Introduction
Ethical Grand Rounds (EGR) serves as an educational platform or lecture series focused on the exploration and examination of ethical issues and dilemmas that healthcare professionals may face in their routine clinical practices or professional conduct. The primary aim of EGR is to enhance ethical decision-making [
1]. This concept is derived from the Grand Rounds in medicine, an interdisciplinary conference format in which healthcare professionals discuss patient cases from a medical perspective, share knowledge, and educate residents [
2].
EGR serves as an effective platform for participants to engage in ethical reflection, critical thinking, and the exchange of insights regarding the moral challenges that are encountered in the clinical field [
3]. This platform holds potential as a valuable tool for undergraduate medical ethics education because it focuses on the ethical complexities that healthcare professionals encounter in their practice and has the capacity to facilitate participants’ learning and deeper comprehension of ethical principles through discussion. The primary steps for incorporating EGR into undergraduate medical ethics education involve collaboration with clinical faculty members (hereafter referred to as “clinicians”) to prepare cases before class that emerge in various clinical contexts, facilitating discussions among small groups of students (approximately four or five), and having clinicians provide constructive feedback [
4].
Among studies reviewing the status of medical ethics education in Korean medical colleges [
5,
6], Choi et al. [
6] found that 34 out of 37 colleges employed lectures, while 23 incorporated small-group discussions in their medical ethics classes. This finding underscores the necessity for a shift in ethics education from instructor-led abstract theory to practical thinking and self-reflective discussion. Even previous studies explored the status or importance of the group discussion in medical ethics classes [
6-
9]; the study on specifically the form of EGR is limited [
1,
4,
10]. Considering the necessity of practical thinking and self-reflective discussion using EGR, this article aims to present six practical tips for developing, implementing, faculty developing, and finally, institutionalizing the EGR program for medical ethics education.
Six tips to teach medical ethics
1. Developing: refining real clinical cases for education
Clinical case studies require refinement to enhance group discussions and serve educational purposes. The complexities of real-world scenarios are often more challenging than expected. Students must engage in critical thinking and dynamic discussions to identify ethical issues [
11]. However, harsh realities obscure the essence of this discussion. For example, cases designed to encourage discussions on patient autonomy and family dynamics influencing patients’ decisions may be overshadowed by other factors such as the patient’s religious beliefs. To ensure students focus on the core ethical challenges, “EGR facilitators” (a term hereafter used to refer to faculty members charged with designing and leading an EGR session) must filter out this “noise” and refine cases before discussion. Once students have engaged with simpler cases in the classroom and are capable of evaluating the significance of multiple variables, they may be prepared to analyze more complex real-world cases without further adjustment. In essence, refinement should align with the learning objectives. While the collection and selection of instances may be seen as the clinician’s responsibility, refinement is more in the domain of EGR facilitators. Through repeated refinement, a collection of cases can be developed and archived [
12].
EGR facilitators must equip clinicians to address questions, provide answers, and offer feedback to students, ensuring that they are neither embarrassed nor uncertain about how to respond. This class may provide clinicians the first opportunity to share their personal experiences. Prior to class, EGR facilitators should inform clinicians about the class sequence, their roles and responsibilities, and what students expect from them. In addition, to facilitate preparation, EGR facilitators should compile a list of the anticipated questions. Consequently, we found that it was helpful to develop a concise scenario for the class and to discuss it with the clinician beforehand.
3. Developing and implementing: inviting clinicians to share experiences of ethical deliberation
EGR facilitators are essential in fostering an environment conducive to open discussions, disclosure, and sharing concerns and challenges with both clinicians and students. This environment encourages students to inquire about their genuine interests and allows clinicians to respond freely to their questions [
13]. Clinicians serve not only as conveyors of knowledge but also as role models who continually grapple with ethical issues, thereby reinforcing students’ understanding and appreciation of medical professionalism [
14]. Clinicians are not expected to offer ethically definitive answers or to recount faultless conduct during EGR sessions; when they share the uncertainties and difficult trade-offs they faced, students gain a more authentic understanding of professional ethics in practice. Moreover, taking time to pause and consider the ethical dimensions of a case is not a sign of weakness, indecision, or deficiency; it reflects prudence and a sense of responsibility to patients and to oneself. EGR facilitators can demonstrate professionalism to students in such situations. By sharing and reflecting on their real-world experiences and insights, clinicians impart the concept of virtues in medical practice, serve as role models, and help future healthcare professionals to bridge ethical theories with the complexities of clinical practice [
15].
