CAMBRIDGE CONSORTIUM OF BIOETHICS EDUCATION TURKEY WORKING GROUP ANNUAL REPORT 2015

Contents CAMBRIDGE CONSORTIUM OF BIOETHICS EDUCATION TURKEY WORKING GROUP ANNUAL REPORT 2015 5th Cambridge Consortium of Bioethics Education, Paris, 24-26 June 2015 The Annual Report of the Turkey Working Group about its activities, including regular workshops, research proposals of Curricular Inventory, Brussels Meeting - December 2014, Amsterdam Interim Meeting of the Working Groups, Research Proposal for Brocher Foundation, Paper on the Turkey Working Groups issued in Turkish Journal of Bioethics 22.06.2015

Contents IVth Workshop of the Turkey Working Group: Notes from Paris 2 Vth Workshop of the Turkey Working Group: Research Proposal Discussion 4 Cambridge Turkey Working Group: Research Proposal: Inventory of Ethics Education Curricula at Schools of Medicine in Turkey 6 Brussels Meeting at the European Commission Ethics Sector 7 Amsterdam Interim Meeting of the Cambridge Consortium of Bioethics Education Working Groups.9 VIth Workshop of the Turkey Working Group: Annual Evaluation.12 Brocher Foundation Application on behalf of the Cambridge Working Groups.13 Academic Paper by the Turkey Working Group publshed in the Turkish Journal of Bioethics..19 Steps Forward 20 1

CAMBRIDGE BİYOETİK EĞİTİMİ TÜRKİYE ÇALIŞMA GRUBU IV. ÇALIŞTAYI Acıbadem Üniversitesi Tıp Fakültesi Tıp Tarihi ve Etik A.D. 12 Eylül 2014 CAMBRIDGE BIOETHICS EDUCATION TURKEY WORKING GROUP WORKSHOP IV: Notes from Paris, 4th Cambridge Consortium of Bioethics Education Acıbadem University School of Medicine Medical History and Ethics Department 12 September 2014 2

İletişim / Contact: Acıbadem Univ. İçerenköy, Kayışdağı cad. No.32. Ataşehir-Ist. 0216 500 41 35 CAMBRIDGE BİYOETİK EĞİTİMİ TÜRKİYE ÇALIŞMA GRUBU IV. ÇALIŞTAYI Acıbadem Üniversitesi Tıp Fakültesi Tıp Tarihi ve Etik A.D. 12 Eylül 2014/ CAMBRIDGE BIOETHICS EDUCATION WORKING GROUP WORKSHOP IV Acıbadem Univ. School of Medicine, Medical History and Ethics Department 12 September 2014 Gündem / Agenda OPENING Paris IV. Cambridge Consortium of Bioethics Education (Paris Impressions, Yesim Ulman s Notes on IV. Consortium) Nadi Bakırcı Volkan Kavas Yeşim Işıl Ülman 09.30-10.00 10.00-11.00 Coffee Break 11.00-11.15 Discussion on Paris June 2014 Notes All Group 11.15-12.30 Öğle Yemeği 12.30-13.30 New Year Planning All Group 13.30-14.30 Coffee Break 14.30-14.45 CLOSING 14.45-15.15 Venue : Acıbadem Univ. School of Medicine, İstanbul Date : 12.09.2014 PARTICIPANTS: Fatih Artvinli, Nadi Bakırcı, Figen Demir, Volkan Kavas, Işıl Pakiş, Pınar Topsever, Yeşim Işıl Ülman, Kevser Vatansever DECISIONS: To design study projects in collaboration with Group members A systematical review of the present literature about bioethics education in Turkey (thesis, article, paper, posters, medical education and bioethics journals on professionalism To design a Study on the Curricular Inventory on Ethics Education in Turkey To attend internationally collaborated meetings To work on applications for international research funds. 3

Cambridge Biyoetik Eğitimi Türkiye Çalışma Grubu V. Çalıştayı Cambridge Bioethics Education Turkey Working Group Workshop V Türkiye de tıp fakültelerinde etik eğitimi müfredatı envanteri The Curricular Inventory of Ethics Education at Schools of Medicine in Turkey İstanbul, 5 Aralık / December 2014 İletişim / Contact: Acıbadem Univ. Tıp Tarihi ve Etik / History of Medicine and Ethics Dept. Kayışdağı cad. No.32. Ataşehir-Istanbul

