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Acta Bioethica ; 18 1: Fernando Lolas 1Eduardo Rodriguez 2. In these 10 years of experience, 50 trainees teecnoetica completed a month training combining on-line and in-person teaching and learning activities, with further support for maintaining contact via webmail and personal meetings. The network formed by faculty and former problrmas has published extensively on issues relevant in the continent and has been instrumental in promoting new master level courses at different universities, drafting regulations and norms, and promoting the use of bioethical discourse in health care and research.
Evaluation meetings have shown that while most trainees did benefit from the experience and contributed highly to developments at their home institutions and countries, some degree of structuring of demand for qualified personnel is needed in order to better utilize the human resources created by the program. Publications and other deliverables of trainees and faculty are presented.
Bioethics, Ethics training, Biomedical research, Psychosocial research. The University of Chile, the oldest public university in Chile and the most accredited research institution in the country, ranking among the most productive and solvent in the Region of the Americas and the Caribbean, has pioneered in the establishment of new fields of inquiry.
Bioethics was among them. The latter, with several burocratic vicissitudes, lasted until March Throughout its existence, CIEB has been instrumental in promoting the dissemination of bioethical discourses and practices in the website www. CIEB also edits books, congress proceedings and monographic issues of Acta Bioethica, freely available at the websites.
This paper reviews one long lasting project supported by the National Institutes of Health NIH through grants from the Fogarty International Center in collaboration with other Institutes. For 10 years, from thruthe emphasis has been placed on training selected professionals and academics from Latin America and the Caribbean in biomedical and psychosocial research ethics. Topics covered have been diverse and recruitment of trainees encouraged multidisciplinarity and differences in outlooks.
Throughout the years, with different emphases, the main goal has been to help increase the number of persons familiar with the ethics of research in the biomedical and problemae disciplines and to foster the development of training programs at different prolemas of the continent.
Curricular development in research ethics — a culture-sensitive approach. Despite improvements in research output in the biological, social, and medical sciences, several problems remain, with ethical underpinnings that justify training in research bioethics in the Region of South and Central America. Some aspects relevant to a training program in research ethics were identified and provided the rationale for this training program.
Enhancements in global health status have been accompanied by a widening health problemsa poverty gap between countries. Increase in research output naturally demands sound ethical oversight. Globalization and resource-poor countries. The trend to globalization in clinical and psychosocial research implies that sponsors in economically advanced countries outsource trials and research to poor communities within developed countries or, most frequently, to resource-poor nations.
The cost of conducting research is less than in advanced countries. Poor countries offer large patient pools for diseases, thus ensuring rapid recruitment and reduction of time for problemmas trials. Regulations are weak or nonexistent, and lack of qualified policymakers and scientists create an imbalance between what is offered to communities and the actual benefits in terms of manpower development or economic support. Public awareness about the need to ethical control of research is imperative.
While information is available on many health-related issues, its conversion to policy and practical measures is delayed precisely in those countries where its application would make a difference in living conditions. This is not only a matter of economic importance.
Its ethical dimension arises from the fact that resource-poor countries- or some privileged groups within them- consider that they have the right to enjoy the highest possible standard derived from scientific progress. Only a cadre of professionals conversant with the state of the art in research and also aware of the value-laden nature of scientific knowledge can enter into a dialogue with experts and lay people regarding the appropriateness and timeliness of investments in the conversion of data into practice.
On the other hand, an equitable distribution of the benefits derived from scientific research is a matter for ethical reflection by the scientific community, policymakers, and public at large. Research is a context-dependent, patterned cultural process. Some activities called research in less developed countries would not qualify as such in scientifically alphabetized countries.
Social demand for research as different from need or desire continues to be low in Latin America, as reflected in resource allocation, social recognition, and employment opportunities. Ethical considerations affect quality of research and opportunities for collaborative work.
