Bridging the professions: an integrated and interdisciplinary approach to teaching health care ethics

Identification of core ethical topics for interprofessional education in the intensive care unit: a thematic analysis

Medical educators have not identified effective approaches for interprofessional ethics education of clinicians who work in intensive care units (ICUs), in spite of the fact that ICUs have a high incidence of ethical conflicts. As a first step in designing an interprofessional ethics education initiative tailored to the needs of ICU team members, we interviewed 12 professionals from the medical and surgical ICUs of a tertiary care academic medical center to understand what they know about medical ethics. Respondents were interviewed between November 2016 and February 2017. We used the 'think aloud' approach and realist thematic analysis of the sessions to evaluate the extent and content of interprofessional team members' knowledge of medical ethics. We found wide variation in their knowledge of and facility in applying the principles and concepts of biomedical ethics and ways of resolving ethical conflicts. Ethics education tailored to these areas will help equip critical care professionals with the necessary knowledge and skills to discuss and address ethical conflicts encountered in the ICU. Preventive ethics rounds are one approach for providing real-time, embedded interprofessional ethics education in the clinical setting.

A postgraduate curriculum for integrated care: a qualitative exploration of trainee paediatricians and general practitioners' experiences

BACKGROUND

Integrated care unites funding, administrative, organisational, service delivery and clinical levels to create connectivity, alignment and collaboration within and between care delivery and prevention sectors. It aims to improve efficiency by avoiding unnecessary duplication of resources. Consequently, implementing integrated care is increasingly important; however, there are many barriers and how we teach healthcare practitioners to work across systems is under-researched. This paper explores an innovative educational curriculum, the Programme for Integrated Child Health (PICH).

METHODS

The PICH involved an experiential learning approach supported by taught sessions on specific issues relevant to integrated care. A qualitative study was conducted by interviewing 23 participants using semi-structured one-to-one interviews. Participants included trainees (general practice, paediatrics) and programme mentors. Data was thematically analysed.

RESULTS

Results are coded under three main themes: integrated care curriculum components, perceptions of a curriculum addressing integrated care and organisational change, and personal and professional learning. The data highlights the importance of real-world projects, utilising healthcare data, and considering patient perspectives to understand and develop integrated practices. Trainees received guidance from mentors but, more crucially learnt from, with, and about one another. They learnt about the context in which GPs and paediatricians work and developed a deeper understanding through which integrated services could be meaningfully developed.

CONCLUSIONS

This study explored participants' experiences and can be taken forward by educationalists to design curricula to better prepare healthcare practitioners to work collaboratively. The emergence of integrated care brings about challenges for traditional pedagogical approaches as learners have to re-align their discipline-specific approaches with evolving healthcare structures. PICH demonstrated that trainees acquired knowledge through real-word projects and experiential learning; and that this facilitated integration, empowering doctors to become leaders of organisational change. However, there are also many challenges of implementing integrated curricula which need to be addressed, including breaking down professional silos and integrating resourceful healthcare. This study begins to demonstrate the ability of an integrated curriculum to support trainees to work collaboratively, but further work is needed to develop the wider efficacy of the programme incorporating other professional groups, and to assess its longer term impact.

Experiences in disaster-related mental health relief work: An exploratory model for the interprofessional training of psychological relief workers

The purpose of this study was to begin to generate an exploratory model of the disaster-related mental health education process associated with the training experiences of psychological relief workers active during the Sichuan earthquake in China. The data consisted of semi-structured interviews with 20 psychological relief workers from four different professions (social workers, psychiatric nurses, psychiatrists, and counsellors) regarding their experiences in training and ideas for improvement. The model explains the need to use a people-centred community interprofessional education approach, which focuses on role-modelling of the trainer, caring for relief workers, paying attention to the needs of the trainee, and building systematic interprofessional education strategies. The proposed model identifies areas for the comprehensive training of relief workers and aims to address the importance of people-centred mental health service provisions, ensure intentional and strategic training of relief workers using interprofessional concepts and strategies, and use culturally attuned and community-informed strategies in mental health training practices.

