Transcript Bioethics for Clinicians

Planning to
Teach Bioethics
Plan of Presentation
Why should we teach?
Who should we teach?
What should we teach?
How should we teach?
How should we
evaluate?
How should we learn?
Why should we teach?
Performance
Performance
Performance
(and quality)
(and moral distress)
Who should we teach?
Medical students
Residents
Fellows
Practicing physicians
Health care teams
What should we teach?
Depends on
profession
level of “student”
specialty
What should we teach?
Critical issues
Formal vs informal
curriculum
Theory vs practice
Principles vs
decision tools vs
paradigm cases
What should we teach?
Medical students
Integrated curriculum
Student-specific ethical dilemmas (Hicks
et al)
conflict between medical education and
patient care
responsibility beyond one's capabilities
perceived substandard patient care
I should call the
staff back...
An intern and clinical clerk are asked
to close a surgical wound; staff then leaves
the OR. Neither the intern or the clerk
has performed this procedure before.
Is this being done
incorrectly?
Will this affect the
clinical outcome?
Intern attempts to
close the incision,
appears to be having difficulty.
How can I call my
staff without humiliating
my resident?
Intern now clearly
has difficulty. Patient
beginning to rouse
from anesthetic.
If I call for help, I’ll
look incompetent, get
less opportunities and
it may affect my mark.
Clerk decides not to
call staff. Intern
finishes closing.
Wound
infection
How should we teach?
Lecture
Teacher’s cases
Paper
Video
Standardized patient
Learner’s cases
Role play
Bedside encounter
Extracurricular activities
Teaching Medical Ethics
the University of Chicago
Program Concepts (“5 C’s”)
• Teaching should be C linically cased
• Real patient C ases should serve as the
teaching focus
• Teaching should be C ontinuous
• Ethics teaching should be C oordinated with
the students’ other learning objectives
• C linicians should be participate actively in
the teaching effort both as instructors and as
role models
Teaching Bioethics
Faculty of Medicine, PSU
Year 1 : 3 hours
General Philosophy
Year 2 : 16 hours
Foundation to Clinical Practice and Medical Ethics I
Introduction to Ethics
Meta-ethics
Ethical reasoning I
Foundation to Clinical Practice and Medical Ethics II
Doctor-patient relationship
Ethical reasoning II
Ethical reasoning III
Teaching Bioethics
Faculty of Medicine, PSU
Year 3 : 21 hours
Foundation to Clinical Practice and Medical Ethics III
Principles of Bioethics
Autonomy
Beneficence and Non-maleficence
Foundation to Clinical Practice and Medical Ethics IV
Difficult patients
Justice and resource allocation
Breaking bad news
Difficult of life and death
Medical codes of ethics
Ethics and law
Teaching Bioethics
Faculty of Medicine, PSU
Year 4 : 12 hours
Health and Diseases of Adults and Elderly
Consent
Confidentiality
Substitute decision-making
Doctor-patient relationship
Preoperative to Postoperative Care
Consent
Truth telling and withholding information
Conflict of interest (student issue)
Family and Community Medicine
Public health ethics
Teaching Bioethics
Faculty of Medicine, PSU
Year 5 : 15 hours
Health and Diseases of Adults and Elderly
Quality end-of-life care
Preoperative to Postoperative Care
Refusal of treatment
Medical negligence
Health and Diseases from Conception to Adolescence
Involving children in decision making
Resource allocation
Health and Diseases of Women
Maternal-fetal dilemma
Medical futility
Reproductive technology
Teaching Bioethics
Faculty of Medicine, PSU
Year 5 (continued)
Emergency Medicine and accidents
Ethics in emergency
Selected Ambulatory Care
Medical negligence
Mistake
Year 6 : 6 hours
Socio-economic issues in health care
Termination of medical care
Palliative care
Medico-legal issues
How should we teach?
Students
• Direct
Formal
Curricular activities
Extra-curricular activities
Informal
• Indirect
Extra-curricular activities
Role models
Staff development
Teaching “Bioethics”
How should we teach?
Simulated patient
Role play
Cultural tour,
12.2%
Exhibition
8.2%
Team-taught lecture
16.3%
Small group discussion
Problem-based learning
63.3%
RCPSC Bioethics Requirements
“The academic program must provide
opportunities for residents to gain an
understanding of the basic principles of
biomedical ethics as it relates to the
specialty”
“That the Royal College extend evaluation
of bioethics in all of its current methods of
evaluation of programs and residents”
RCPSC Bioethics Project
Goals
To integrate bioethical knowledge and skills
into the clinical practice of residents
To assist Canadian post-graduate program
directors to teach bioethics
To develop model curricula in medicine,
surgery, OBGYN, and psychiatry
To develop evaluation strategies
RCPSC Bioethics Project
Medicine Curriculum Topics
truth telling
consent
capacity
substitute decision
making
confidentiality
conflict of interest
appropriate use of
life-sustaining
treatment
euthanasia /
assisted suicide
resource allocation
research ethics
How shall we evaluate?
Knowledge
Mutliple choice, true / false
Analysis
Essay question
Performance
Chart review
OSCE
In-training evaluation
How shall we evaluate?
 Knowledge/Analysis
 Essay
question
 Modified essay question (MEQ)
 Multiple choice question (MCQ)
 Performance
 Chart
review
 Objective structured clinical examination
(OSCE)
 Direct observation
 In-training evaluation
Thank You for
Your Attention