CAMBRIDGE BİYOETİK EĞİTİMİ TÜRKİYE ÇALIŞMA GRUBU CAMBRIDGE BIOETHICS EDUCATION WORKING GROUP V. ÇALIŞTAYI / WORKSHOP V Acıbadem Üniversitesi Tıp Fakültesi /Acıbadem Univ. School of Medicine, 5 Aralık 2014/ 21 December 2014 OPENING Draft of Research Proposal Web site, latest situation Agenda Pınar Topsever, Figen Demir, Yeşim Ülman, Işıl Pakiş, Fatih Artvinli 09.30-10.00 10.00-10.15 Coffee Break 10.15-10.45 General Discussion on Research Proposal Moderator: Nadi Bakırcı All Group 10.45-12.00 Lunch 12.00-14.00 General Revision & Division of labour All Group 14.00-15.30 Kahve Arası / Break 15.30-15.45 Article Drafting Process CLOSING Volkan Kavas, Kevser Vatansever, YIÜlman All Group 15.45-15.15 15.15-16.00 PARTICIPANTS: Fatih Artvinli, Nadi Bakırcı, Figen Demir, M. Volkan Kavas, Işıl Pakiş, Pınar Topsever, Yeşim Işıl Ülman, Kevser Vatansever, Vedat Yıldırım 5

RESEARCH PROPOSAL: CAMBRIDGE TURKEY WORKING GROUP INVENTORY OF ETHICS EDUCATION CURRICULA AT SCHOOLS OF MEDICINE IN TURKEY The Curricular Inventory of Ethics Education at Schools of Medicine in Turkey RESEARCH PROPOSAL (12.11.2014) Aim: develop an inventory of topics taught about ethics at Turkish medical faculties Outcomes: assess academic teaching infrastructure (fiziki şartlar ve insan gücü) for medical ethics assess topics about medical ethics included in the curricula assess academic profile (teaching manpower) and professional background of faculty (teaching manpower) involved in teaching medical ethics assess educational strategies and curriculum design in terms of medical ethics [workload, context, teaching-learning methodologies, assessment of student performance (expected level of performance), evaluation of curriculum ] 1. Study design: cross sectional descriptive survey 2. Setting-relevant population: all TR universities with medical faculties 3. Sample-sampling: convenience sampling all consenting TR universities with medical faculties, (we have not calculated a sample size, representativeness will not be sought?) a. Eligibility criterion: consenting TR medical faculties 4. Data collection tool: survey developed by researchers* 5. Primary outcome: desription of inventory of medical ethics topics taught at TR Medical faculties 6. Secondary outcomes: other factors related to te primary outcome (see outcomes above) 7. Statistical analyses: descriptive statistics, frequencies in %, numeric variables with even distribution as mean±sd, the ones with uneven distribution as median and range. 8. Time frame: data collection and analyses: 6 months from start 9. Funding: none (self-funded ) Methodology of survey development will be explained elsewhere (page 5) Sources examined: UNESCO Bioethics Core Curriculum Tomorrow s Doctors, General Medical Council MEDINE, Avrupa Tıp Eğitimi Tematik Ağı, Dünya Tıp Eğitimi Federasyonu Tıp Eğitiminde, Niteliğin Geliştirilmesi için Evrensel Standartlar, Avrupa Spesifikasyonları AMEE, European Core Curriculum, The Students Perspective, 5th Internation Follow-Up Conference on the Bologna Process in Medical Education WORLD FEDERATION FOR MEDICAL EDUCATION, Basic Medical Education, WFME Global Standards for Quality Improvement, The 2012 Revision Learning Outcomes/ Competences for Undergraduate Medical Education in Europe The Tuning Project (Medicine) European Accreditation Council for Continuing Medical Education National Core Curriculum Programme (ÇEP) Research Proposal prepared by: Pınar Topsever, Figen Demir, Yeşim Işıl Ülman, Işıl Pakiş, Fatih Artvinli (15.11.2014) 6

