Evaluating the effect of a human values seminar series on ethical attitudes toward resuscitation among pediatric residents

Abstract

A human values seminar series was designed to provide training in medical ethics for residents in pediatrics. Attitudes of residents toward resuscitation of children were surveyed before and after the seminar series. Nonpediatric residents rotating through pediatrics served as control subjects. Although both groups of residents demonstrated a significant change in attitude on six scales at the end of 1 year of training, pediatricians and nonpediatricians differed from each other with respect to only one of these scales. After the seminar series, pediatric residents expressed decreased willingness to resuscitate certain critically ill infants in the emergency room, whereas nonpediatricians expressed more willingness (P less than 0.009). Attitude change in decision making among pediatricians was significantly correlated with the consideration given to societal needs, sanctity of life, and anticipated poor morbidity (P less than 0.05). Among nonpediatricians, attitude change was significantly correlated with poor prognosis for survival (P less than 0.05), morbidity (P less than 0.05), or anticipated poor intellectual outcome (P less than 0.01). Attitude differences between the two groups of residents were unrelated to differences in preexisting attitudes or demographic factors. These findings show that attitudes about ethical decisions are influenced by both "maturation," or progression through a training program, and formal instruction. The finding that clinical attitudes change rapidly as residents progress through training confirms our previous findings and suggests that residency training programs should provide support and formal instruction in ethics during this time of change. The small change caused by this current method of instruction indicates that preliminary studies are needed to delineate the goals and the structure of future ethics courses.