September 12, 2006

A lesson in medical ethics: medical residents and faculty pinpoint priorities in ethics education

ANN ARBOR, MI – It sounds like a scene from Grey’s Anatomy: “I had to tell them that their dad had cancer, something that would change their life, and they would remember me telling them the news and how I said it and if I connected…but I felt like I couldn’t find the right words.” So reports a resident when asked about training needs in ethics and professionalism.

There is no shortage of opinions on what physicians in training need to learn in ethics and professionalism; what has been lacking is data. In an article published in the most recent edition of The American Journal of Bioethics, researchers asked residents, faculty, ethic committee members and practicing physicians what residents need to learn to practice medicine ethically.  The authors identified several categories of needs:

• Issues about individual ethics or actions, for example honesty in keeping medical records
• Interprofessional relations, for example disagreements between residents and faculty
• Issues related to individual patients, including how to break bad news (as in the opening example)
• Issues arising from the work environment, for example working when sleep-deprived
• Issues related to teaching and learning, for instance tension between efficiency and the responsibility to train future physicians
• Issues arising due to external forces, such as insurance coverage and malpractice litigation

“Commonly, a small group of educators decides what topics to cover for residency training in graduate medical education, or it is assumed they will learn by being around proper role models. This study asked residents what issues they confront, and faculty, practicing physicians and other in-the-know professionals what they think residents should learn,” says author Susan Dorr Goold, M.D., MHSA, MA, director of U-M’s Bioethics Program and an associate professor of medicine and health management and policy. “For ethics training to be useful, and used, it needs to be relevant to medical practice. This study is one of the few that collected data about what people think is relevant.”

Residents reported many of the same priorities in ethics and professional training as did faculty, practicing physicians, and other professionals. Still, there were differences. For example, practicing physicians, with their real-world experience, called for more training in the ethics of resource allocation for patients: should patients be just told how their doctor is going to treat their condition, or should patients be presented with alternatives that might be more expensive, or not covered by insurance? Residents raised concerns about conflicts between their need to learn and providing patients with the best care, and wondered how to handle situations in which they feel a supervising physician acts improperly.

Besides obtaining an overview of needs in ethics and professionalism education, the authors specifically looked for topics and issues common to many specialties.

“All residency programs are required to teach in this area,” says Goold “and some of the topics cross specialty boundaries. Learning about confidentiality, or how to obtain consent, is important for internists, surgeons, family practitioners, neurologists – just about every specialty. Why not develop and use the same tools to teach all of them instead of reinventing the wheel in each department?”

Goold and coauthor David Stern, M.D., Ph.D., a U-M associate professor of internal medicine and medical education, did just that at the University of Michigan, developing curricula in several topics that can be used across the institution. The study took place in 1999, prior to the launch of the Accreditation Council of Graduate Medical Ethics outcomes-based requirements for residency education, and portions of the curriculum have been emulated at many other institutions.

E-mail this information to a friend

Recent Press Releases