Ethical Dilemmas at the Beginning and End of Life: A Needs-Based, Experience-Informed, Small-Group, Case-Based Curriculum for Pediatric Residents.
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SUBMITTER: Herbst LA
PROVIDER: S-EPMC7187913 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundVaccination is the most cost-effective medical intervention known to prevent morbidity and mortality. However, data are limited on the effectiveness of residency programs in delivering immunization knowledge and skills to trainees. The authors sought to describe the immunization competency needs of medical residents at the University of Toronto (UT), and to develop and evaluate a pilot immunization curriculum.MethodsResidents at the University of Toronto across nine specialties were recruited to attend a pilot immunization workshop in November 2018. Participants completed a questionnaire before and after the workshop to assess immunization knowledge and compare baseline change. Feedback was also surveyed on the workshop content and process. Descriptive statistics were performed on the knowledge questionnaire and feedback survey. A paired sample T-test compared questionnaire answers before and after the workshop. Descriptive coding was used to identify themes from the feedback survey.ResultsTwenty residents from at least six residencies completed the pre-workshop knowledge questionnaire, seventeen attended the workshop, and thirteen completed the post-workshop questionnaire. Ninety-five percent (19/20) strongly agreed that vaccine knowledge was important to their career, and they preferred case-based teaching. The proportion of the thirty-four knowledge questions answered correctly increased from 49% before the workshop to 67% afterwards, with a mean of 2.24 (CI: 1.43, 3.04) more correct answers (P < 0.001). Sixteen residents completed the post-workshop feedback survey. Three themes emerged: first, they found the content specific and practical; second, they wanted more case-based learning and for the workshop to be longer; and third, they felt the content and presenters were of high quality.ConclusionsFindings from this study suggest current immunization training of UT residents does not meet their training competency requirements. The study's workshop improved participants' immunization knowledge. The information from this study could be used to develop residency immunization curriculum at UT and beyond.
| S-EPMC7671185 | biostudies-literature
Project description:IntroductionMost residents have limited education or exposure to health policy during residency.AimsWe developed a course to (1) educate residents on health policy topics applicable to daily physician practice; (2) expose residents to health policy careers through visits with policy makers and analysts; (3) promote personal engagement in health policy.SettingResidents registered for a 3-week elective offered twice annually through the George Washington University Department of Health Policy.Program descriptionThe course format includes: daily required readings and small-group seminars with policy experts, interactive on-site visits with policy makers, and final team presentations to senior faculty on topical health policy issues.Program evaluationOne hundred thirty residents from 14 specialties have completed the course to date. Seventy completed our post-course survey. Most participants [59 (84%)] felt the course was very or extremely helpful. Participant self-ratings increased from pre- to post-course in overall knowledge of health policy [2 (3%) good or excellent before, 58 (83%) after], likelihood of teaching policy concepts to peers [20 (25%) vs. 62 (86%)], and likelihood of pursuing further health policy training [28 (37%) vs. 56 (82%)].ConclusionsThis 3-week elective in health policy improves self-reported knowledge and interest in health policy research, advocacy, and teaching.
| S-EPMC2787946 | biostudies-literature
Project description:National and international codes of research conduct have been established in most industrialized nations to ensure greater adherence to ethical research practices. Despite these safeguards, however, traditional research approaches often continue to stigmatize marginalized and vulnerable communities. Community-based participatory research (CBPR) has evolved as an effective new research paradigm that attempts to make research a more inclusive and democratic process by fostering the development of partnerships between communities and academics to address community-relevant research priorities. As such, it attempts to redress ethical concerns that have emerged out of more traditional paradigms. Nevertheless, new and emerging ethical dilemmas are commonly associated with CBPR and are rarely addressed in traditional ethical reviews. We conducted a content analysis of forms and guidelines commonly used by institutional review boards (IRBs) in the USA and research ethics boards (REBs) in Canada. Our intent was to see if the forms used by boards reflected common CBPR experience. We drew our sample from affiliated members of the US-based Association of Schools of Public Health and from Canadian universities that offered graduate public health training. This convenience sample (n = 30) was garnered from programs where application forms were available online for download between July and August, 2004. Results show that ethical review forms and guidelines overwhelmingly operate within a biomedical framework that rarely takes into account common CBPR experience. They are primarily focused on the principle of assessing risk to individuals and not to communities and continue to perpetuate the notion that the domain of "knowledge production" is the sole right of academic researchers. Consequently, IRBs and REBs may be unintentionally placing communities at risk by continuing to use procedures inappropriate or unsuitable for CBPR. IRB/REB procedures require a new framework more suitable for CBPR, and we propose alternative questions and procedures that may be utilized when assessing the ethical appropriateness of CBPR.
