Ethics Education in COVID-19: Preclinical Medical Students’ Approach to Ventilator Allocation

Abstract

IntroductionCOVID-19 has confronted clinicians with a potential need to ration ventilators. There is little guidance for training medical students to make such decisions in future practice. How students would make ventilator triage decisions remains unknown. MethodsOne hundred fifty-three medical students in 18 problem-based learning groups participated in a ventilatorrationing exercise in April 2020 as part of an ethics curriculum adapted in response to the COVID-19 pandemic. Students were provided with a prompt requiring fictional patients to be prioritized for ventilators in the face of scarce resources. The authors reviewed group responses, tallied triage criteria, and identified approaches to triage decisions. ResultsThe most common triage criteria were patient comorbidities, clinical status, age/life stage, prognosis, life expectancy, and an individual's role in pandemic response. Additional criteria included quality of life, ventilator availability, public perception, and patient need. Students approached triage decisions by developing systems for triage, appealing to empirical evidence and academic literature, making value judgments, and identifying adjuncts and alternatives to triage. DiscussionWith minimal input from educators, students learned key ethical principles in triage medicine, recapitulated approaches to triage described in the clinical and bioethics literature, and suggested methods for tolerating distress of complex ethical decisions. Medical education should equip students to critically consider bioethical concerns in triage and prepare for possible moral distress during public health crises.

COVID-19: Falling Apart and Bouncing Back. A Collective Autoethnography Focused on Bioethics Education

“…Our results also indicate that elements of ethical reasoning can also play an important part both in the continuing education of healthcare professionals, as well as routine interventions that are intended to enhance healthcare professionals' and medical students' psychological well-being, such as Balint groups (35). This conclusion corresponds with other voices in bioethical literature, which argue that the COVID-19 pandemic emphasized the importance of preparing students for situations of moral distress and shaping their moral resilience also in the classroom setting (27,36). This provides some evidence to support the position that a resilient posture in the face of adversity is a feasible goal of bioethics education.…”

Medical School Curriculum Relating to Clinical Ethical Decision Making During a Pandemic: A Scoping Review

“…For example, Brodar 2021 mentions resource allocation and patient care, while Tebeka 2022 mentions healthcare worker obligations and communication. 15 , 27 Nevertheless, ethical issues identified in the literature are all important regarding pandemic preparedness.…”

“… 30 , 31 When the demand for resources exceeds the availability of supply, healthcare workers must be able to appropriately discern which patient groups demand a greater need for resources (ie, elderly patients, patients belonging to marginalized communities, or those that live with pre-existing conditions). 8 , 15 , 20 …”

“…The four studies that included patient care as part of the curriculum varied in terms of the discussion of treatment, end-of-life care, and triage concerning patient care during a pandemic. 15 , 20 , 21 , 25 Nevertheless, it is beneficial to include different components of patient care in the medical curriculum during a pandemic. Students must be equipped to adjust their approach to patient care in pandemic settings.…”

“…The lack of medical education on ethical issues related to clinical practice during a pandemic is a substantial gap in the current literature. 7 , 15 This study aims to identify the literature regarding pandemic preparedness and ethics modules that address ethical issues related to clinical practice during a pandemic. It is important to note that this study does not consider additional ethical problems related to the pandemic, such as research ethics and public health ethics, due to the variation in these ethical issues and the enormous scope of research it includes.…”