Ethics knowledge of recent paediatric residency graduates: the role of residency ethics curricula

Kesselheim, Jennifer C.; Najita, Julie; Morley, Debbie; Bair, Elizabeth F.; Joffe, Steven

doi:10.1136/medethics-2016-103625

Cited by 13 publications

(18 citation statements)

References 29 publications

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“…Residents at our institution 22 confirmed previously identified gaps in medical ethics education. 3,5,7,11,12,14,15 This module is a valuable addition to formal medical ethics education, which is recognized as a requirement by the ACGME, ABP, and AAP. 7,8 It adds to previously published curricula utilizing problem-based learning to address futility in the adult setting 23 by providing content specific to pediatrics.…”

Section: Discussionmentioning

confidence: 99%

“…9 Given the significant variation in how and what pediatric residents are taught regarding medical ethics, it is not surprising that a majority of recent pediatric residency graduates reported gaps in their ethics education and knowledge. 5,11,12 Residents similarly have reported minimal training regarding discussions about death and end-of-life care, 4,13 which makes addressing ethical dilemmas at the end of life even more challenging.…”

Section: Introductionmentioning

confidence: 99%

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Ethical Dilemmas at the Beginning and End of Life: A Needs-Based, Experience-Informed, Small-Group, Case-Based Curriculum for Pediatric Residents

Herbst

deSante-Bertkau

2020

MedEdPORTAL

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Introduction: Pediatric residents are faced with ethical dilemmas in beginning-and end-of-life situations throughout their training. These situations are innately challenging, yet despite recommendations that residents receive training in ethics and end-of-life domains, they continue to report the need for additional training. To address these concerns, we developed an interactive and reflective palliative care and medical ethics curriculum including sessions focusing on ethical dilemmas at the beginning and end of life. Methods: This module includes a trio of case-based, small-group discussions on artificial nutrition and hydration, futility, and ethical considerations in neonatology. Content was developed based on a needs assessment, input from local experts, and previously published material. Trainees completed assessments of comfort and understanding before and after each session. Results: The module was attended and assessed by an average of 27 trainees per session, including residents and medical students. Knowledge of ethical considerations improved after individual sessions, with 86% of trainees reporting understanding ethical considerations involved in the decision to withdraw or withhold medically provided nutrition and hydration and 67% of trainees reporting understanding the use of the term futility. Trainee comfort in providing counseling or recommendations regarding specific ethical issues demonstrated a trend toward improvement but did not reach statistical significance. Discussion: We successfully implemented this innovative module, which increased trainees' comfort with end-of-life care and ethical conflicts. Future studies should focus on the trainees' ability to implement these skills in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ethical Dilemmas at the Beginning and End of Life: A Needs-Based, Experience-Informed, Small-Group, Case-Based Curriculum for Pediatric Residents

Herbst

deSante-Bertkau

2020

MedEdPORTAL

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“…In recent years, there has been a desperate need for systematic education for paediatricians 28 29. One recent study showed that proper education helps physicians become tolerant professionals in terms of making correct decisions for their patients 30…”

Section: Discussionmentioning

confidence: 99%

Decision-making dilemmas of paediatricians: a qualitative study in Japan

et al. 2019

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ObjectiveTo delineate the critical decision-making processes that paediatricians apply when treating children with life-threatening conditions and the psychosocial experience of paediatricians involved in such care.DesignWe conducted semistructured, individual face-to-face interviews for each participant from 2014 to 2015. The content of each interview was subjected to a comprehensive qualitative analysis. The categories of dilemma were extracted from a second-round content analysis.ParticipantsParticipants were board-certified paediatricians with sufficient experience in making decisions in relation to children with severe illnesses or disabilities. We repeated purposive sampling and analyses until we reached saturation of the category data.ResultsWe performed interviews with 15 paediatricians. They each reported both unique and overlapping categories of dilemmas that they encountered when making critical decisions. The dilemmas included five types of causal elements: (1) paediatricians’ convictions; (2) the quest for the best interests of patients; (3) the quest for medically appropriate plans; (4) confronting parents and families and (5) socioenvironmental issues. Dilemmas occurred and developed as conflicting interactions among these five elements. We further categorised these five elements into three principal domains: the decision-maker (decider); consensus making among families, colleagues and society (process) and the consequential output of the decision (consequence).ConclusionsThis is the first qualitative study to demonstrate the framework of paediatricians’ decision-making processes and the complex structures of dilemmas they face. Our data indicate the necessity of establishing and implementing an effective support system for paediatricians, such as structured professional education and arguments for creating social consensus that assist them to reach the best plan for the management of severely ill children.

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“…Similarly, prior studies found that many practicing pediatricians rate the ethics education they received during residency as poor or fair [16][17][18] and that knowledge of ethics once in practice was lacking in several important domains. 19 Recognizing the significant challenge of curricular crowding, the higher and intermediate priority ethics themes presented in Table 2 could be preferentially addressed in a targeted fashion by implementing and/or adapting existing curricula. Given the generally high importance ratings in the present study, caution should be exercised in excluding topics altogether.…”

Section: Discussionmentioning

confidence: 99%

Evaluating pediatrics residents’ ethics learning needs using multisource interprofessional feedback

MacPherson¹,

Emberley²

2017

Can. Med. Ed. J

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Background: Ethics education is a required component of pediatric residency training. Limited instructional time requires educators to identify and prioritize learning needs. This is the first study to identify pediatric residents' ethics learning needs using a multisource (360 degree) assessment. We hypothesized that pediatricians or allied health care professionals would identify unperceived ethics learning needs.Methods: Pediatric residents, pediatricians, respiratory therapists (RTs), and registered nurses (RNs) working at a university children's hospital rated the importance of twelve ethics themes as learning needs for trainees using a Likert-type scale. One-way ANOVA was used to determine differences between the groups, followed by post-hoc testing. Results:Response rates were 65%, 70%, 57%, and 47% for residents, pediatricians, RTs, and RNs, respectively. Themes were categorized into three priority groupings based on mean importance ratings. Where significant differences existed between residents and other respondent groups, pediatric residents rated the theme as being more important. Conclusion:This study provides an interprofessional assessment of pediatric residents' perceived ethics learning needs. High priority ethics topics were identified, allowing for targeted teaching. Pediatricians and allied HCPs did not rate any ethics themes higher than residents. Medical educators may consider using methods inspired by multisource feedback for program evaluation.

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Ethics knowledge of recent paediatric residency graduates: the role of residency ethics curricula

Cited by 13 publications

References 29 publications

Ethical Dilemmas at the Beginning and End of Life: A Needs-Based, Experience-Informed, Small-Group, Case-Based Curriculum for Pediatric Residents

Ethical Dilemmas at the Beginning and End of Life: A Needs-Based, Experience-Informed, Small-Group, Case-Based Curriculum for Pediatric Residents

Decision-making dilemmas of paediatricians: a qualitative study in Japan

Evaluating pediatrics residents’ ethics learning needs using multisource interprofessional feedback

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