Improving ethics education during residency training

Abstract

Background: Trainees struggle with the evaluation and management of inpatient clinical ethical dilemmas.

Aim: To meet their needs for both conceptual clarification and practical management, we designed a program to teach medical residents a systematic approach to resolving clinical ethical dilemmas.

Methods: We instituted monthly resident ethics educational case conferences to clarify residents' understanding of key concepts of medical ethics and to teach an 8-step systematic approach to resolving ethical dilemmas. We surveyed learners on the appropriateness, immediate utility, and potential for future usefulness of the approach.

Results: The vast majority of residents found the approach to be applicable and helpful with clinical decisions and interactions with patients and their family members.

Conclusions: Teaching residents to use a systematic approach in understanding and resolving ethical dilemmas can facilitate their management of the ethical dilemmas that arise in clinical practice. Providing trainees with a concise structure for the thought process involved gives them confidence in their ability to address the issues directly and to act for reasons that are explicit, transparent, and reflect medical professionalism.

Notes

Notes

1. Rawlsian reflective equilibrium (Rawls 1993) is a device for achieving a resolution of dilemmas in the hypothetical deduction of the basic principles for founding fair and just political society. Beauchamp and Childress draw on that model for resolving medical dilemmas. Step #7 in our model reflects a similar concern with achieving an overlapping consensus. Our model, however, is significantly different from the model advanced in the Principles of Bioethics in that our hypothetical model draws on the distinctive ethics of medicine as opposed to the ethics of everyday life. This distinction reflects Rawls's point in Political Liberalism that ‘the distinct purposes and roles of the part of the social structure … explains there being different principles for distinct kinds of subjects.’ (Rawls 1993: 262). It also reflects our fundamental disagreement with Beauchamp and Childress in holding that medical ethics is not just ordinary morality applied to medicine.

Additional information

Notes on contributors

David Alfandre

DAVID ALFANDRE, MD, MSPH is a General Internist in the Department of Medicine at the Mount Sinai School of Medicine. He divides his time between patient care, research and resident teaching.

Rosamond Rhodes

ROSAMOND RHODES, PhD is Professor of Medical Education and Director of Bioethics Education at the Mount Sinai School of Medicine and Professor of Philosophy at The Graduate Center, CUNY. She writes on a broad array of issues in bioethics.