Assistant Professor, Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine.
Assistant Professor, Department of Pediatrics, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine; Volunteer Assistant Professor, Department of Family & Community Medicine, Palliative Care Team, University of Cincinnati Medical Center and University of Cincinnati College of Medicine.
MedEdPORTAL. 2021 Feb 11;17:11094. doi: 10.15766/mep_2374-8265.11094.
Most medical decisions in pediatrics involve surrogate decision-makers. Because of this, pediatricians are even more likely to encounter ethical conflicts and dilemmas surrounding medical decision-making. Pediatricians continue to report a lack of preparedness to manage situations when conflicts and dilemmas arise, suggesting a gap in education. In response to this gap, we developed a module on the ethics of medical decision-making focused on pediatrics.
The Ethics of Pediatric and Young Adult Medical Decision-Making module included three case-based, small-group sessions on decision-making capacity and advance directives, parental decision-making, and informed consent and adolescent assent. Session materials were developed based on expert opinion and previously published content. Sessions were developed for pediatric residents; however, medical students rotating on pediatrics also participated in most sessions. Trainees completed pre- and postsession assessments of comfort and understanding.
An average of 19 learners completed each session. Understanding of ethical principles increased after each session. Seventy-nine percent of trainees reported increased understanding of ethical principles related to decision-making capacity, and 88% reported increased understanding of standards of surrogate decision-making. Following the session on obtaining consent and assent, 71% of trainees reported comfort obtaining consent compared to 57% reporting comfort obtaining assent.
This module successfully increased trainee comfort with many ethical issues related to pediatric medical decision-making. Areas where trainee comfort was still low postsession-specifically, obtaining consent or assent-are content areas where actual practice of these psychomotor skills is likely necessary.
儿科的大多数医疗决策都涉及代理人决策者。正因为如此，儿科医生更有可能遇到围绕医疗决策的伦理冲突和困境。儿科医生继续报告说，他们缺乏处理冲突和困境时的准备，这表明教育存在差距。为了弥补这一差距，我们开发了一个针对儿科医学决策伦理的模块。
儿科和青年医学决策伦理模块包括三个基于案例的小组会议，内容涉及决策能力和预先指示、父母决策、知情同意和青少年同意。会议材料是根据专家意见和以前发表的内容制定的。会议是为儿科住院医师开发的；但是，轮转儿科的医学生也参加了大多数会议。学员在每次会议前后都要对舒适度和理解程度进行评估。
每次会议平均有 19 名学员完成。每个课程结束后，学员对伦理原则的理解都有所提高。79%的学员报告说，他们对与决策能力相关的伦理原则的理解有所提高，88%的学员报告说，他们对代理人决策标准的理解有所提高。在获得同意和同意的课程结束后，71%的学员报告说，与 57%的学员报告说在获得同意时感到舒适相比，他们在获得同意时感到更加舒适。
该模块成功地提高了学员对与儿科医疗决策相关的许多伦理问题的舒适度。学员在课程结束后的特定领域仍然感到不舒适，即获得同意或同意，这是实际实践这些心理运动技能的领域。
