Langerman Alexander, Cutrer William B, Yakes Elizabeth Ann, Meador Keith G
Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
HEC Forum. 2020 Jun;32(2):163-174. doi: 10.1007/s10730-020-09410-y.
The clinical clerkships in medical school are the first formal opportunity for trainees to apply bioethics concepts to clinical encounters. These clerkships are also typically trainees' first sustained exposure to the "reality" of working in clinical teams and the full force of the challenges and ethical tensions of clinical care. We have developed a specialized, embedded ethics curriculum for Vanderbilt University medical students during their second (clerkship) year to address the unique experience of trainees' first exposure to clinical care. Our embedded curriculum is centered around core "ethics competencies" specific to the clerkship: for Medicine, advanced planning and end-of-life discussions; for Surgery, informed consent; for Pediatrics, the patient-family-provider triad; for Obstetrics and Gynecology, women's autonomy, unborn child's interests, and partner's rights; and for Neurology/Psychiatry, decision-making capacity. In this paper, we present the rationale for these competencies, how we integrated them into the clerkships, and how we assessed these competencies. We also review the additional ethical issues that have been identified by rotating students in each clerkship and discuss our strategies for continued evolution of our ethics curriculum.
医学院的临床实习是实习生将生物伦理学概念应用于临床实践的首个正式机会。这些实习通常也是实习生首次持续接触临床团队工作的“现实”，以及临床护理中各种挑战和伦理冲突的全部压力。我们为范德堡大学医学院学生在二年级（实习年）开发了一门专门的嵌入式伦理学课程，以应对实习生首次接触临床护理的独特经历。我们的嵌入式课程围绕实习特有的核心“伦理能力”展开：对于内科，是提前规划和临终讨论；对于外科，是知情同意；对于儿科，是患者-家庭-医护人员三元组；对于妇产科，是女性自主权、未出生胎儿的利益和伴侣的权利；对于神经科/精神科，是决策能力。在本文中，我们阐述了这些能力的基本原理、我们如何将它们融入实习以及我们如何评估这些能力。我们还回顾了各实习轮转学生所发现的其他伦理问题，并讨论了我们使伦理学课程持续发展的策略。
