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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
   Group activity
     Humanism, Ethics, and
The BCRP Curriculum in Medical Ethics

                  Jennifer Kesselheim, MD, M.Ed
                  December 12, 2006

   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
The Medical Literature

   Medical students and residents perceive a
    –   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
            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
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
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
    –   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

   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
   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!

Accreditation Council for Graduate Medical Education: general competencies.
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
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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