularly the development of ethical attitudes and behaviors of the medical students, young physicians and healthcare professionals in general. This determining factor in question can have either positive or negative effects. As a result of this interaction, the student develops attitudes and behaviors different from the point he has started in the beginning of medical education process.
The Cambridge Consortium of Bioethics Education was established by the Cambridge University Press in 2011. The Platform mainly aimed at developing bioethics education through annual meetings with other bioethics educators around the world to share experiences and ideas on developing curricula . The Consortium initiated country-based Working Groups in June 2013, specifically in Hungary, New Zealand, Pan-Arab (Lebanon), Romania, Russia, Serbia, Spain, The Netherlands, and Turkey .
The purpose of the Working Groups is to encourage people and institutions to work together on developing bioethics education in their countries by setting up focus groups that invite others to share information and develop mutual projects; to further how bioethics is taught in universities, hospitals, and to the general public.
Turkey Working Group
Upon the invitation of the Cambridge Consortium, the Turkey Working Group was established in 2013. Focus Group Members in Turkey are composed of Murat Aksu, Fatih Artvinli, Nadi Bakirci, Tuna Cakar, Muhtar Cokar, Figen Demir, Volkan Kavas, Gulsum Onal, Isil Pakis, Melike Sahiner, Pinar Topsever, Inci User, Yesim Isil Ulman (chair), Kevser Vatansever, Vedat Yildirim. The Group is based in the History of Medicine and Ethics Department at Acibadem University School of Medicine in Istanbul. The Group dynamic is based on the volunteering zeal and dedication of the professionals forming this collective.
The Group began to act by organizing workshops to assign its aims and strategies. The aims of the Group are to raise awareness in ethics education and moral decision making in the academy and at clinical setting; to work multiprofessionally in coordination with other healthcare professionals; to enhance advocacy of ethics teaching at university; to follow humanities perspective; to share ideas on curriculum development; to compare and learn mutually from the experiences; to choose topics for discussion on the issues of bioethics and societal issues; to structure multi-based research among countries. It is opening a specific website to facilitate the cooperation and sharing of information.
The Group specified its third workshop on the methodology of teaching bioethics at medical schools. This workshop will take place at Ankara University School of Medicine on May 23rd, 2014, hosted by the Department of Medical History and Ethics. This oral presentation will give information about the functions of the Group in detail.
(Eylül 2011-Kasım 2012)
Türkiye Biyoetik Derneği Değerli Üyeleri,
Türkiye Biyoetik Derneği 2012 e-Bülteni ile yeniden birlikteyiz. Bültende Derneğimizin gerçekleştirdiği bilimsel toplantı ve katıldığı çeşitli etkinliklere ilişkin haber ve değerlendirmeler yer alıyor. Son bir yıllık dönem de öncekiler gibi uzmanlık alanımızı ve Derneğimizi yurt içinde ve dışında ihtiyaç duyulan her alanda en iyi biçimde temsil etme gayreti ile geçti. Bültenimizde bunlardan örnekler yer alıyor.
(I) Derneğimizin Gerçekleştirdiği Bilimsel Toplantılar:
EACME 2011 (İstanbul, 15-17 Eylül 2011)
Türkiye Biyoetik Derneği ev sahipliğinde, 15-17 Eylül 2011 tarihinde İstanbul’da gerçekleştirilen EACME 2011 Avrupa Tıp Etiği Merkezleri Birliği uluslararası kongresi EACME tarihinde rekor bir katılımla, başarıyla gerçekleşmiştir. Benzerlerine kıyasla çok daha kapsamlı bir Bildiri Özeti Kitabı ile dikkatleri çeken Kongre, yurt dışında Derneğimize ciddi prestij getirmiştir. Kongre raporunu, katılımcının izlenimlerini Bültenimiz sayfalarında sunuyoruz.
GLEUBE Yaz Okulu (İstanbul, 11-14 Eylül 2011)
Oslo Üniversitesi liderliğinde ERASMUS programı kapsamında gerçekleştirilen Globalising European Bioethics Education Yaz Okulu Türkiye’den ve dünyanın çeşitli ülkelerinde 20 öğrenci ile başarıyla yapılmış; Türkiye Biyoetik Derneği, üyeleri ile birlikte bu organizasyona bilimsel, eğitsel katkı sunmuşlardır.
