Guarding the guardians: Bioethics curricula for psychiatrists-in-training in developing countries

A good physician must be both clinically and ethically competent. High ethical standards are especially important in psychiatry in which several unique challenges present due to a vulnerable patient population, intimate physicianpatient relationships, diagnoses made on signs and symptoms rather than irrefutable laboratory investigations, and therapeutic options directed at altering thinking and behaviour. It is critical that psychiatric training equip practitioners with the ability to identify ethical dilemmas in clinical practice and research and respond appropriately. Despite a call to action and the development of guidelines for ethical practice by several regulatory bodies, formal ethics teaching in psychiatry training programmes is still in embryonic stages in the developed world and virtually non-existent in the developing world. Here we highlight the current status of bioethics teaching in psychiatry residency programmes in Pakistan, an example of a developing country where such training is vital, as unethical practices abound in resource-poor settings where clinical and research practices are non-transparent and there are no effective regulatory, legal and accountability bodies. It is critical and urgent that needs-responsive bioethics curricula are developed, institutionalized and implemented in medical schools and post-graduate training programs across the developing world. "Take-home" points •Bioethics teaching should be a key, assessed component of all psychiatric training programmes •Bioethics curricula should be culturally contextual, responsive to stakeholder needs and geared towards preparing psychiatrists for ethical clinical practice and research, bioethics teaching and institutional leadership Future directions •Comprehensive needs assessment studies should be conducted to document current bioethics-related knowledge and attitudes in psychiatry training programmes in developing countries •Development, institutionalization and dissemination of needs-responsive bioethics curricula for psychiatry programmes in developing countries