Learning by doing: effectively incorporating ethics education into residency training

Abstract

Background: Medical ethics is a critical component of the curriculum for clinical trainees. Educational initiatives should adapt content to participants' experience in order to ensure relevance and retain their interest.

Aim: To develop and evaluate an experiential educational program for physicians.

Setting: Academic medical center.

Participants: Senior internal medicine residents (n = 40).

Program description: A case-based didactic program was designed in which each resident shared a difficult ethics case from their clinical experience. We created a curriculum around these cases involving formal didactics as well as open-ended discussion and summarized the ethical issues most relevant to the participants. A course survey was administered based upon the validated Students' Evaluation of Educational Quality (SEEQ).

Program evaluation: Common issues raised included surrogate decision-making (18 %), refusal of treatment (14 %), capacity/informed consent (10 %), and medical futility (10 %). Mean SEEQ subscale scores for learning value, organization/clarity, group interaction, breadth of coverage, and assignments/readings were 4.5 (maximum possible score 5). Residents unanimously rated the course overall as good/very good, and all agreed or strongly agreed that the course was useful and its structure effective.

Discussion: An experiential case-based didactic program in medical ethics engaged adult learners and facilitated a comprehensive and clinically relevant educational initiative.

Figure 1.

Summary of ethical issues in solicited cases. *Total > 40 because many cases encompassed multiple issues.