Türkiye Biyoetik Derneği VII. Kongresi (12-13 Ekim 2012)
Derneğimizin iki yılda bir gerçekleştirdiği kongresi, insan hakları, eğitim, sağlık politikaları ana temaları altında, toplumumuzun ve sağlık sistemimizin temel sorunlarını ele alan bilimsel bir tartışma platform şeklinde, uluslararası katılımlı olarak gerçekleşmiştir. Doğrudan biyoetik uzmanı olmayan disiplinlere mensup araştırmacıların ilgiyle ve merakla katkı verdikleri kongremizin Sonuç Bildirgesine Bültenimizden erişebilirsiniz.
(II) Derneğimizin Kitapları:
Biyoetik Araştırmaları: Esas olarak, Derneğimizin 2009-2011 döneminde gerçekleştirdiği uluslararası ve yurt içi toplantılarda sunulan bildirilerden geliştirilen makaleleri içeren bu kitap, alanımız literatürüne özgün bir araştırma kaynağı hizmeti sunmak üzere yayımlanmıştır. Bu yayınla, Derneğimizin başlangıcından, Ekim 2012 tarihine kadar yayımladığı Görüş’leri toplu halde bir araya getirilmektedir. Derneğimizin üyesi bulunduğu EACME tarafından yurt dışında geniş bir kitleye, alanın ilgililerine duyurulmuştur.
Değişen Dünyada Biyoetik: Temel olarak Türkiye Biyoetik Derneği VII. Kongresi'nde gerçekleştirilen konferans, panel ve bildiri metinlerinden geliştirilerek oluşan bu kitapta; toplumumuzda, ülkemizde tartışılmakta olan birçok mesele biyoetik değerler sistemi açısından ele alınmıştır. Kitapta insan hakları biyoetik bağından, kişi hak ve özgürlüklerine; akademik bağımsızlıktan, katılımcı demokrasiye; sağlık çalışanlarına, kadınlara yönelik şiddetten, kadın cinayetlerine; namusun medikalizasyonundan, namus cinayetlerine; dünyada sağlık reformlarından, ülkemizde sağlıkta dönüşüme; tıp eğitiminden yeni bilimsel teknolojilere içinde yaşadığımız toplumun ve akademinin güncel sorunları ele alınmıştır.
Klinik Araştırma Etik Kurulları Kılavuzu Çevirisi
Avrupa Konseyi Biyoetik Yürütme Komitesi (CDBI) tarafından 17 Şubat 2011 tarihinde kabul edilerek yayımlanan bu el kitabı Yeşim Ülman tarafından dilimize çevrilmiş ve EACME Kongresi’nde okurlarla buluşmuştur. Kılavuz kısa zamanda tükenince 2. Baskısı yapılmıştır.
(III) Derneğimizin “Görüş”leri
Son bir yılda Derneğimiz “Yaşamın Başlangıcına Dair (Kürtaj ve Sezaryen olguları bağlamında) Görüş”, “Sağlık Çalışanlarına Yönelik Şiddetin Değerlendirilmesi ve Önlenmesi hakkında Görüş”, “Çalışan Güvenliğinin Sağlanması Genelgesi Hakkında Görüş”, “Türkiye Biyoetik Derneği Organ Nakli ve Etik Görüşü”, “663 sayılı Kanun Hükmünde Kararname hakkında Görüş” yayımlayarak, internet sayfasından ilgili taraflar ve kamuoyu ile paylaşmıştır. Bu metinler Derneğimizin Biyoetik Araştırmaları isimli kitabında yayımlanmış olup; Dernek internet sayfasında erişime açıktır.
(IV) Türkiye Biyoetik Derneği Araştırma Etiği Ödülü
Türkiye Biyoetik Derneği Araştırma Etiği Ödülü, ilk defa olarak, “insan sağlığını üstün tutan bilimsel araştırmaları” nedeniyle Kocaeli Üniversitesi Halk Sağlığı uzmanı Prof. Dr. Onur Hamzaoğlu’na verilmiştir. Derneğimizin 10.10.2012 tarihli Yönetim Kurulu kararıyla, değerli bilim insanına ödülü Türkiye Biyoetik Derneği VII. Kongresi’nde yer alan “Etik Açıdan Hamzaoğlu Paneli” sonunda takdim edilmiştir. Ödül beratını bültenimizde sunuyoruz.
