Training pediatric house staff in evidence-based ethics: an exploratory controlled trial

Abstract

Objective: To evaluate an educational intervention in evidence-based ethics (emphasizing clinical knowledge, epidemiologic skills, and recognition of ethical issues) administered to house staff before rotating through our neonatal intensive care unit.

Study design: A controlled trial of 64 pediatric house staff assigned to alternating control and intervention rotations. Questionnaires were administered at the end of the rotation.

Results: Some benefits of the intervention were observed. However, a large percentage of intervention and control house staff substantially overestimated (>1.25 correct value) predischarge mortality (23% vs. 55% of house staff; p<0.02), mortality or major morbidity (74% vs. 46% of house staff; p=0.04), and cerebral palsy rates (70% vs. 87%; p=0.12). Neither group cited many methodological criteria for evaluating follow-up studies (3.3 vs. 2.4 criteria; p=0.05) or ethical issues considered in treatment recommendations for extremely premature infants (3.1 vs. 2.8 issues; p=0.35).

Conclusion: Improved house staff training in evidence-based ethics is needed.