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Case-Based Knowledge and Ethics Education: Improving Learning and Transfer Through Emotionally Rich Cases

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Abstract

Case-based instruction is a stable feature of ethics education, however, little is known about the attributes of the cases that make them effective. Emotions are an inherent part of ethical decision-making and one source of information actively stored in case-based knowledge, making them an attribute of cases that likely facilitates case-based learning. Emotions also make cases more realistic, an essential component for effective case-based instruction. The purpose of this study was to investigate the influence of emotional case content, and complementary socio-relational case content, on case-based knowledge acquisition and transfer on future ethical decision-making tasks. Study findings suggest that emotional case content stimulates retention of cases and facilitates transfer of ethical decision-making principles demonstrated in cases.

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Correspondence to Chase E. Thiel.

Appendices

Appendix A: Big Pharma Case

Information that is underlined was manipulated in various case conditions. The type of case content manipulated is identified in italicized labels.

Big Pharma Case

Jason is in his second year and Robin is just finishing her first year of postdoctoral training in a cell biology lab where they share a good working relationship. They have generous fellowships thanks mostly to their mentor’s enterprising associations with the pharmaceutical industry. Dr. Davis, their mentor, does contract work that requires review and approval by industry scientists before work can be submitted for publication.

His university has offered to negotiate with the drug companies for better publication terms. Davis has so far refused on the grounds that he does not want to compromise his competitive edge which has won him a solid reputation along with continued funding for a team of first rate graduate students and post-docs. Davis was always disappointed with other funding sources and the lack of recognition he received from those projects. He decided long ago to compete for private funding because he knew the larger budgets could open the door to limitless research possibilities, and maybe even help him achieve that “break-through” finding he had dreamed of. [Secondary Case Character Emotion].

The two post docs are using different animal models to test the efficacy of a gene product. It is hoped that this gene product will interfere with cancer cell-signaling and slow or arrest meta-static activity. Jason’s results are extremely encouraging, but Robin’s are not. Frustrated, she confides to her friend that she is disappointed with her failing project and a year’s loss in productivity. She is also frustrated because Davis has hinted that she must be doing something wrong. After all, Robin is working with the same protein as Jason, and it is reasonable to expect that her results would at least show a similar trend. This diverging pattern of results really makes Robin uncomfortable and worried, to the point that she feels like she starts to question her ability as a scientist. She wants to talk to others about the situation, but worries that their reactions will be similar to Davis’. Robin even begins to worry that she may not have been well prepared to enter such a challenging postdoctoral position. [Primary Case Character Emotion].

In speaking with Jason, he replies candidly about what he learned in his first year—that the industry’s emphasis is on getting results. He points out that if the Davis group does not produce, the project will be turned over to another team that will, and the fellowships will follow the money. Jason admits that he was surprised when he came to know of this reality, but expresses the satisfaction he now feels for the opportunities provided from these industry funds. His rationale is that as long as everyone is benefiting, there is no harm in interpreting the results with industry goals in mind. [Secondary Case Character Emotion].

What Jason said made sense, but Robin is uncomfortable with the implication she thought was being conveyed. She made a noncommittal remark and changed the subject. However, the new information preyed on her mind. Was she being naively idealistic about science?

In the weeks following Robin and Jason’s conversation, however, Robin’s feels less guilt and more anger. She is angry that her research abilities are being questioned because she has chosen to cleanly interpret her data. Robin’s anger begins to influence her attitude about the lab in general, and relationships with other members of the laboratory. More specifically, her anger is starting to cause some confrontational interactions with Jason, as she feels that he is to blame for her embarrassment. [Primary Case Character Emotion].

Robin tries to think of solutions to the problem, but worries that whatever she tries to do would do more harm than good for herself. Dr. Davis is a well-respected researcher in the field, and is quite established. It would be almost impossible to publicly question the integrity of his laboratory’s research given his position and status. Furthermore, with that power and status Dr. Davis could seriously threaten Robin’s chances at finding future employment. Robin has thought about just confronting Jason, but worries that she would ultimately have to deal with Dr. Davis. Jason is more experienced and has already gained respect from Dr. Davis. Dr. Davis would most certainly trust Jason more than Robin, and it would be extremely difficult to make a case to him. Plus, she is confident that Dr. Davis is aware of the sloppy data practices and biased interpretations. [Power Dynamics].

Robin continues to feel uncomfortable with the climate of the lab and her interactions with Jason. While her anger has somewhat subsided, she once again feels fearful about her involvement in what she considers to be highly unethical behavior. Robin’s fears cause her to wonder what might happen to her and her career if she stays under Dr. Davis any longer. [Primary Case Character Emotion] She contemplates discussing the issue with Davis but fears he will react just like Jason. Ultimately, she decides that the best course of action is to not change her results and to leave the laboratory altogether. When she discusses her resignation with Davis he is surprised and asks for an explanation. She circumvents the real issue, simply telling him that she doesn’t feel like she fits in very well and would like to take her career in a different direction. Robin, admittedly, is conflicted over her decision to withhold information from Davis, but fears that she might create a bigger issue if she shares the entire truth. Davis seems content with her response, and is actually happy that he will no longer need to deal with this semi-controversial student. His satisfaction causes him to ignore the other possible explanations for her departure, and to assume that business can operate as usual. [Secondary Case Character Emotion].

