How do medical leaders make wise and ethical decisions, when there are multiple factors to consider and when the 'right' decision in one circumstance may offer little guide to the best and most ethical decision in another? Mervyn Conroy and Catherine Weir report on a 3-year research project using interviews with doctors at various points in their clinical practice to understand how medical leaders approach decision-making.
By Mervyn Conroy and Catherine Weir
Phronesis, or practical wisdom, is a leadership ability to make ethical decisions that draw on experience from many previous practice situations. For a doctor it is a way to take all the virtues of relevance to any one patient decision into consideration and take action that brings the best outcome for that patient and their community. It is in effect an “executive virtue” that allows a leader to come to a wise decision when there seems to be many competing demands in any given situation. Ethical decision making can be complex with the “right” decision in one set of circumstances, for one patient not being the right decision for another.
The Phronesis and the Medical Community project began in May 2015 with a 3 year Arts and Humanities Research Council (AHRC) grant. The project offers a unique methodology that combines virtue ethics (humanities) with a film based depiction of findings and analysis as part of a virtual community (arts) The latter forms a learning resource for medical schools and other CPD providers to help them with their medical ethics teaching. Although the resources are aimed at doctors at any stage of their career the resource could also be used by any health and social care discipline wishing to improve teaching associated with ethical decision making.
The project is led by HSMC but with strong collaborative input from across the University and beyond. Our primary research questions are:
Whilst there is a wealth of theoretical work on medical ethical decision making there has been very limited empirical work. Our literature review found only 14 studies of phronesis in healthcare of which nine were focussed on nursing. Our project has therefore been designed to address this gap in empirical research.
We have collected rich narrative by interviewing 140 Doctors from Birmingham, Warwick and Nottingham as they navigate their way through pre-clinical education, clinical training and into consultant or GP roles. We have complemented this with observations, reflective diaries, workshops and patient and public focus groups. The latter designed to understand wise decision making and its impact on trust in the medical profession from a patient and public perspective.
The methodology adopted is a hybrid that combines narrative based interview approaches with an arts and humanities analysis to produce an educational debating resource in the form of a video based odyssey. The odyssey is made up of six episodes that follow a consultant and GP as they navigate their way from medical school to experienced practitioners. Our analysis of the data identified a set of ‘virtue continuums’ which doctors tell us have a bearing on their decision making and which seem to change as they develop experience and practical wisdom. The odyssey collates the findings by using the narratives collected in an anonymised form to construct the storylines and scripts to convey the complexity of ethical decision making and where phronesis can be observed or not. The resource is not meant to be conveying ‘this is how it should be done’ but to convey the collective wisdom from our participants and allow students to debate the morality of each situation. The odyssey debating resource was designed and developed with the University of Cumbria who host ‘Stilwell’ (a fictional town in the UK) virtual community in which the odyssey storylines are based. The learning resource and associated materials will be piloted in our partner Medical Schools in early 2018 with further impact and engagement funding being sought to enable evaluation and expand the engagement and impact through UK medical schools and CPD providers in 2018/2019.
Any questions or comments please contact the Principal Investigator Dr Merv Conroy.
Project Team led by Dr. M. Conroy: Ms. C. Hale (University of Birmingham, MDS), Dr. B. Kotzee (University of Birmingham, Education), Dr. D Biggerstaff (University of Warwick, MDS), Dr. R. Knox (University of Nottingham, MDS), Dr. A. Malik (University of Birmingham, HSMC), Ms. C. Weir (University of Birmingham, HSMC), Lt Comm. A. Brockie (University of Birmingham, MDS), Ms. J. Plumb (University Hospitals Birmingham NHS Foundation Trust), Dr. A. Hewison (University of Birmingham, MDS), Dr. C. Turner (University Hospitals Coventry and Warwickshire NHS Trust), Ms. D. Broomfield (Patient Representative), Mr James Liddiard (University of Birmingham, HSMC) and the Stilwell Team based at University of Cumbria.