CAMBRIDGE BIOETHICS EDUCATION WORKING GROUPS EUROPEAN COMMISSION MEETING NOTES Brussels, EU Commission DG Ethics Sector, 23 December 2014 Venue: European Commission DG Research & Innovation, B7 Ethics and Research Integrity Sector, Brussels - Belgium Date: 23 December 2014 / Hour: 11.00-12.30 Agenda: Presentation about Cambridge Consortium of Bioethics Education Working Groups, Interview and discussion for Funding Availability / Opportunity / Advice Participants: Dr. Isidoros Karatzas (Head of DG Ethics Sector), Prof. Dr. Guy Widdershoven (Amsterdam VUMC, Head of Medical Humanities), Prof. Dr. Yesim Isil Ulman Possible Funds and Calls: 1) Horizon 2020 Societal Challenges Spreading excellence and widening participation Science with and for Society Improve knowledge on science communication in order to improve the quality and effectiveness of interactions between scientists, general media and the public http://ec.europa.eu/research/participants/portal/desktop/en/opportunities/h2020/index.html#c,call s=specificprogrammelevel2names/t/eu.1.1./0/1/1&specificprogrammelevel2names/t/eu.1.2./0/1/ 1&SpecificProgrammeLevel2Names/t/EU.1.3./0/1/1&SpecificProgrammeLevel2Names/t/EU.1.4./0/1 /1&SpecificProgrammeLevel2Names/t/EU.2.1./0/1/1&SpecificProgrammeLevel 2) COST Action http://www.cost.eu/participate/open_call Dr. Isidoros Karatzas advised: Ethics is a preferred discipline to support with regard to European Commission funds. But the 2015 Calls are closed now. One should examine 2016 Calls by applying during 2015. First of all the Calls should be followed and examined very attentively. Application to the Call should be done long before the deadline of that specific Call. While writing a proposal, wording should be prepared right in response to the needs of the Call. Text and content of the Proposal should be flexible and capable to answer the questions of the Call. Whatever the Call would be, the impact of the Project (proposal) should be very well expressed. The referees (panelists) put emphasis on the impact factor, the resulting outcome, definite value of the Proposal. This has to be very well worded and designed in the text of the Project. In other words the Project should be written up to convince the referees on the added value of the proposal. Therefore one should get in touch with and seek advice of the contact person in charge at the local research fund in each country (i.e. TUBITAK) You should benefit from the view and advice of local contact persons of the Horizon ve COST Action funds immediately. 7

Registration in the system of Horizon 2020 funds as expert would be beneficial. If one acts as a reviewer, that would also provide insight in what kind of proposals are submitted The registration and accessibility through the system both as a panelist and a researcher are important for the evaluation. Cambridge Working Groups Consortium seems to be more appropriate for COST Action. DG-SANCO Funds may be relevant, as well. It would be beneficial to make an appointment and interview with the contact persons of COST and DG-SANCO. Each Working Groups may seek to participate in the clinically oriented proposals. This will be very effective during evaluation process. Post Interview Assessment: Widdershoven and Ulman will inform of the Cambridge Groups about the details of the interview with EC Ethics Sector in Brussels. Widdershoven and Ulman will complete and stimulate colleagues to register as experts through the portal of the EC funds systems: Horizon 2020: https://ecas.ec.europa.eu/cas/login?loginrequestid=ecas_lr-7380530- RFheMzSDr1IezQ3Gub8j9agK5D3kRhxzvdYUL4QCIWdW6JSzIL0fDPkjuEU6oLSkzyrci0mYza6cUjelPgqV NAk0-Jj71zxYb8yrVpACJbZNqAa-gzv0iAKIzjIDX00hQrvxcpRnGJSxdDFFOQfy08GoZfUG COST Action: http://www.cost.eu/participate Widdershoven will also get in touch with DG-SANCO programme based in Luxembourg Widdershoven and Ulman will give a briefing to other Cambridge representatives (Hungary, Serbia etc.) at the joint meeting in Amsterdam on January 29th, 2015. The larger Group will take a collective decision about the fund to apply in that meeting. The Draft will be shared with all Groups members. The Cambridge Network will be ready to follow the 2016 Calls and apply on time in 2015. Wrap up: Cambridge Bioethics Education Working Groups is an original and self-motivated network to act as an international scientific collaboration based on the infrastructure of the Cambridge Consortium. It is worth pursuing. YIUlman, 3.01.2015 / G Widdershoven 8.01.2015 8

