Enhancing residents' training in medical ethics: an exploratory study assessing attitudes of internal medicine residents.

Internal medicine residents at the University of Hawai'i were surveyed in 2005 to identify their attitudes regarding ethics consultation based on exposure to ethics education as part of residency training. Our hypotheses were that senior residents are more likely than interns to request an ethics consultation; and providing or forgoing life-sustaining treatment would outrank other situations for requesting a consult. After two mailings, 46 out of 65 residents completed the survey (71% response rate). Statistical methods included Fisher's exact test for categorical variables, and general linear models to compare means between groups. A majority of residents stated that instruction on ethics was received through lectures and rounds. They were most likely to request an ethics consult for issues concerning medical futility and disagreement resolution. Comparing residents by yearof training for reason for ethics consultation, senior residents were more likely to request a consult for questions about artificial nutrition and hydration (p = 0.06). There was no difference between residents with or without previous exposure to ethics consultation or formal instruction in ethics and the likelihood of requesting a consultation in the future. A majority of residents felt it appropriate for any team member to request an ethics consultation. Ethics consultation can potentially be utilized to strengthen post-graduate medical education in keeping with the Accreditation Council for Graduate Medical Education requirements.