Proposing a structured framework for students unsure about initiating discussions can significantly enhance the learning process. Students, particularly those in Korean medical colleges, where instruction is predominantly lecture-based [
6], may lack the familiarity required for active participation. Such students may not be accustomed to active participation and, as a result, may feel immobilized when given the opportunity to engage in discussions. EGR facilitators can support students by providing a framework or set of guidelines such as Albert Jonsen’s “four-quadrant” or “four-box” approaches [
16,
17] (
Fig. 1). This approach is widely used because it analyzes ethical issues through four key topics: medical indications, patient preferences, quality of life, and contextual features. Each box in the four-box method includes guiding questions designed to clarify clinical circumstances and link them to relevant ethical principles [
16]. This method provides a structured approach for analyzing and discussing ethical issues in a clinical setting. Although students may tend to think “inside the box” due to the focus on four topics, which can limit ethical exploration, this approach serves as a valuable starting point to facilitate discussion.
EGR serves as a valuable tool for advancing medical education among faculty members, particularly clinicians. Faculty development is conceptualized as the personal and professional growth of medical college personnel to fulfill institutional objectives, visions, and missions, encompassing social responsibilities and ethical obligations to the community [
18]. Through exposure to structured clinical-ethics analysis, clinicians are better able to navigate ambiguous situations [
19] and to avoid unreflective responses by making practical, context-sensitive decisions that take real-world constraints into account [
1]. Participation in EGR provides junior faculty members with exposure to a pedagogical model that prioritizes discussions, case-based reasoning, and ethical sensitivity [
20]. As a more practical example, at the university or academic level, EGR can be effectively introduced through workshops designed for newly appointed faculty members. This approach enables clinicians to understand their roles and responsibilities as role models, become acquainted with medical ethics courses, and remain open to participating in case development.
Institutions, medical colleges, and university hospitals should employ positive reinforcement to motivate clinicians to develop new cases. Clinicians play an integral role in case development, which is not just important but essential to the process. Many faculty members in medical colleges experience substantial workloads. Faculty members specializing in medical humanities typically teach integrative medical humanities encompassing ethics, history, and communication [
21]. However, clinicians are not obligated to do so, and are already too busy with teaching their own specialties. Even when participants are interested in medical ethics, competing demands can leave them short on time and unable to commit the effort needed for ethics classes. Genuine dilemmas encountered in daily clinical practice, alongside clinicians’ goodwill towards patients and their ethical considerations, have substantial educational implications that should be bequeathed [
22]. Of course, intrinsic motivation also plays a crucial role. For instance, clinicians may find personal reward in the emotional release gained through collaboration with other clinicians and EGR facilitators on EGR, organizing their thoughts, and building networks with faculty members from various specialties. However, given the current state of Korean medical education, intrinsic motivation or personal reward alone are insufficient for clinicians. Moreover, this situation may be perceived by clinicians as unfair. Consequently, the development of cases for medical humanities classes should be acknowledged as a performance metric to incentivize clinician participation.
Conclusion
In this article, we presented six teaching tips for utilizing EGR with a real-world clinical case as a methodological approach to instructing undergraduate medical students in medical ethics. It is not intended to be definitive but rather descriptive of existing knowledge, as outlined in the literature. By contextualizing evidence within the framework of the current understanding, we aspire for this approach to be well-informed and adopted by both current and future healthcare professionals. In conclusion, the EGR framework, the role of each EGR facilitator and clinician, and interactions among clinicians, students, and facilitators hold intrinsic value. We believe that the teaching tips proposed in this article will assist EGR facilitators in preparing for medical ethics classes with enhanced insights.
Acknowledgements
None.
Funding
This work was supported by the Dong-A University research fund (2025).
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Author contributions
CJK conceptualized the study concept and design. MJK and CJK investigated the literature. MJK wrote the original draft. MJK and CJK reviewed, edited, and approved the final manuscript.
Fig. 1.
Albert Jonsen’s “Four-Quadrant”
Reprinted from Jonsen A, et al. Clinical ethics: a practical approach to ethical decisions in clinical medicine. 7th ed. New York, USA: McGraw-Hill Education; 2010, with permission from McGraw-Hill Education [
17].
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