| S-EPMC2219570 | biostudies-other
Project description:IntroductionPediatricians are at the front line to diagnose new-onset diabetes and treat acute diabetes complications in children. Pediatric residents need a strong foundation in recognizing and managing pediatric diabetes, imposing a demand for a structured, comprehensive pediatric-specific diabetes curriculum.MethodsThis three-module case-based curriculum focused on diabetes fundamentals relevant to pediatricians in the outpatient and inpatient settings. Each module covered an independent topic within pediatric diabetes. Topics included diabetic ketoacidosis, new-onset diabetes management, and acute complications of diabetes. The modules were focused, short, and flexible to accommodate learners' demanding clinical duties and time limitations. We delivered the curriculum to pediatric residents rotating in the inpatient endocrinology department over 3 separate days. Pre- and posttests assessed learners' knowledge and confidence in diabetes care.ResultsWe tested the curriculum for 7 months in 10 individual cycles, with 11 learners participating. We noted an increase in learners' scores on diabetes knowledge assessment of 16% (95% CI, 5-28; p = .01) after completing the curriculum. The residents' confidence in performing diabetes clinical care skills also improved, with the majority going from reporting low or neutral confidence before instruction to reporting high confidence after instruction. Learners reported 100% extreme satisfaction with the curriculum.DiscussionThis case-based curriculum exposed residents to pediatric diabetes using authentic, clinically relevant, engaging scenarios. The curriculum enabled learners to actively rationalize their thought process and slow down learning. Short and focused, the curriculum was suitable for mitigating the cognitive load and the time constraints in busy clinical environments.
| S-EPMC8155076 | biostudies-literature
Project description:IntroductionThe American Board of Emergency Medicine identifies medical toxicology as an essential curricular element for emergency medicine (EM) residencies; however, access to medical toxicology education varies widely by institution. We hypothesized that EM residents are uncomfortable with core toxicology content and would be interested in a dedicated toxicology curriculum.MethodsAn electronic needs assessment survey developed by experts in EM and medical toxicology was sent to residents and program leadership at nine EM programs participating in the Emergency Medicine Education Research Alliance (EMERA), a geographically diverse sampling of academic EM residency programs. We queried the presence of a current toxicology curriculum, interest in a dedicated toxicology curriculum, and comfort with core toxicology concepts for board examinations and in clinical practice. RESULTS: A total of 148 residents and 8 faculty leadership completed the survey. Only 29% of resident respondents felt comfortable with toxicology concepts, and only 66% of respondents reported access to a toxicology curriculum. Of those without a known toxicology curriculum, most were interested in a formal curriculum. Faculty respondents reported 6/8 programs offered a toxicology curriculum. Faculty at the two programs without a formal curriculum expressed interest in a dedicated curriculum.ConclusionsEmergency medicine residents remain uncomfortable with the core toxicology content in clinical practice. The majority of residents without a known toxicology curriculum would be interested in a dedicated toxicology curriculum.
| S-EPMC8206434 | biostudies-literature
Project description:BackgroundDespite significant teaching responsibilities and national accreditation standards, most residents do not receive adequate instruction in teaching methods. Published reports of residents-as-teachers programs vary from brief one-time exposures to curricula delivered over several months. A majority of interventions described are one or two-day workshops with no clear follow-up or reinforcement of skills. A three-year longitudinal teaching skills curriculum was implemented with these goals: 1) deliver an experiential skill-based teaching curriculum allowing all residents to acquire, practice and implement specific skills; 2) provide spaced skills instruction promoting deliberate practice/reflection; and 3) help residents gain confidence in their teaching skills.MethodsOne hundred percent of internal medicine residents (82/82) participated in the curriculum. Every 10 weeks residents attended a topic-specific experiential skills-based workshop. Each workshop followed the same pedagogy starting with debriefing/reflection on residents' deliberate practice of the previously taught skill and introduction of a new skill followed by skill practice with feedback. Every year, participants completed: 1) assessment of overall confidence in each skill and 2) retrospective pre-post self-assessment. A post-curriculum survey was completed at the end of 3 years.ResultsResidents reported improved confidence and self-assessed competence in their teaching skills after the first year of the curriculum which was sustained through the three-year curriculum. The curriculum was well received and valued by residents.ConclusionsA formal longitudinal, experiential skills-based teaching skills curriculum is feasible and can be delivered to all residents. For meaningful skill acquisition to occur, recurrent continuous skill-based practice with feedback and reflection is important.
