From Johns Hopkins U: Ethics Skills Laboratory Experience for Surgery Interns

J Surg Educ. 2014 Jul 7. pii: S1931-7204(14)00095-6. doi: 10.1016/j.jsurg.2014.03.010. [Epub ahead of print]

Ethics Skills Laboratory Experience for Surgery Interns.

Moon MR1, Hughes MT2, Chen JY3, Khaira K4, Lipsett P5, Carrese JA2.

Author information

• 1Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland. Electronic address: mmoon4@jhmi.edu.
• 2Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
• 3Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland.
• 4National College of Natural Medicine, Portland, Oregon.
• 5Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.

Abstract

INTRODUCTION AND PURPOSE:

Ethics curricula are nearly universal in residency training programs, but the content and delivery methods are not well described, and there is still a relative paucity of literature evaluating the effect of ethics curricula. Several commentators have called for more ethics curriculum development at the postgraduate level, and specifically in surgery training. We detail our development and implementation of a clinical ethics curriculum for surgery interns.

METHODS:

We developed curricula and simulated patient cases for 2 core clinical ethics skills-breaking bad news and obtaining informed consent. Educational sessions for each topic included (1) framework development (discussion of interns' current experience, development of a consensus framework for ethical practice, and comparison with established frameworks) and (2) practice with simulated patient followed by peer and faculty feedback. At the beginning and end of each session, we administered a test of confidence and knowledge about the topics to assess the effect of the sessions.

RESULTS:

A total of 98 surgical interns participated in the ethics skills laboratory from Spring 2008 to Spring 2011. We identified significant improvement in confidence regarding the appropriate content of informed consent (<0.001) and capacity to break bad news (<0.001). We also identified significant improvement in overall knowledge regarding informed consent (<0.01), capacity assessment (<0.05), and breaking bad news (0.001). Regarding specific components of informed consent, capacity assessment, and breaking bad news, significant improvement was shown in some areas, while we failed to improve knowledge in others.

CONCLUSIONS:

Through faculty-facilitated small group discussion, surgery interns were able to develop frameworks for ethical practice that paralleled established frameworks. Skills-based training in clinical ethics resulted in an increase in knowledge scores and self-reported confidence. Evaluation of 4 annual cohorts of surgery interns demonstrates significant successes and some areas for improvement in this educational intervention.