Bioethics curriculum for paediatrics residents: implementation and evaluation

Abstract

Context and setting At Children's Hospital Boston, residents in paediatrics routinely see patients who are ethically challenging, providing fertile ground for the development of moral quandaries. Approaching an ethical dilemma systematically is a skill that must be learned and cultivated over time. Residents must acquire this proficiency, as well as countless others, during their 3-year training programme. Without deliberate efforts towards this end, it is unreasonable to expect residents to acquire these skills on their own. Residents should learn the principles of bioethics needed to develop a sound approach to moral dilemmas in their educational curriculum. Why the idea was necessary Research shows that residents crave more structured learning on informed consent, the doctor−patient relationship and end-of-life decision making. A needs assessment survey administered to 120 residents in paediatrics at Children's Hospital Boston revealed a desire to know more about medical futility, ethics in medical research, and ethical practice in the age of managed care. Studies indicate that residents gain confidence and feel more competent when addressing moral questions after their programmes establish a formal ethics curriculum. What was done An innovative 12 session, 2-year curriculum in bioethics was developed and implemented in September 2003 such that 6 lunchtime conferences per year are dedicated to teaching in ethics. Each of the 12 conferences addresses ethical issues related to specific hospital services on which residents spend time. Examples include ‘Ethics and the ICU Patient’, ‘Ethics and Primary Care’ and ‘Ethics in the Emergency Room.’ Sessions are led by multidisciplinary teams of faculty in bioethics, attending doctors, nurses and lawyers, all of whom have backgrounds in bioethics. Evaluation of results and impact The curriculum in bioethics is evaluated by 2 methods. Firstly, after each session, residents complete feedback forms. Residents have given high ratings to the curriculum's relevance to a paediatrician's career, its importance to the care of children, and its ability to effectively convey important knowledge. Secondly, a formal research study is underway, aiming to create a new research tool that could then be used to evaluate the efficacy of the new ethics curriculum. Mentored by Dr Steven Joffe from the Dana−Farber Cancer Institute, I designed 5 online ethics vignettes. In May 2004, pilot respondents were asked to identify relevant ethical issues raised by the vignettes and to develop and justify a plan to address the ethical dilemmas. A scoring sheet was also developed and 2 independent readers have scored the pilot responses. Data analysis is underway to determine if the instrument has sufficient interrater reliability to make it a useful tool. To date, no instrument has been developed that will validly and reliably assess learning and competency in ethics. This study hopes to contribute such a tool that may be utilised in future research in ethics education. If successful, this new instrument will then be used in a future cohort study to evaluate the new curriculum in ethics at Children's Hospital Boston in an effort to define and evaluate ethical competency among our paediatricians.