Medical students, residents want more ethics training
Medical students, residents want more ethics training
Real-time exposure to ethical dilemmas needed
Two-thirds of medical students and residents believe there is a need for more ethics training during their curricula and training programs, according to a survey of 129 medical students and 207 residents done in 2009 and 2010 at University of Maryland School of Medicine in Baltimore.
There is a general feeling among educators that medical students and residents haven't had sufficient ethics education to deal with medical ethics issues that they confront when they begin to practice, according to Henry Silverman, MD, the study's lead author and faculty in the Department of Medicine at University of Maryland.
"Nonetheless, such beliefs need to be confirmed and documented in order to convince top officials at universities to further enhance ethics education in the curriculum," says Silverman. "Having said this, the present study did document that medical students and residents do desire more ethics education in their curriculum."
Only eight of 35 scenarios covered in the survey resulted in more than 70% of respondents saying they felt comfortable. Physicians-in-training felt least comfortable when dealing with reporting medical errors, cultural issues, resolving disagreements between family members, talking with family members after a patient has died, and determining when it is appropriate to withhold life-sustaining treatments from patients.
"These results are very concerning. They indicate most students and residents surveyed are not comfortable dealing with ethics issues they will encounter on a regular basis in clinical practice," says Marianne L. Burda, MD, PhD, a Pittsburgh, PA-based ethics consultant and educator.
Physicians-in-training felt very comfortable with breaking bad news, discussing do-not-resuscitate orders, and obtaining informed consent, which probably reflects recent emphasis on these issues, says Silverman.
Only 13.4% of respondents reported receiving a formal course in ethics during medical school training. Having had any type of prior ethics education in medical school was not associated with being more comfortable dealing with clinical ethics dilemmas, notes Silverman. "This finding suggests that physicians-in-training are not receiving optimal training to deal with real-world clinical ethics dilemmas," he says. "To be sure, curricula that teach abstract ethical principles and even critical thinking skills do not go far enough to prepare students for the wards."
Residents felt more comfortable with many of the clinical ethics issues than medical students. "Essentially, physicians-in-training gain experience by actually confronting clinical ethics issues while on the wards, the so-called 'experiential' curriculum. However, much of this experience is unstructured and unfocused," says Silverman. "What they need is more formal instruction within the context of real-time exposure to ethical dilemmas." For instance, medical students could participate in weekly conferences to discuss ethics issues in a formal manner as they occur, instead of discussing hypothetical cases.
The authors conclude that the best approach to ethics training may be "experiential" training that exposes students and residents to ethical dilemmas in the actual clinical setting, with a structured format that develops ethical reasoning skills. One such approach is already in place at Drexel University College of Medicine, reports Burda. Third-year medical students participate in a class where they encounter patients or family members in a number of common clinical ethical dilemmas.
"Students have the opportunity to practice applying classroom ethics knowledge to clinical situations," she says. Other experiential approaches include observing and participating in clinical ethics case consultations and including clinical ethicists on teaching rounds to help train students and residents in identifying and resolving ethical issues, adds Burda.
Horace M. DeLisser, MD, associate professor of medicine at the University of Pennsylvania's Perelman School of Medicine, recommends an approach that covers all four years of medical school. "Our approach begins in year one with formal course work, instruction on ethical analysis, and discussion of classic cases. It continues through the clinical clerkships with frequent opportunities for students to discuss ethically challenging experiences with faculty and peers," he says. "It concludes in the fourth year, two months before graduation, with an intensive capstone bioethics course. That includes a lot of small group discussion."
Reference
- Silverman HJ, Dagenais J, Gordon-Lipkin, et al. Perceived comfort level of medical students and residents in handling clinical ethics issues. J Med Ethics 2012 Oct 12. [Epub ahead of print]
Sources
- Marianne L. Burda, MD, PhD, Pittsburgh, PA. Phone: (724) 933-0265. E-mail: [email protected].
- Horace M. DeLisser, MD, Associate Professor of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Phone: (215) 573-9916. Fax: (215) 746-1224. E-mail: [email protected].
- Henry Silverman, MD, MA, Professor of Medicine/Chair, Ethical Advisory Committee, University of Maryland, Baltimore. Phone: (410) 328-4881. Fax: (410) 328-0177. E-mail: [email protected].
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.