de la Garza Santiago, Phuoc Vania, Throneberry Steven, Blumenthal-Barby Jennifer, McCullough Laurence, Coverdale John
University of Colorado, Denver, CO, USA.
The Mayo Clinic, Rochester, MN, USA.
Acad Psychiatry. 2017 Aug;41(4):520-525. doi: 10.1007/s40596-016-0608-x. Epub 2016 Sep 19.
One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students.
PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials.
Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous.
None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.
一个目的是识别并综述关于向精神病学住院医师讲授医学伦理学的研究。为了从已在该领域发表研究的其他学科中获取见解，另一个目的是识别并综述关于向所有其他培训专业的住院医师以及向医学生讲授医学伦理学的研究。
在PubMed、EMBASE和PsycINFO中检索关于讲授医学伦理学且有定量结果的对照试验。检索词包括伦理学、生物伦理学、医学伦理学、医学生、住院医师/专科住院医生、教学、教育、结果和对照试验。
发现9项研究符合纳入标准，包括5项随机对照试验和4项非随机对照试验。研究对象包括医学生（5项研究）、外科住院医师（2项研究）、内科住院医生（1项研究）以及家庭医学带教教师及其医学生（1项研究）。不同研究之间的教学方法、课程内容和结果测量差异很大。常见的方法学问题包括分配方案未隐藏、未设盲以及作为学习者的研究对象数量普遍较少。一项使用标准化病人对外科住院医师进行教学的随机对照试验被认为在方法学上特别严谨。
没有一项试验纳入了精神病学住院医师。伦理学教育工作者应开展更多严格对照试验，以便为医学伦理学课程设计奠定坚实的证据基础。精神病学伦理学教育工作者也可从其他学科以及本科医学教育的试验结果中受益。
