Equipping African medical students with ethical decision-making skills: A case-based method from Burundi

In addition to medical ethical issues faced in every context globally, many African contexts have the challenge of additional ethical scenarios particular to African culture, resource limitation, and more varied levels of professional expertise. In an effort to equip medical trainees with the knowledge and skills to confront these situations well and from a particularly Christian vantage point, we developed a bioethics module for African medical students in Burundi that began with a didactic ethics lecture and spent most of the time on student-led, facilitated case discussions. The cases were designed to highlight problems specifically created by the particularities of our rural, African, under-resourced context. Five rounds of implementing this module have shown a positive and interactive reception, with students critically thinking about the problems, engaging in personal application, and being willing to disagree with each other. Evaluation after each module has resulted in some cases being discarded and others modified. Facilitation of case discussions has been especially aided by structuring cases that specifically force the making of a difficult ethical decision, soliciting an articulation of any disagreements existing within the presenting group, and exploring permutations of each case in order to see if that changes opinions and to clarify the underlying ethical principles at play. In our setting, the creation of bioethical case scenarios that are specifically applicable to the context of our African learners has been helpful in making a module with useful content capable of growing the ethical decision-making capacity of the participants