Cambridge Consortium of Bioethics Education Working Groups Interim Meeting (Minutes) Venue: Amsterdam VU University Department of Medical Humanities Date: 29.01.2015 Participants: Kevser Vatansever, Volkan Kavas, Yesim Isil Ulman (Turkey), Yolande Voskes, Menno de Bree, Guy Widdershoven (Netherlands), Peter Kakuk (Hungary), Vojin Rakic (Serbia), Rouven Porz (Switzerland, guest). Aim of the meeting: to exchange experiences and explore the opportunities for mutual, multi-based scientific research for the working groups in the Cambridge Consortium of Bioethics Education. Program of the meeting: After an introductory round of the participants, a draft research proposal was presented on behalf of the Turkish working group. In the afternoon, a seminar was organized with the staff of the Department of Medical Humanities, on ethics education in international perspective. Next, possibilities for funding were discussed, especially COST. Finally, future cooperation was discussed, focusing on goals and possible contributions to European programs, and decisions were made for further actions. 1. Draft Research proposal by Kevser Vatansever on behalf of the Turkish working group: Learning of professional Values and Bioethics Aims: Determining the health professionals learning process of professional values 9

Defining the influential personal, social, economic, contextual, educational and political (health policy) factors on learning and preserving of professional values. Developing a scale to be used on evaluation Study design: Mixed methods For further information: see the powerpoint of the presentation 2. Seminar Ethics education in international perspective. The seminar started with a presentation of Yesim Ulman on objectives and strategies of the Turkish working group (see the powerpoint of the presentation). The discussion focused on questions about the value of collaboration between universities on a national as well as international level. A brainstorm was held on the possibilities for such collaborations, the way in which networks can play a role in them, and different strategies for collaborations. 3. Possibilities for funding Possibilities for funding include COST and Horizon 2020. Participants of Cambridge Bioethics Education Interim Meeting: Yolande Voskes, Rouven Porz, Guy Widdershoven (back) Kevser Vatansever, Peter Kakuk, Vojin Rakic (back) Yesim Isil Ulman, Menno de Bree (back), Volkan Kavas Steps for COST: Examine the website: http://www.cost.eu/participate/open_call Register the system as «expert» COST funds mobility only, not the content of research There should be 5 countries at least to compose a network / consortium 10

Coordinator country has 1 proposer, 2 researchers There are two call periods per year The Spring Call s deadline is: 24.03.2015 (now open) Applications are reviewed by a scientific committee + higher committee Decisions are received in eight months 4. Goals and contributions to European programs Finally, future cooperation was discussed, focusing on the goals and the possible contributions to European programs which might provide a basis for funding. For (current and future) participants in the Cambridge Consortium for Bioethics Education, the core value of further cooperation lies in exchange of best practices, mutual support to put the topic of Bioethics Education on the (national and international) agenda, and possibilities for research. The contributions to European programs lie in promoting ethics teaching of (new) professionals, based upon experience and international cooperation between experts in the field. Goals: Contributions: Sharing knowledge and experience Becoming a power block Promote best practices Support groups / projects that fit our aims Personal development + publications Teaching and research Teach professionalism Philosophical analysis Initiate networking collaboration Exchange of students and professors (ERASMUS+) Preparing a mission statement Medium for communication and research Extended experience on education Multidisciplinary approach Teaching professionalism (also for new professions) Taking care of the new generation Bridging the gap between medical education and ethical practice Supporting new developments (for instance Research Integrity) Providing specific methodologies (moral case deliberation) As a title for a project the group came up with: Making Ethics Work. 5. Further actions Preparation of COST Action proposal: Yesim and Peter Investigation of possibilities in Horizon 2020: Vojin and Guy Preparation of further discussion at the 5 th Cambridge Consortium of Bioethics Education: Yesim and Guy Notes by YIUlman and G Widdershoven 11

Cambridge Biyoetik Eğitimi Türkiye Çalışma Grubu VI. Çalıştayı Cambridge Consortium of Bioethics Education Turkey Working Group Workshop VI Cambridge Consortium of Bioethics Education Working Groups: Amsterdam Interim Meeting İstanbul, 6 Mart / March 2015 İletişim / Contact: Acıbadem Univ. Tıp Tarihi ve Etik / History of Medicine and Ethics Dept. Kayışdağı cad. No.32. Ataşehir-Istanbul 12

