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从做中学:将伦理教育有效地纳入住院医师培训。

Learning by doing: effectively incorporating ethics education into residency training.

机构信息

Division of Medical Ethics, Weill Cornell Medical College, 435 E. 70th St. Suite 4-J, New York, NY 10021, USA.

出版信息

J Gen Intern Med. 2013 Apr;28(4):578-82. doi: 10.1007/s11606-012-2277-0. Epub 2012 Nov 21.

Abstract

BACKGROUND

Medical ethics is a critical component of the curriculum for clinical trainees. Educational initiatives should adapt content to participants' experience in order to ensure relevance and retain their interest.

AIM

To develop and evaluate an experiential educational program for physicians.

SETTING

Academic medical center.

PARTICIPANTS

Senior internal medicine residents (n = 40).

PROGRAM DESCRIPTION

A case-based didactic program was designed in which each resident shared a difficult ethics case from their clinical experience. We created a curriculum around these cases involving formal didactics as well as open-ended discussion and summarized the ethical issues most relevant to the participants. A course survey was administered based upon the validated Students' Evaluation of Educational Quality (SEEQ).

PROGRAM EVALUATION

Common issues raised included surrogate decision-making (18 %), refusal of treatment (14 %), capacity/informed consent (10 %), and medical futility (10 %). Mean SEEQ subscale scores for learning value, organization/clarity, group interaction, breadth of coverage, and assignments/readings were 4.5 (maximum possible score 5). Residents unanimously rated the course overall as good/very good, and all agreed or strongly agreed that the course was useful and its structure effective.

DISCUSSION

An experiential case-based didactic program in medical ethics engaged adult learners and facilitated a comprehensive and clinically relevant educational initiative.

摘要

背景

医学伦理学是临床培训生课程的重要组成部分。教育计划应根据参与者的经验来调整内容,以确保相关性并保持他们的兴趣。

目的

为医生开发和评估一种体验式教育计划。

地点

学术医疗中心。

参与者

高级内科住院医师(n=40)。

计划描述

设计了一个基于案例的教学计划,每个住院医师分享他们临床经验中的一个困难伦理案例。我们围绕这些案例创建了一个课程,包括正式的教学以及开放式讨论,并总结了与参与者最相关的伦理问题。根据经过验证的学生教育质量评估(SEEQ)进行了课程调查。

计划评估

提出的常见问题包括代理决策(18%)、拒绝治疗(14%)、能力/知情同意(10%)和医疗无效(10%)。学习价值、组织/清晰度、小组互动、涵盖范围和作业/阅读的平均 SEEQ 子量表得分为 4.5(最高可能得分为 5)。住院医师一致对课程整体评价为良好/非常好,并且都同意或强烈同意该课程有用且其结构有效。

讨论

医学伦理学的体验式基于案例的教学计划吸引了成年学习者,并促进了全面和具有临床相关性的教育计划。

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