| S-EPMC8207581 | biostudies-literature
Project description:The ethical dilemma (ED) of whether autonomous vehicles (AVs) should protect the passengers or pedestrians when harm is unavoidable has been widely researched and debated. Several behavioral scientists have sought public opinion on this issue, based on the premise that EDs are critical to resolve for AV adoption. However, many scholars and industry participants have downplayed the importance of these edge cases. Policy makers also advocate a focus on higher level ethical principles rather than on a specific solution to EDs. But conspicuously absent from this debate is the view of the consumers or potential adopters, who will be instrumental to the success of AVs. The current research investigated this issue both from a theoretical standpoint and through empirical research. The literature on innovation adoption and risk perception suggests that EDs will be heavily weighted by potential adopters of AVs. Two studies conducted with a broad sample of consumers verified this assertion. The results from these studies showed that people associated EDs with the highest risk and considered EDs as the most important issue to address as compared to the other technical, legal and ethical issues facing AVs. As such, EDs need to be addressed to ensure robustness in the design of AVs and to assure consumers of the safety of this promising technology. Some preliminary evidence is provided about interventions to resolve the social dilemma in EDs and about the ethical preferences of prospective early adopters of AVs.Supplementary informationThe online version contains supplementary material available at 10.1007/s10676-021-09605-y.
| S-EPMC8253245 | biostudies-literature
Project description:Introduction:The interpretation of electrocardiograms (ECGs) is a critical competency for internal medicine trainees, yet time and resources to foster proficiency are limited. Methods:This resident-authored ECG email curriculum for first-year residents involved 129 first-year internal medicine residents at three major academic university hospitals. Residents either received the resident-authored ECG email curriculum (intervention group) or continued standard training (control group). The curriculum involved 10 multiple-choice ECG cases emailed biweekly over the 6-month study period. All participants were asked to complete a pre- and postintervention test to assess ECG interpretation competency and attitudes. The primary outcome was improvement in ECG test performance. Results:Among the 129 first-year residents participating, 21 of the 65 (32%) randomized to the intervention group and 13 of the 64 (20%) randomized to the control group completed both the pre- and posttests for analysis. While all participants' ECG test scores improved over the study period (p < .001), improvement did not differ between groups (p = .860). We found that the effect of the intervention on ECG test performance varied significantly by the number of cardiology rotations an intern experienced (p = .031), benefiting naïve learners the most. All intervention group participants who completed the posttest reported they would recommend it to a colleague. Discussion:While it did not improve resident performance on an ECG posttest, this resident-authored ECG email curriculum offers a scalable way to provide trainees additional practice with ECG interpretation, with particular benefit to trainees who have not yet rotated on cardiology.
| S-EPMC7431182 | biostudies-literature
Project description:Newborn infants are among those most severely affected by humanitarian crises. Aid organisations increasingly recognise the necessity to provide for the medical needs of newborns, however, this may generate distinctive ethical questions for those providing humanitarian medical care. Medical ethical approaches to neonatal care familiar in other settings may not be appropriate given the diversity and volatility of humanitarian disasters, and the extreme resource limitations commonly faced by humanitarian aid missions. In this paper, we first systematically review existing guidelines relating to the treatment and resuscitation of newborns in humanitarian crises, finding little substantive ethical guidance for those providing humanitarian healthcare. We next draw on paradigm cases and published literature to identify and describe some of the major ethical questions common to these settings. We divide these questions into quality of life considerations, allocation of limited resources, and conflicting cultural norms and values. We finally suggest some preliminary recommendations to guide ethical decision-making around resuscitation of newborns and withdrawal of treatment in humanitarian settings.
| S-EPMC6916396 | biostudies-literature
Project description:IntroductionQuality improvement (QI) is an increasingly important aspect of health care and residency education. There is relatively little research describing QI curricula for residents in psychiatry. Although QI curricula have been published in MedEdPORTAL, the current resource represents the first such curriculum specific to psychiatry residents. This resource aims to present a QI curriculum for psychiatry residents.MethodsThe University of Wisconsin psychiatry residency program implemented a QI curriculum for our PGY 3 psychiatry residents in 2010. The initial version of the curriculum has undergone marked changes over the ensuing years, reflecting feedback received from learners and faculty instructors, as well as ongoing review of the literature, to ascertain best practices in this area of medical education. Steps taken have included faculty training, development of evaluation forms, and implementation of elements to increase accountability for successful, sustainable project development.ResultsDuring the 8 completed years of this curriculum, 77 PGY 3 psychiatry residents have completed it. The Quality Improvement Knowledge Application Tool adapted for psychiatry was completed by PGY 3 residents in advance of and upon completion of the curriculum for the first 2 years of the curriculum; results demonstrated a significant improvement in scores as a measurement of QI knowledge and skills. Thirty-one of 32 resident teams (97%) have implemented a QI project.DiscussionOur QI curriculum for PGY 3 psychiatry residents has been successful in equipping residents with QI knowledge and having them implement QI projects.
| S-EPMC7012317 | biostudies-literature