CAMBRIDGE BİYOETİK EĞİTİMİ TÜRKİYE ÇALIŞMA GRUBU CAMBRIDGE CONSORTIUM OF BIOETHICS EDUCATION WORKING GROUP V. ÇALIŞTAYI / WORKSHOP V Acıbadem Üniversitesi Tıp Fakültesi /Acıbadem Univ. School of Medicine, 6 Mart 2015/ March 2015 AÇILIŞ/ OPENING Moderator: Nadi Bakırcı Notes of Amsterdam Interim Meeting Gündem / Agenda Kevser Vatansever M.Volkan Kavas Yeşim Işıl Ülman 10.30 10.30-11.00 Kahve Arası / Break 11.00-11.15 Moral Case Deliberation in Professionalism Cambridge ConsortiumDraft Research Proposal Yeşim Işıl Ülman Kevser Vatansever 11.15-11.45 11.45-12.30 Yemek / Lunch 12.30-13.30 Projeler Değerlendirme: Local & International Projects /Task Division Tüm Katılımcılar All Group 14.00-15.30 Kahve Arası / Break 15.30-15.45 KAPANIŞ/ CLOSING 15.45-16.00 Participantnts of Cambridge Consortium of Bioethics Education Working Groups Interim Meeting VU University Medical Centre, Department of Medical Humanities, Amsterdam, 29.01.2015: Yolande Voskes, Rouven Porz, Kevser Vatansever, Guy Widdershoven (back), Peter Kakuk, Vojin Rakic, Yesim Isil Ulman, Menno de Bree (back), Volkan Kavas 13

Cambridge Biyoetik Eğitimi Türkiye Çalışma Grubu Toplandı Acıbadem Üniversitesi merkezli olarak çalışan Cambridge Biyoetik Eğitimi Çalışma Grubu 6 Mart 2015 tarihinde VI. Çalıştayı nı Kerem Aydınlar Kampüsünde gerçekleştirdi. Türkiye de biyoetik eğitimi ve altyapısı ile ilişkili ulusal ve uluslararası işbirliğine yönelik projelerin tartışıldığı VI. Çalıştay a, Acıbadem Üniversite Tıp Fakültesi nden Prof. Dr. Yeşim Işıl Ülman, Prof. Dr. Nadi Bakırcı, Doç. Dr. Pınar Topsever, Yrd. Doç. Dr. Fatih Artvinli, Yrd. Doç. Dr. Figen Demir; Ege Üniversitesi Tıp Fakültesi nden Yrd. Doç. Dr. Kevser Vatansever; Ankara Üniversitesi Tıp Fakültesi nden M. Volkan Kavas ve Başkent Üniversitesi Tıp Fakültesi nden R. Vedat Yıldırım katıldı. Çalıştay sonunda ulusal ölçekteki Türkiye de Biyoetik Eğitimi Envanteri çalışmasının Dr. Volkan Kavas ın, uluslararası kapsamdaki Profesyonel Değerler Edinimi ve Biyoetik başlıklı çalışmanın ise Dr. Kevser Vatansever in koordinatörlüğünde yürütülmesine karar verildi. Grup ayrıca sonbahar ayında klinik etik konulu uluslararası bir sempozyum yapmaya karar verdi. --- Cambridge Bioethics Education Turkey Working Group held its 6th Workshop Cambridge Bioethics Education Turkey Working which is based on Acibadem University, Istanbul, held its 6th Workshop on March 6th, 2015 at the Kerem Aydinlar Main Campus. The participatimg members of the Group were Kevser Vatansever (Ege University), Volkan Kavas (Ankara Unşiversity), Vedat Yildirim (Baskent University), Nadi Bakirci, Yesim Isil Ulman, Pinar Topsever, Figen Demir, Fatih Artvinli (Acibadem University). The main theme of the VIth Workshop was to evaluate the collaboration possibilities of multibased studies at local and international levels on the bioethics education regarding its content, infrastructure and technique. It was unanimously decided that the Curricular Inventory Study will be led by Dr. Volkan Kavas and the International Project on the Learning (Acquisition?) of Professional Values and Bioethics will be coordinated by Dr. Kevser Vatansever, The Group put on its agenda an international symposium on clinical ethics in upcoming autumn to be organized by Yesim Isil Ulman. 14

