Ethical Dilemmas at the Beginning and End of Life: A Needs-Based, Experience-Informed, Small-Group, Case-Based Curriculum for Pediatric Residents

Abstract

Introduction: Pediatric residents are faced with ethical dilemmas in beginning-and end-of-life situations throughout their training. These situations are innately challenging, yet despite recommendations that residents receive training in ethics and end-of-life domains, they continue to report the need for additional training. To address these concerns, we developed an interactive and reflective palliative care and medical ethics curriculum including sessions focusing on ethical dilemmas at the beginning and end of life. Methods: This module includes a trio of case-based, small-group discussions on artificial nutrition and hydration, futility, and ethical considerations in neonatology. Content was developed based on a needs assessment, input from local experts, and previously published material. Trainees completed assessments of comfort and understanding before and after each session. Results: The module was attended and assessed by an average of 27 trainees per session, including residents and medical students. Knowledge of ethical considerations improved after individual sessions, with 86% of trainees reporting understanding ethical considerations involved in the decision to withdraw or withhold medically provided nutrition and hydration and 67% of trainees reporting understanding the use of the term futility. Trainee comfort in providing counseling or recommendations regarding specific ethical issues demonstrated a trend toward improvement but did not reach statistical significance. Discussion: We successfully implemented this innovative module, which increased trainees' comfort with end-of-life care and ethical conflicts. Future studies should focus on the trainees' ability to implement these skills in clinical practice.

Ethics of Pediatric and Young Adult Medical Decision-Making: Case-Based Discussions Exploring Consent, Capacity, and Surrogate Decision-Making

“…As previously stated, a primary challenge we faced following initial curriculum development and implementation was the breadth of content that could be included when educating on palliative care and medical ethics. 26 We tailored the structure of our sessions to fit into the morning-report curriculum, which allowed for better attendance than embedding sessions into individual rotations.…”

Medical students positions regarding resource allocation in times of crisis

“…It is also possible that clinical experience makes students more decisive in general, although a previous study found a correlation between decisiveness and personality, but not with medical knowledge. 12 A questionnaire-based study by Silverman HJ, Dagenais J et al 13 done on clinical year students and medical residents suggests that the course of medical school and residency help prepare the subjects to handle ethical problems in the clinical setting. Early clinical experience is a part of the curriculum at Ben Gurion University, as preclinical students are exposed to different medical fields (e.g.…”

Educación bioética en la formación del fisioterapeuta: Perspectiva de los estudiantes

“…Siendo la Fisioterapia una disciplina del área de la salud, debe tener la capacidad de dar soluciones a las encrucijadas propias de las ciencias sanitarias (Ministerio de Salud y Protección Social [MinSalud], 2015), porque en su práctica clínica, los estudiantes, con frecuencia, tienen que navegar desafiantes dilemas éticos y conflictos interpersonales que pueden desarrollarse en estos escenarios (Herbst y DeSante-Bertkau, 2020), resaltando la necesidad de desarrollar el autoanálisis, la resolución y análisis de problemas éticos (Sorê, 2020). De igual manera, la enseñanza de bioética debe estar bien integrada en la formación, para que los futuros profesionales estén preparados en la toma de decisiones éticas (Brooks y Bell, 2017).…”