(V) Derneğimizin katkı sunduğu toplantılar, çalışmalar:
TTB-UDEK Tıpta Uzmanlık Kurultayı ve Çalışma Grupları
25–27 Kasım 2011 tarihlerinde Ankara’da gerçekleştirilen TTB-UDEK Tıpta Uzmanlık Eğitimi Kurultayı’nda ilk gün gerçekleştirilen Çalışma Grubu toplantılarına Doç. Dr. Murat Civaner (Etik), Yrd. Doç. Dr. Hafize Öztürk Türkmen (Sürekli Tıp Eğitimi Sürekli Mesleki Gelişim), Yrd. Doç. Dr. Volkan Kavas (Toplum Sağlığını Geliştirme), Dr. Önder İlgili (Asistan ve Genç Uzman Hekimler) Derneğimizi temsil etmişlerdir. Üyelerimizin raporları Bültenimizde yer almaktadır.
Bu Kurultay’da, ilk defa, uzmanlık dernekleri için etkinliklerini, çalışma amaç ve hedeflerini anlatacakları özel bir oturum ayrılmıştır. Bu bölümde Derneğimiz adına Yönetim Kurulu Başkanımız Doç. Dr. Yeşim Işıl Ülman Derneğimiz deneyimlerini katılımcılarla paylaşmıştır. Sunum metni Kurultay kitabında makale olarak yayımlanmış tır. (TTB-Uzmanlık Dernekleri Eşgüdüm Kurulu XVII. Tıpta Uzmanlık Eğitimi Kurultayı Kitabı, “Türkiye Biyoetik Derneği Etkinlikleri: Deneyimler Örnekler”, TTB, Ankara Tabip Odası etkinliği, Ankara, Kasım 2011:39-44). Bu makalenin yönetim dönemimizin sonuna kadar genişletilmiş, geliştirilmiş halini Bültenimizde sunuyoruz.
Türk Tabipleri Birliği Organ ve Kompozit Doku Nakilleri Komisyonu ve Raporu
TTB Nisan ayında derneklere yaptığı çağrı ile ülkemizde son dönemde gerçekleşen yüz ve kompozit doku nakilleri hakkında bir çalışma grubu oluşturmuştur. Derneğimizin temsil edildiği bu Komisyon, olguları tıbbi, etik ve hukuki boyutu ile inceleyerek, oluşturduğu raporunu yayımlamış ve bir basın toplantısı ile kamuoyu ve ilgili taraflarla paylaşmıştır. Bu önemli eli kitabının oluşmasında Türkiye Biyoetik Derneği, Son Dönemde gerçekleştirilen organ ve kompozit doku nakilleri raporu Görüşü önemli kaynaklardan birini oluşturmuştur. Türk Tabipleri Birliği Organ ve Kompozit Doku Nakilleri Raporu, TTB yayınları Ankara Haziran 2012. (http://www.ttb.org.tr/kutuphane/kompozitrpr.pdf)
Organize Sanayi Bölgelerinde Sokak Hayvanları Sorunu Projesi
Tuzla Organize Sanayi bölgesinde faaliyet gösteren Fritem firması Derneğimize başvurarak, bilimsel destek talebinde bulunmuşlardır. Sosyal sorumluluk projesi kapsamında hazırlamış oldukları, sanayi bölgeleri içinde sokak hayvanlarını; itlaf edilmeden, yaşadıkları doğal çevreden dışlanmadan, uzaklaştırılmadan; beslenme, barınma, tedavi ihtiyaçlarının insani biçimde temin edildiği; insan ile dost, çevre ile uyumlu yaşayabilmelerinin sağlandığı projelerine Derneğimizce destek verilmiştir. Ülke çapında örnek proje olarak geliştirilen bu çalışma, VII. Biyoetik Kongresi’nde bir panelde irdelenmiş Değişen Dünyada Biyoetik kitabımızda yer almıştır.
Derneğimizin 10. Çalışma Dönemi 24 Kasım 2012 tarihinde Ankara’da yapılacak Olağan Seçimli Genel Kurulumuzla tamamlanıyor. Derneğimizin yeni yönetime, yeni projelerinde içtenlikle başarılar diliyoruz.
TÜRKİYE BİYOETİK DERNEĞİ YÖNETİM KURULU
(21 Kasım 2009-24 Kasım 2012)