Research Proposal for Brocher Foundation EMERGING SCIENCES AND TECHNOLOGIES IN BIOETHICS EDUCATION Through the Perspective of Professionalism Workshop Proposal Draft Cambridge Consortium of Bioethics Education Working Groups Introduction Modern science was born in Europe in the 16th and 17th Century. The vast potential of knowledge and technology to change the human condition was anticipated from its early days. Francis Bacon famously stated: Human knowledge and human power come to the same thing, for where the cause is not known, the effect cannot be produced. In the vision of Bacon, his contemporaries and his successors, Science held the key to a new world in which the wild forces of Nature were domesticated and humanity prospered; a world of generosity and enlightenment, dignity and splendour, piety and public spirit. The Utopian hope for science and technology was reiterated and reinforced during the Enlightenment, promising a society of welfare, equality, justice and happiness 1. In the latter half of the 19th Century and throughout the 20th Century, modern science and technology came to fulfil many of the old visions and hopes. Human understanding and technological command over Nature have reached a level unthinkable for our predecessors. Health and medicine; food and nutrition; production and supply of energy; housing and transportation these are but some examples of sectors and functions in our societies that have been repeatedly transformed as science and technology developed ever faster during the 20th Century. At present, early in the 21st Century, new scientific disciplines and research fields are emerging, such as nanoscience and nanotechnology, neuroscience and cognitive science, systems biology and synthetic biology. Other fields have a longer history but appear to have entered a stage of rapid and qualitative progress, such as robotics and information and communication technologies. Finally, there are immense research efforts undertaken to combine and converge the insights from the various sciences into the so-called converging sciences and technologies. History justifies us to expect innumerous benefits for humankind resulting from these efforts and developments 2. Research and innovation are particularly difficult to govern because they create novelty and surprise. The implementation of technology into society is a complex, open-ended and unpredictable process. The full extent of risks and side-effects can only be known by experience; and by that time they may be irreversible due to their magnitude or their entrenchment into societal infrastructures or human culture. Political and regulatory action accordingly has to include an element of anticipation, acting upon sociotechnical imaginaries, that is, narratives that imagine the future of science, technology and society and their interactions. Sociotechnical imaginaries have real influence on research practice and policy, and they can be an object of governance. The production of sociotechnical imaginaries has been dominated by scientists, innovators and investors. Lately, however, many European governments, the USA as well as the European Union devote more effort into soft governance to democratize the processes of agenda-setting for research and innovation 3. 1 Report on Ethical Issues Raised by Emerging Sciences and Technologies Report written for the Council of Europe, Committee on Bioethics by Roger Strand & Matthias Kaiser Centre for the Study of the Sciences and the Humanities, University of Bergen, Norway 23 January 2015, presented and issued at the meeting of Council of Europe Bioethics Committee (DH-Bio) on Emerging Sciences and Tecnologies and Bioethics on May 4th, 2015 Strasbourg Palais de l Europe, p. 8. Accessed on 12.05.2015 http://www.coe.int/t/dg3/healthbioethic/activities/12_emerging%20technologies/bergenstudy%20e.pdf 2 Ibid. p. 8. Accessed on 12.05.2015 http://www.coe.int/t/dg3/healthbioethic/activities/12_emerging%20technologies/bergenstudy%20e.pdf 3 Ibid. p. 3. Accessed on 12.05.2015 http://www.coe.int/t/dg3/healthbioethic/activities/12_emerging%20technologies/bergenstudy%20e.pdf 15