In many Latin American countries informed consent, responsible conduct of research, risk assessment, protection from harm, privacy and confidentiality, equitable opportunities for subjects, and avoidance of stigmatization among other issues are still more a matter of compliance with donor agencies than a felt need of the scientific community.
A combination of face-to-face and distant training within the same cultural community has proven appropriate for dealing with these issues. Ethics is always local, despite the fact that research may be considered a universal intellectual enterprise. Scarcity of personnel, professional traditions, and restricted funding are responsible for confusion between the roles of caregiver and researcher in many Latin American settings. Special emphasis given to public health topics and anthropological analysis was dictated by the priorities of healthcare systems in the continent and the multicultural, pluralistic environments in which researchers must act.
Increasing globalization of the research enterprise and the need to enter into meaningful dialogues for good results make it imperative to develop local capacity. The challenge is not only to increase sound scientific production. A constructive contribution of Latin American science requires sound ethical oversight systems, good quality training, and awareness of the needs and expectations of the populations. Even if our trainees were not in the forefront of research, their expanded vision of the situation and the awareness of the goals of research in its proper context would help improve the translation of evidence-based facts into value-based actions.
Even language diversity is a factor hampering research, particularly in the field of social studies and public health.
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tefnoetica The sustainability of this effort is ensured by the empirical, albeit anecdotal, evidence we have gathered during the conduction of the program. The danger of a group that is closed and immune to criticism is not supported by our experience.
These factors justify the need for highly trained professionals from developing countries to assume positions of leadership nationally and internationally in addressing the ethical and social issues of global health research.
Since this research is inherently multidisciplinary and interdisciplinary, students from a growing range of disciplines directly or indirectly related to health seek training, thus producing a heterogeneous group whose members not necessarily share the same ethos of service or are not sufficiently committed to the relationship between science and ethics in the creation and application of knowledge.
There are also tecnoehica cultural variations regarding the social implications of scientific research, the roles of researchers in the community, and the expectations regarding social impact of science and technology. It is recognized that ethical oversight tecnoetoca research is best performed locally; avoiding mistrust and dependence sometimes associated with foreign funding and foreign institutions the autonomy of the groups and tscnoetica was sought.
Research is an activity probllemas widely performed in the Latin American continent. Scientists and scholars represent a privileged minority and many of its members feel that they belong to elites whose contribution to science and technology may be hampered or otherwise limited by ethical oversight.
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All along, the emphasis on accountability of researchers and research has been a permanent feature of our training effort. After successful application about 30 applicants annuallyfive to six trainees were selected each year for courses and activities at CIEB, with an international faculty.
Table 1 presents a listing of trainees with their professions, country of origin, and other relevant information. The program was advertised through standard academic channels websites and flyers.
Former graduates constituted a good source of information for new applicants. The selection process involved analysis of previous activities, publications and other deliverables, and support from home institutions in order to keep a position or provide development opportunities after training.
The program underwent changes. At the beginning, no virtual on-line component was present and trainees were hosted at the CIEB, University of Chile, for nine months; three additional months spent doing work in a country different from the country of origin. Thus, useful contribution to the development of ethics committees and ethics regulations was possible in Peru, Dominican Republic, and Costa Rica.
In the ensuing years, with the introduction of virtual learning modules adapted from the CITI program developed at the University of Miami and the Fred Hutchinson Cancer Center, Seattle, Washington 2a period of virtual training was introduced before the in-person, face-to-face portion of the program.
This period served for providing a common ground for all successful applicants, homogenized the language and familiarized trainees with the topics and terminology to be employed in the courses offered at CIEB in Santiago. The in-person period at CIEB was reduced to three months of full time commitment. The virtual phase served as a baseline for comparison with knowledge and attitudes at the end of the training period; it was used also as a teaching device: During their stay at the CIEB in Santiago, Chile, trainees were exposed to a wide range of contents and training experiences.
