BackgroundEffective management of clinical ethical issues has a significant impact on patients’ experience and outcome. Our anonymous survey found that final year medical students have a confidence of 5.6 (10-point Likert scale) of the management of common clinical medical ethical issues. We have designed high-fidelity simulation teaching to teach about ethical principles and their practical application to patient cases.MethodologyWe identified three common clinical ethical issues through focus group work with junior doctors. We designed three high-fidelity simulation scenarios to cover the issues. The scenarios were; (1) maintaining patient confidentiality when talking to relatives, (2) mental capacity assessment in a self-discharge case and (3) acting in a vulnerable patient’s best interests. We delivered the three scenarios with detailed debriefs to five groups of final year medical students.ResultsThirty-three medical students provided feedback (n = 33) through an anonymous paper questionnaire. We collected qualitative and quantitative feedback via fre text boxes and 10-point Likert scales.Confidentiality: After the confidentiality scenario there was an improved awareness of 1.38/10 (p-value 0.0007) from 8.21 to 9.59. There was an improvement in confidence with management of 2.36/10 (p-value <0.0001) from 5.97 to 8.33.Capacity: This scenario showed an improved perceived relevance of 1.01/10 (p-value 0.0015) from 8.58 to 9.59. Student’s confidence with management improved by 1.94/10 (p-value < 0.0001) from 6.70 to 8.64.Best interests: Students reported an improved awareness of 1.03/10 (p-value < 0.0052) from 8.58 to 9.61. The student’s confidence with management improved by 2.30/10 (p-value < 0.0001) from 5.97 to 8.27.Students commented in the feedback that there was a ‘massive difference to learning in real time than textbook’ and it made the ethics teaching ‘much more fun and more memorable.’RecommendationsWe hope to expand this teaching to students within other healthcare professions and postgraduate healthcare professionals.
BackgroundOne incident of domestic violence is reported to the police every minute.1 The healthcare professional’s confidence and ability in management is vital. Patient confidentiality with such cases can prove particularly difficult to manage when talking to partners and relatives. We designed a two-part multi-disciplinary simulation teaching session. The primary aim was to increase awareness and confidence with management of domestic violence and patient confidentiality. The secondary aim was to improve and highlight the importance of multi-disciplinary team work.MethodBetween the medical and nursing student faculties we organised a series of simulation sessions. We designed a two-part simulation scenario, which was set in a simulated Emergency Department. A young girl presents with rib pain. For part one, she is reviewed by two nursing students, who then phone the two medical students for further assessment. The patient reveals that the injury was caused by domestic violence but she does not want anyone to know. For part two, the patient leaves and then her partner arrives, demanding details. The multi-disciplinary team worked together to manage the patient and talk with the relative.ResultsWe collected quantitative and qualitative data using free text boxes and 10-point Likert scales, from an anonymous, optional paper questionnaire, n = 29. Domestic violence: The feedback showed an improved awareness of domestic violence of 1.59/10 (p-value < 0.0019), from 7.69 to 9.28. There was an improved confidence in management of a domestic violence case of 2.97/10 (p-value <0.0001) from 4.48 to 7.45. Confidentiality: Students’ awareness of confidentiality improved by 1.22/10 (p-value 0.0139) from 8.07 to 9.29. Confidence with managing patient confidentiality improved by 2.24/10 (p-value <0.0001), from 6.62 to 8.86.RecommendationsThe feedback has demonstrated a statistically significant improvement in students’ awareness and confidence. We hope to extend this session to further Academies and Trusts for both undergraduate and postgraduate students.ReferenceWoman’s Aid, Statistics
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