Much ethics education focuses on students and residents, but practicing physicians also need ethics expertise. An ethics and professional curriculum was piloted for faculty in obstetrics and gynecology.1

“Our motivation was the awareness that faculty model ethical knowledge, behavior, and care formally, informally, and via the hidden curriculum,” says Kavita Shah Arora, MD, MBE, MS, one of the study’s authors.

The goal was to fill gaps in ethics education. Twenty-eight faculty members attended a single four-hour session. Participants reported less burnout. “We were happy to see that our curriculum was both feasible and well-received. Faculty are looking for this information,” says Arora, an associate professor of reproductive biology and bioethics at Case Western Reserve University.

While efforts have been made to educate trainees, there has been a relative lack of ethics education focused on medical faculty. “Further work is necessary to assess whether we also raised knowledge in ethics and impacted use of ethics consultative services,” Arora adds.

Ethicists who work alongside obstetrician-gynecologists should consider offering these routine educational opportunities, according to David I. Shalowitz, MD, MSHP:

• Review common ethical issues (advance care directives, informed consent for procedures, or whether sale of nonmedical products is permissible in the clinic);

• Give updates on intersections between the law and ethics;

• Discuss cases that clinicians have found particularly challenging.

“Obstetrician-gynecologists routinely encounter ethical challenges during clinical care,” notes Shalowitz, assistant professor of gynecologic oncology at Wake Forest Baptist Health.

Some of these issues are addressed by the Committee on Ethics of the American College of Obstetricians and Gynecologists. This provides adequate guidance in most circumstances, Shalowitz says. “However, in some cases, uncertainty may remain, in which case an ethics consultant may provide much-needed clarity,” he explains.

Continuing ethics education is vital for practicing physicians, “especially in our field,” says Ginny Ryan, MD, MA (Bioethics), an associate professor in University of Iowa’s department of obstetrics and gynecology. “Medical students I work with consistently rank obstetrics and gynecology as the most ethically fraught experience they have on their rotations,” she reports.

Students find it challenging to consider pregnant women as separate from the fetus. “Students also struggle with issues surrounding abortion, pelvic exams on anesthetized patients, reproductive rights, and the lack of availability of infertility care,” Ryan adds.2

Hospital leaders also can support providers by encouraging continuing ethics education and conference attendance. “Leaders can look into hosting their own conferences or roundtables to address locally or regionally pertinent ethics issues,” Ryan suggests.

REFERENCES

  1. Hollins LL, Wolf M, Mercer B, Arora KS. Feasibility of an ethics and professionalism curriculum for faculty in obstetrics and gynecology: A pilot study. J Med Ethics 2019;45:806-810.
  2. Mejia RB, Shinkunas LA, Ryan GL. Ethical issues identified by obstetrics and gynecology learners through a novel ethics curriculum. Am J Obstet Gynecol 2015;213:867.e1-867.e11.