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Humanism, Ethics, and Teaching: A Medical Education Workshop December 12, 2008 Katharine Garvey, MD Jennifer Kesselheim, MD David Urion, MD Conference Objectives To explore the current strategies underway to teach ethics, humanism, professionalism, and cultural sensitivity to residents at Children’s Hospital To share experiences and collaborate about teaching in these important arenas of medical education – Which also happen to be an ACGME mandate! Conference Agenda BCRP Curriculum in Medical Ethics Humanism and Professionalism in Pediatrics Ethics in a Multicultural Setting for Neurology Residents Group activity Humanism, Ethics, and Teaching: The BCRP Curriculum in Medical Ethics Jennifer Kesselheim, MD, M.Ed December 12, 2006 Objectives Explore rationale for teaching medical ethics to residents Describe BCRP Curriculum in Medical Ethics – Focus on unique aspects – Triumphs and tribulations Why Teach Ethics to Residents? Pediatric residency training is morally challenging Identifying the proper Discussing of poor decision-maker prognoses Navigating the Decision-making about dynamics of withholding or Patient/MD/Parent withdrawing relationships Disclosing medical Maintaining errors professionalism Working with large and Recognizing conflicts of complex teams interest Caring for patients on research protocols Medical Literature Prior studies indicate that residents crave structured teaching – End-of-life issues – Physician-Patient relationship – Informed Consent True for residents in many fields, including Pediatrics The Medical Literature Medical students and residents perceive a need – Practical dilemmas of ethics – Daily challenges to professionalism Residents gain confidence in addressing difficult moral questions after their programs establish formal ethics curricula Medical Literature Pediatricians who recently completed residency training (N=150) – Lack confidence in confronting several ethical dilemmas End-of-life Research ethics – Rated the quality of ethics education from residency as fair/poor in 45% of cases Both formal and informal ethics teaching was influential Accreditation Council for Graduate Medical Education Recent guidelines support a rigorous examination of ethics education Professionalism – respect, compassion, and integrity – commitment to ethical principles How are we to meet ACGME requirements? BCRP Curriculum in Medical Ethics Development of BCRP Curriculum in Medical Ethics: 2002-2003 Establish partnership with the Office of Ethics Discussions with residency program leadership Consultation with Residency Program Training Committee (RPTC) – Established institutional support Needs assessment survey of house staff – Begin to identify content areas Revisit the Office of Ethics – Validation of content areas and strategies for teaching Development of BCRP Curriculum in Medical Ethics: 2002-2003 Incorporated sessions into noon conference schedule – Utilizing pre-existing structure 12 sessions over 2 years Format usually case based – Mix of discussion and didactic components Unique features – Content was often organized around clinical service in hospital or patient population – Facilitators multidisciplinary Ethicists, physicians, nurses, social workers, legal, chaplain Implementation: the first curricular cycle Met with facilitators in advance of session Established objectives for session Decided on a case to focus discussion Selected supporting materials – Professional guidelines – Review articles – Empiric study – Policy statements – Other handouts from hospital resources The Original 12 Sessions Physician and Social Primary Care Responsibility Emergency Department Fetal Interventions Pediatric Clinical Organ Transplantation Research Decision-making for minors Adolescent Medicine Patients with Chronic Neonatal ICU Illness Critical Care Medical Futility What We Have Learned Curriculum receives excellent feedback from residents – Response bias What is easy to teach vs. what we should teach – Newer sessions have been implemented Making room for ourselves: seize on any gaps – August sessions Sustainability concerns – Resident champion – Ongoing institutional buy-in Communication with RPTC and residency leadership Residents’ needs can change – Needs assessment updated in 2006….due for another round! References Accreditation Council for Graduate Medical Education: general competencies. http://www.acgme.org/outcome/comp/GeneralCompetenciesStandards21307.pdf. Eckles RE et al. Medical Ethics Education: where are we? Where should we be going? Acedemic Medicine. 2005; 80(12): 1143-52. Wenger NS and Lieberman JR. An assessment of orthopaedic surgeons’ knowledge of medical ethics. Bone and Joint Surgery. 1998; 80: 198-206. Roberts LW, Warner TD, Green KA, et.al. Becoming a Good Doctor: Perceived Need for Ethics Training Focused on Practical and Professional Development Topics. Academic Psychiatry;2005;29(3):301-309. Stevens L, Cook D, Guyatt G, Griffith L, Walter S, McMullin J. Education, ethics, and end-of-life decisions in the intensive care unit. Crit Care Med. 2002; 30: 290-6. Angelos P, DaRosa DA, Derossis AM, Kim B. Medical ethics curriculum for surgical residents: results of a pilot project. Surgery. 1999; 126: 701-5. Shulmasy DP, Geller G, Levine DM, Faden R. Medical house officers’ knowledge, attitudes, and confidence regarding medical ethics. Arch Intern Med. 1990; 150: 2509-13.
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