Six months later, Robin finds herself in an entry-level position at a small bio-medical company. She is satisfied with her current work and is relieved that she no longer faces the pressures of her previous lab. She is even more relieved that she left her post-doc position when she receives word from a former lab mate that Davis’s laboratory has lost its funding after being investigated by the Office of Research Integrity on data fabrication charges.

Appendix B: Tight Schedule Low-Fidelity Task

You are a member of a dedicated team of graduate students working on a project that is funded by the National Institute of Mental Health (NIMH), which is a federal government agency. The project is designed to track the effectiveness of state-run mental health care programs for the poor. The study requires extensive interviews with a large number of people on a yearly basis and the team is running behind schedule.

You and the other students believe that the schedule was unrealistic, and that it would have been almost impossible to stick to the schedule, even in a best-case scenario. There is just too much to do in a short amount of time. The project director, Dr. O’Connell, is highly focused on results and completing the project on time, and he insists on accelerating the pace of interviewing in order to meet the deadline. You are beginning to feel overwhelmed.

On top of this project, you decided to take an extra class this semester. You wanted to take this extra class, because you want to graduate a year early. Your plan is to take an extra class this semester, an extra class next semester, and three classes next summer. You wanted to leave school early because you recently got engaged, and you want to get married and start your new life. Your fiancée recently moved out of town, and you have been spending a lot of your weekend time visiting him/her.

You talked to your advisor about your fast-tracked plan for your coursework, and he discouraged the idea of graduating early. He emphasized that it would be very difficult and time-consuming, but you were convinced that because you wanted it so much, you would be able to do it.

An important progress report to the NIMH is due in 1 month. You and the other staff members still do not know how you are going to complete the rest of the interviews. If this progress report does not work out, it will hurt the opportunity to get more funding in the future. This has put even more pressure on all of the staff and Dr. O’Connell. If you lose funding for this project, all of your hard work will have been for nothing. Dr. O’Connell is putting even more pressure on the graduate students to catch up to the already impossible schedule. You have scheduled your time this semester so tightly that you have very little flexibility in how and when you fulfill your responsibilities to this and other projects. You are not sure how you are going to get the extra interviews done in time.

Appendix C: Friendswood City Council Low Fidelity Task

You are an expert building contractor. You have a master’s degree in civil engineering, and after 20 years of working as a licensed contractor, you decided to retire. You live in Friendswood, a small community with your spouse, and you are very active in the community. You often volunteer your services and expertise to local organizations that need your help. For instance, when city structures are being built, you often volunteer your expertise as a contractor free of charge, so that the city can save money.

You are on the board of the Friendswood city council. There are twelve people that make up the council, including you. Members of the city council are elected by the residents of the city. You feel like the city council elections have become somewhat of a popularity contest, and it seems like the members of the council are the wealthiest members of the community, not necessarily the people would benefit the community most. You feel like some of the members of the city council have no interest in giving back to the community; they just want to feel important by being a part of this organization.

Recently, two of the members of the council have begun to feud. Bill Knight and John Cosby got into an argument over which of them owns a lake that borders both of their property. The council members have begun to take sides, and the council is dividing into two factions. It is getting to the point where city council meetings are not productive. The meetings always turn into a political forum for Bill and John to voice why each is right in the argument.

Furthermore, the in-fighting has caused the members not to communicate well. There are subcommittees in the council for various projects, including community fundraising, maintenance of Main Street, and community social events. The subcommittees have turned into cliques that are not communicating their progress to each other, and communication is essential for productive functioning of the city council. You think the whole argument is silly, and you refuse to take sides. You have considered quitting your position on the council because of this, but you do enjoy giving back to the community, so you decided to stay.

Recently, the city council began looking to fund a renovation project of your local community center. Because you are an expert in construction, you designed the application for constructing companies to bid on this project. Furthermore, because you do not want to work closely with your colleagues on projects, since all of the in-fighting, you decided to design the application by yourself.

You are now a part of the committee reviewing and approving the proposals. The city has expressed a desire for the renovations to begin as soon as possible, and you feel like the committee is rushing the process a little. Nine proposals have passed a first screen by meeting the criteria outlined in the application you designed. You and several others conducted more extensive reviews of the nine proposals. The team of reviewers has identified the winning proposal, which has many outstanding features. As you scan it one more time, however, you notice that it does not meet one of the ten criteria used in the initial screening process; this proposal should never have even made it past the first round of evaluations. No one else has caught this. Now you wonder what you should do.

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Thiel, C.E., Connelly, S., Harkrider, L. et al. Case-Based Knowledge and Ethics Education: Improving Learning and Transfer Through Emotionally Rich Cases. Sci Eng Ethics 19, 265–286 (2013). https://doi.org/10.1007/s11948-011-9318-7

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