in medical practice, assess the factors that compose a ‘case’, the issues and practical options. Depending on the respective circumstances, the use of this stile is limited. Being a step between (a) and (c) it is difficult to keep the balance between encouragement and control.
(c) The most demanding and rewarding stile of teaching creates a synchronic structure of communication and multilateral interaction. Ideally, it makes use of all human (moral and intellectual) resources present in the classroom. The teacher combines his contribution with different designs of group activity, forms of generating morally meaningful context for decision-making (drama, role play, presentation and discussion among peers, etc.), and assigns special tasks to individual students, according to their respective engagement and ability. This engages the students’ creativity and it informs the teacher about different facets of the class’s characteristics. This format may provoke emotional heat or grave misjudgements on the side of active students. It demands patience when class has wandered off the track and tolerance when the teacher’s authority is challenged (just as a patient may provoke, stun or lead the doctor). The teacher’s task is to reflect the group process, wrap up ‘teaching points’ and set structural marks accommodating the process of learning. The most appropriate symbol here is a healthy ecosystem, with strong roots and high productivity. This approach is problematic if overdone, or when circumstances (such as huge classes, unwilling students or uninspired teachers) make it untenable. The situation might deteriorate into hypertrophic activity and paralyse the learning process. On the other hand, even such an event would be used as a teaching point. According to our particular experiences in China, emphasis on discipline is rather an obstacle than in need. At present, young adults who are becoming professionals in a highly competitive society and a difficult labour market display a serious, prudent and pragmatic attitude that supports this teaching stile. However, special attention should be paid to shy and less articulate students.
Participants found it challenging to appreciate this threefold model of teaching stiles in its integrated organic structure and composed moral logic. It is not the goal to expose these models as alternative options. From the perspective of the third model, they are all logically inter-related. Only viewed from within the confinements of (a) or (b) could there occur restrictions that are not inspired by ethical or pedagogic considerations of teaching medical ethics. Still, it proved difficult to communicate the integrative and organic character of this modelling. In my explanations I used the illustration of a ‘tool kit’. The greater the variety and number of tools the better the teacher is prepared to accommodate class. Refined instruments allow subtle and precise operations on the most sophisticated level. However, in acknowledgement of moral deliberation as a practice and the goal of conciliating life and ethics, together with ancient Confucian symbolism (as in the classic of the Great Learning, Daxue) the images of sprout, ‘roots and branches’, life inside a green house and an ecosystem now appear to me more appropriate.
As mentioned above, in many ways, a teacher resembles the doctor in relation with the patient. This observation was reconfirmed through an accidental aspect in this course. Owing to the international and multilingual origin of the lecturers (Chinese, English, German) we had to deal with language barriers. Except for technical problems, it turned out that paying attention to problems of communication has different levels that affect teaching as well as the patient-doctor relationship. When it is expected that successful communication is rather a goal than a given in exchanges of information, opinion and emotion, all parties are prepared to be more attentive to “translation” as a requirement not only between mother tongues but between professional and lay person, male and female, young and old, jargon and common language, cultures, the doctor and the patient. This phenomenon should be studied more closely as a paradigm for teaching and practicing medical ethics.
6 Lessons from evaluations
It is unclear to me, who learned more from these courses, the lecturers and in particular myself, or the participants. We invited evaluations at mid-term and after the course. Here are a few selected responses.
-In teaching medical ethics it is crucial to fully appreciate the circumstances of the participants (such as, very large classes in traditional lecture halls, requirement to use standard texts and to