The broad spectrum of new emerging technologies is technological convergence, in particular so-called NBIC convergence. NBIC refers to four key technologies: nanotechnology, biology, information technology, and cognitive sciences. The mutual interplay between these four key technologies is denoted as NBIC convergence 4. Technological convergence simply combining different technologies has always been an important source for innovation, because technological breakthroughs often take place on the boundaries between technologies and industrial sectors. In particular, the convergence of information technology into a wide range of scientific disciplines and industrial and service processes, and actually in every aspect of society, characterizes the information revolution (Castells 1996). It is no surprise that the term convergence was used more and more in the IT sector during the 1980s. An example of such convergence in those years is mechatronics, i.e. combining IT and production technologies. A decade later the Internet resulted from the convergence between IT and communication technologies. During that period, the Human Genome project also provided a prime example of technological convergence: between biology and IT (so-called BI convergence). The mapping of the human genome is strongly dependent on computer power. Vice versa, developments in and concepts from biology also inspired the IT community, as illustrated by notions such as neural networks, swarm intelligence, and DNA computers 5. Holt argues that Web 2.0 has brought a change to how we communicate and disseminate information with the use of Twitter, Facebook, YouTube, instant messaging and blogging. This technology is beginning to be used in the health field for public awareness campaigns, emergency health alerts, medical education and remote healthcare services to reconcile organizational policies and procedures regarding the use of Web 2.0 technologies within the existing legal framework of privacy, confidentiality and consent 6. Only recently articles on the ethics of using emerging online technologies are published in the literature. There is an urgent need for guidelines for dealing with the ethical dilemmas that arise due to usage of these forums 7. Besides these challenges, the digital world and social media are providing new teaching and assessment opportunities for medical educators, who are struggling with how to conceptualize, teach and assess professionalism in medicine 8. Social-media can be classified into six categories: blogs and micro-blogs (e.g. Twitter), collaborative projects (e.g. Wikipedia), content communities (e.g. YouTube), virtual social worlds (e.g. Second Life), virtual game 4 Roco, M.C. & W.S. Bainbridge (eds.) (2002). Converging technologies for improving human performance: Nanotechnology, biotechnology, information technology and cognitive science. Arlington, VA: National Science Foundation (NSF), Department of Commerce (DOC): Cited by: Rinnie van Est, Dirk Stemerding, Virgil Rerimassie, Mirjam Schuijff, Jelte Timmer, Frans Brom, From Bio to NBIC Convergence _ From Medical Practice to Daily Life, report written for the Council of Europe, Committee on Bioethics, The Hague, Rathenau Institut, presented and issued at the meeting of Council of Europe Bioethics Committee (DH-Bio) on Emerging Sciences and Tecnologies and Bioethics on May 4th, 2015 Strasbourg Palais de l Europe, p. 8. Accessed on 12.05.2015. Accessed on May 12th, 2015 http://www.coe.int/t/dg3/healthbioethic/activities/12_emerging%20technologies/rapport%20from%20bio%2 0to%20NBIC_web.pdf 5 Rinnie van Est, et al, From Bio to NBIC Convergence _ From Medical Practice to Daily Life, report written for the Council of Europe, Committee on Bioethics, The Hague, Rathenau Institut, presented and issued at the meeting of Council of Europe Bioethics Committee (DH-Bio) on Emerging Sciences and Tecnologies and Bioethics on May 4th, 2015 Strasbourg Palais de l Europe, p. 12. Accessed on May 12th, 2015: http://www.coe.int/t/dg3/healthbioethic/activities/12_emerging%20technologies/rapport%20from%20bio%2 0to%20NBIC_web.pdf 6 Holt, Claire. Emerging Technologies: Web 2.0 [online]. Health Information Management Journal, Vol. 40, No. 1, 2011: 33-35 7 Guseh, J., R. Brendel, and D.H. Brendel, Medical professionalism in the age of online social networking. Journal of medical ethics, 2009. 35(9): p. 584-586. 8 Ferdig, R.E., et al., Medical students and residents use of online social networking tools: Implications for teaching professionalism in medical education. First Monday, 2008. 13(9). 16

