{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:59:49Z","timestamp":1790704789126,"version":"4.1.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Integrating bioethics into clinical training is challenging, particularly in resource-constrained settings. Scalable and low\u2011cost models are needed but are under\u2011evaluated. This implementation case study assessed the feasibility and perceived impact of a peer-led, case-based bioethics discussion model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology\/principal findings<\/jats:title>\n                    <jats:p>We conducted a single embedded case study at the College of Medicine in the Kurdistan Region of Iraq. Forty-four final-year medical students participated in structured peer\u2011led discussions of authentic clinical ethics cases using a four\u2011step analytical framework. Quantitative data (post-intervention Likert questionnaire) were analyzed descriptively. Qualitative data (open\u2011ended responses, case summaries) underwent deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators across five domains. Students strongly endorsed the intervention: 59.1% strongly agreed that ethics education is important (mean 4.51\/5.0). Enjoyment was high (75% agreed\/strongly agreed). Self-efficacy was variable (54.5% confident, 29.5% uncertain). CFIR analysis revealed key implementation determinants: low cost and high perceived relevance (facilitators), supportive peer culture (facilitator), limited time (barrier), and need for faculty orientation (barrier). From these findings, we derived three generalizable propositions for implementing low\u2011cost ethics curricula.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions\/significance<\/jats:title>\n                    <jats:p>A peer-led, case-based bioethics model is feasible and well received. Three generalizable lessons are offered: (1) peer\u2011led models require protected time and leveraged peer cultures; (2) single sessions raise awareness, but longitudinal reinforcement is essential for self\u2011efficacy; and (3) CFIR reporting enables analytical generalizability for single\u2011case studies. These propositions provide a blueprint for replication and further testing in low\u2011resource settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356377","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:29:59Z","timestamp":1790702999000},"page":"e0356377","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Peer\u2011led bioethics education in clinical rotations: Three generalisable lessons from a CFIR\u2011informed implementation case study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0896-0578","authenticated-orcid":true,"given":"Tara M. A.","family":"Shallal","sequence":"first","affiliation":[{"name":"College of Medicine, Hawler Medical University","place":["Erbil, Kurdistan, Iraq"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russel F.","family":"D\u2019Souza","sequence":"additional","affiliation":[{"name":"International Chair in Bioethics","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"issue":"2","key":"pone.0356377.ref001","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s10730-020-09410-y","article-title":"Embedding ethics education in clinical clerkships by identifying clinical ethics competencies: The vanderbilt experience","volume":"32","author":"A Langerman","year":"2020","journal-title":"HEC Forum"},{"issue":"1","key":"pone.0356377.ref002","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1186\/s12909-024-05376-4","article-title":"Bioethics curriculum for undergraduate medical students: an evaluation study utilizing mixed methods approach","volume":"24","author":"AA Allana","year":"2024","journal-title":"BMC Med Educ"},{"issue":"6","key":"pone.0356377.ref003","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2015.07.023","article-title":"Ethical issues identified by obstetrics and gynecology learners through a novel ethics curriculum","volume":"213","author":"RB Mejia","year":"2015","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"pone.0356377.ref004","first-page":"9","article-title":"Problem\u2011based learning in bioethics: A new pedagogical approach","volume":"21","author":"FG D\u00edaz","year":"2015","journal-title":"Acta Bioeth"},{"key":"pone.0356377.ref005","doi-asserted-by":"crossref","first-page":"23","DOI":"10.12688\/mep.19022.1","article-title":"Practical tips for teaching ethics and humanism to medical students","volume":"12","author":"KR Meacham","year":"2022","journal-title":"MedEdPublish (2016)"},{"issue":"1","key":"pone.0356377.ref006","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1186\/s12909-022-03865-y","article-title":"Building connections between biomedical sciences and ethics for medical students","volume":"22","author":"O Olaiya","year":"2022","journal-title":"BMC Med Educ"},{"issue":"1","key":"pone.0356377.ref007","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12910-017-0181-1","article-title":"Principle\u2011based structured case discussions: Do they foster moral competence in medical students?","volume":"18","author":"O Friedrich","year":"2017","journal-title":"BMC Med Ethics"},{"issue":"1","key":"pone.0356377.ref008","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s12909-022-03124-0","article-title":"To debate or not to debate? 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