Courses were offered on the philosophical foundations of ethics, the history of bioethical thinking, the applications of bioethical discourse to research questions, statistical reasoning as it pertains to ethical formulation of methods, bioethical problems arising in medical and psychosocial research, qualitative and quantitative research methods, health economics, institutionalization of bioethics, structure and functions of ethics committees, anthropology and bioethics, and other topics selected on the basis of personal interests and available teaching resources.
These essays were presented in evaluation sessions, graded, and constituted publications in accredited journals or presentations at seminars, workshops, or congresses, attendance to which was sometimes covered by special allowances from the program. A list of publications produced by trainees and faculty during the period is presented in the Appendices. During the first two years of the program, along with formal training and delivery of the above mentioned contents, other activities were programmed.
Among them was exposure to group dynamics and direct experience with emotional manifestations in group sessions. This activity demanded some effort on the part of faculty and trainees and although results were enlightening, the practice was abandoned in view of resistances voiced by some participants. The training period at CIEB was mainly devoted to work in groups under the leadership of a faculty member, avoiding any resemblance to an asymmetrical relation of the type mentor-trainee or tutor-trainee.
The covert dimension of the curriculum was to illustrate practically the dialogical nature of the bioethical enterprise and the development of bioethical discourse through open manifestation of ideas.
Among the guiding principles implemented, the following can be mentioned: The teaching of statistical methods, participant observation, qualitative and quantitative approaches to data acquisition and presentation was aimed at reinforcing the idea that no good science in the ethical sense of good can be obtained without careful attention to method. Not to be confused with moral relativism, the presentation of different perspectives is essential in creating an adequate environment for democratic and fact-producing dialogue.
This ideal of interaction was sought after by encouraging manifestation of personal preferences and emotion-laden material related to case analyses. Success was measured by requesting a personal evaluation from trainees after the completion of the face-to-face period. The interdisciplinary nature of our effort was accompanied by the effort to underscore what is meant by a truly transcultural approach.
Contact with anthropological thinking was provided by priblemas anthropologists who illustrated their methods and data with examples drawn from the cultural and the health fields. Their methods and approaches were considered valuable by trainees and helped to create awareness of the multiethnic and multicultural character of Latin American societies.
The relevance of this knowledge for a culturally fair bioethics was stressed all along.
Although an ambitious goal not always easy to attain, it was expected that after the training period, attitudes toward problems, ethical dilemmas, and current or possible solutions could undergo changes. Again, this was reflected in self evaluations made by trainees and faculty and was the subject del of testimonies collected after the experience was finished. Trainees were exposed to a variety of approaches for improving written and oral communication, and special teccnoetica sessions were deal to the design and development of websites, listserv lists, slide presentations, oral reports and written materials.
This was essential given the different training experiences of participants and the need to represent ideas and attitudes to wider audiences.
This portion of the training experience also served to highlight moral problems associated with scientific communication and thus introduce participants to a crucial aspect of research integrity. Al though implicit, the notion that a crucial competence necessary for a successful implementation of bioethical discourse is tolerance and the capacity to listen to discrepant or adversary views was reinforced throughout the training period and was continued in the aftermath of the face-to-face experience, when networking activities at the home institution were supported and followed.
When the training period was completed, participants were requested to write down formal and publishable papers and to prepare an activity in their home country or at their institution of origin, to which a faculty member was invited.
Thus, continuity of effort was assured and support from the home institution assessed. Evaluation of program and outcomes. A complete assessment of impact may require an extended time to complete and should probably consider aspects well beyond immediate effects on research ethics.
Multiplying effects of the experience through the work and effort of participants probably need years to show manifest outcomes in research practice, policymaking, and committee work.
These could be more qualitative than quantifiable in terms of publications, policies, or other deliverables. The effects of the program can be evaluated at the tecnoeetica, the institutional, and the national levels.
Faculty members served as tutors and provided advice and support to trainees throughout the training period and afterwards.