Abstract

Debates and discourse are effective means of teaching or learning bioethics. Opportunities for continuous training in bioethics are inadequate in low- and middle-income countries. This report highlights the experiences of teaching bioethics to the secretariat of the Scientific and Ethics Review Unit, a research ethics committee in Kenya. The participants were introduced to bioethics through discourse and debates, and their learning experiences or recommendations were noted. Debates and discourses were considered interesting, thought-provoking, informative, engaging, practical, and interactive ways of learning bioethics.

Keywords: short-term training, debates and discourse, teaching bioethics, research ethics committee, LMICs.

Introduction

Clinical research conducted in low- and middle-income countries (LMICs) is increasing [1]. Therefore, there is a need for an efficient and effective research ethics review system to ensure adequate research participant protection and ethical research [2]. However, research ethics committees (RECs) in the LMICS, for instance, in Africa, encounter the challenge of insufficient bioethics training for members and secretariat [2, 3].

Bioethics education in Kenya

The Moi University, Amref International University in Nairobi, and Kabarak University in collaboration with Trinity International University offer bioethics training at the master’s degree level in Kenya [4, 5, 6]; however, these training programmes take more than a year to complete. Hence, there was a need for short-term bioethics courses that would suit the busy schedule of REC secretariat and members [6].

The Centre of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT) in Pakistan, in collaboration with the Kenya Medical Research Institute (KEMRI) in Kenya, provide short-term certificate training in bioethics for the REC secretariat and members [6].

Bioethics training for the secretariat of SERU — my postgraduate diploma project

As a project for my postgraduate Diploma in Biomedical ethics training at the CBEC-SIUT, I conducted bioethics training for the secretariat of the Scientific and Ethics Review Unit (SERU), a REC at the KEMRI. The project used debates and discourses to deliver the training.

While debates involve discourse and dialogue to explore and find truth through interactions purposefully [7], discourse involves discussions, thinking, interpreting, expressing, reflecting, agreeing and disagreeing [8]. Debates and discourses enhance critical thinking, presentation, communication, cooperation, and interest in bioethics education [9].

Structure of bioethics course for the SERU secretariat

The topics for the course were selected based on bioethics issues encountered by the participants (SERU secretariat) during their REC work. The discourse topics included an introduction to bioethics, informed consent, and selected concepts/terminologies in research and public health ethics. The debate topics included ethical issues in foreign-funded research in developing countries and ethical issues and the role of RECs in research involving sample storage, shipment and import.

The participants were divided into two groups and allocated a topic (case) for debate at least two weeks before the session. The participants chose their speakers and had group meetings before the debate.

The first speakers from either side of the motion talked for and against it for 10 minutes each, followed by 10 minutes breakaway to discuss their rebuttals. The second speakers from either side then presented their rebuttal for 10 minutes each. It was followed by a 20-minute large group activity involving contributions from the entire group. The debate session ended with a 15-minute presentation highlighting the basic definition of the topic, further clarifications and recommendations.

A bioethics case study, a video or an image, was presented to the participants for discussion, taking approximately 30 to 40 minutes, while a large group discussion took around 60 to 80 minutes. It was followed by a 15-minute presentation highlighting the bioethics concept(s) contained in the case.

The participants shared their experiences of attending the sessions.

Lessons and the way forward

The participants considered the discourse and debate sessions interesting, thought-provoking, informative, engaging, practical, and interactive. Some participants noted that debates and discourses, using videos and images, practically highlighted ethical issues in real life, making bioethics learning interesting.

From the experience I have gained from this project, I recommend the following points for those who wish to teach short-term bioethics courses.

i. Prepare various topics to introduce participants to more expansive areas of bioethics.

ii. Allocate sufficient time for discussion and clarifying concepts.

iii. Incorporate videos and case studies with a local context. Sufficient time makes it easy for the participants to relate to and identify context-related bioethical issues.

iv. Make presentations to clarify the bioethical concepts or conclude the topic.

v. Ensure non-partisan moderation for the debates, reverse group roles for each debate topic, and circulate the debate topics before the session to enable group members to prepare adequately. Switching group roles allows each participant to interact with the pros and cons of the bioethics topic under discussion.

Conclusion

Debates and discourses improve learning bioethics. However, it is essential to be aware of the dos and don’ts of using such techniques.

Acknowledgement: I thank CBEC and the CBEC-KEMRI Bioethics Training Initiative (CKBTI) consortium for offering me a scholarship to pursue a postgraduate diploma in biomedical ethics and carry out this project. I appreciate Ms Anika Khan and Prof Elizabeth Bukusi for their supervision and guidance for the project. Lastly, I thank KEMRI and the SERU secretariat for providing facilities and an audience for my project.

Funding: Fogarty International Centre-National Institutes of Health, USA awarded CKBTI a grant (1R25TW010509-01) through which I received the scholarship for my course work and project.

Conflict of Interest: None to be declared.

Statement of similar work: No other article has been published from this project.