worlds (e.g. World of Warcraft) and social-networking sites (e.g. Facebook) 9. There are many benefits of these social-media platforms in medical education as they can provide technical support for student collaboration, student-generated content, student student communication 9. For example, respectful clinical narratives written by medical students that avoid disclosing any information about patients can help to enhance understanding, reflection, and greater appreciation of the patient-physician interaction, or in a hospital quality improvement study, better results can be achieved through better communication via social media 10. Blended learning is the keyword for use of social media in higher education, as it incorporates traditional teaching environments with virtual ones/social media. It means combining instructional modalities, combining instructional methods and/or combining online and face-to-face instruction and it also giving a central role to computer-based technologies in teaching and learning 11. By giving a central role to computer-based technologies, actually blended learning puts more emphasis on self-paced and self-directed learning and better interaction learning materials, when compared to traditional face-to-face learning typically occurs in a teacherdirected environment without allowing self-direction 11. Many higher education teachers discuss whether it makes sense to deliver a lecture when students can see the same material at their own pace and on their own schedule 12. Blended learning systems combine the best of both worlds and have the advantages of; (1) pedagogical richness, (2) access to knowledge, (3) social interaction, (4) personal agency, (5) cost effectiveness, and (6) ease of revision 11. Blending can occur at (a) activity level, (b) course level, (c) program level and (d) institutional level 11. A common used system of blended learning is flipped classroom 13,14,which has become popular in higher education in last decade and recently drew some attention in medical education. In a flipped classroom, the core idea is to flip the instructional approach, and having instruction occur at home instead of and prior to the class, through teacher-created videos and interactive lessons utilizing the advantages of social media and other computer environments 14. Class becomes the live environment to study through problems, advance concepts, and engage in collaborative learning 14. In Stanford School of Medicine, first- and second-year medical students have been exposed to flipped classroom activities, including content in biochemistry, genetics, health policy, biomedical ethics, endocrinology, and women s health 15. On the other hand, there are specific online teaching platforms such as Blackboard or Moodle that help to incorporate traditional methods with computer-assisted teaching modalities 16. However, students and residents use social media excessively and this creates a double-faced problem. First, sharing information in social media about themselves and patients create some ethical and reputational problems. Second, common and popular platforms among students also have the potential of becoming teaching and learning environment 16. For a better use of social media as a teaching environment 16, it is generally recommended that; 9 Cartledge, P., M. Miller, and B. Phillips, The use of social-networking sites in medical education. Medical teacher, 2013. 35(10): p. 847-857. 10 Greysen, S.R., T. Kind, and K.C. Chretien, Online professionalism and the mirror of social media. Journal of general internal medicine, 2010. 25(11): p. 1227-1229. 11 Bonk, C.J. and C.R. Graham, The handbook of blended learning: Global perspectives, local designs2012: John Wiley & Sons. 12 Berrett, D., How flipping the classroom can improve the traditional lecture. The chronicle of higher education, 2012. 12: p. 1-14. 13 Prober, C.G. and S. Khan, Medical Education Reimagined: A Call to Action. Academic Medicine, 2013. 88(10): p. 1407-1410. 14 Tucker, B., The flipped classroom. Education Next, 2012. 12(1): p. 82-83. 15 Prober, C.G. and S. Khan, Medical Education Reimagined: A Call to Action. Academic Medicine, 2013. 88(10): p. 1407-1410. 16 Kind, T., et al., Twelve tips for using social media as a medical educator. Medical teacher, 2013. 36(4): p. 284-290. 17

1. For a better use of social media, think about goals and what you hope to do, learn, and share. 2. Select a social media tool on the basis of your goals and the strength of the platform in supporting educational activities 3. Observe the platform and gain some acquaintance with the platform, see the types of users and normative interactions, and determine things to avoid 4. Be a responsible user of social media and develop your own programs social media guidelines 5. Decide how to handle friend requests from trainees and the consequences of your reactions, think through how much sharing is appropriate, especially if you evaluate them 6. Engage, learn, reflect, teach, investigate, mentor and be mentored An article reports that among first year medical students at one medical school, an online discussion activity on social media and professionalism, and following written assignment exercise led to thoughtful reflection and increased professional role awareness of students 16. Educational activities and programs on professionalism and ethics curricula using blended learning systems can involve not only medical schools but also other health professionals schools even other professions such as law and might include scenarios and active debates among students, healthcare professionals, and other professionals, possibly lawyers 16. Innovative blended learning programs within medical schools and inter-professionally can provide the opportunity to schools to lead student-centered and self-paced programs, helping students to achieve higher levels of outcomes. (Drafted by, Kevser Vatansever, Yesim Isil Ulman, Guy Widdershoven, M. Volkan Kavas, 27.04.2015) 18

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Steps Forward To develop, share and discuss national and international ideas and experiences on ethics curriculum at universities To plan research and in collaboration with group members To propose and to promote multi-based research among countries To report activities yearly at the Cambridge Consortium 20

Pictures by YIUlman 21