Teaching Health Care Ethics: why we should teach nursing and medical students together

This article argues that teaching medical and nursing students health care ethics in an interdisciplinary setting is beneficial for them. Doing so produces an education that is theoretically more consistent with the goals of health care ethics, can help to reduce moral stress and burnout, and can improve patient care. Based on a literature review, theoretical arguments and individual observation, this article will show that the benefits of interdisciplinary education, specifically in ethics, outweigh the difficulties many schools may have in developing such courses.

Utilizing codes of ethics in health professions education

Codes of ethics abound in health care, the aims and purposes of which are multiple and varied, from operating as a decision making tool to acting as a standard of practice that can be operational in a legal context to providing a sense of elevated seriousness and professionalism within a field of practice. There is some doubt and controversy, however, regarding the value and use of these codes both in professional practice and in the education of healthcare professionals. I intend to review and analyze the various aims and purposes of ethics codes particularly within the study and practice of healthcare in light of various criticisms of codes of ethics. After weighing the strength and import of these criticisms, I plan to explore effective means for utilizing such codes as part of the ethics education of healthcare professionals. While noting significant limitations of this tool, both in practice and in education, I plan to demonstrate its potential usefulness as well, in both generating critical thinking within the study of ethics and as a guide for practice for the professional.

Balancing confidentiality and collaboration within multidisciplinary health care teams

As multidisciplinary perspectives are increasingly integrated into the treatment of health problems, opportunities for clinical psychologists in medical settings are expanding. Although cross-discipline collaboration is at the core of multidisciplinary treatment models, psychologists must be particularly cautious about information sharing due to their profession's ethical standards regarding patient confidentiality. Psychologists' ethical obligations require them to achieve a delicate balance between contributing to the treatment team and protecting patient confidentiality. In the current review, relevant ethical standards and federal guidelines are applied to everyday practices of clinical psychologists in medical settings. Additionally, recommendations for individual psychologists, health care organizations, and graduate training programs are presented.

Utilization of research methodology in designing and developing an interdisciplinary course in ethics

Development research methodology was utilized to design an interdisciplinary ethics course for students from seven disciplines: dental hygiene, nursing, nurse anesthesia, occupational therapy, physician assistant, physical therapy, and social work. Two research questions, 'What content areas should be considered for inclusion in an interdisciplinary course in Ethics?' and 'What design framework, format, or structure would best fit the content chosen?' guided the study. An interdisciplinary faculty design team conducted a comparative analysis of each of the seven discipline's codes of ethics to find common topics of interest. Further analysis then grouped these topics into eight categories of professional responsibility. The result was a fifteen-week course with validated content relevant to all disciplines.

Is an Interdisciplinary Session on Ethics and Law in Obstetrics and Gynaecology Effective?

OBJECTIVE

To evaluate the effects of an interdisciplinary session on medical ethics and legal issues related to obstetrics and gynaecology on medical students' knowledge, attitudes, and behaviours.

METHODS

Second-year medical students at the University of Alberta were asked to complete surveys before and after an interdisciplinary panel session on ethics and legal issues in reproductive health. Survey questions were related to knowledge of ethics and law, attitudes toward controversial topics in reproductive health, and predicted behaviours in specific clinical scenarios. In the postsession survey, students were asked to evaluate the session's usefulness and impact.

RESULTS

Fifty-seven students completed both the pre- and postsession surveys. Most students listed family, religion, culture, peer groups, scientific thought and theory, and school and education as influences on their own personal ethics and morality. Fifty-five students (97%) stated that the panel session was useful. Most students (79%) reported that the session increased their knowledge of ethical and legal issues in reproductive health. Many students felt that the panel session would change the way they practise in similar clinical situations (63%). The panel session appeared to affect knowledge and predicted behaviour.

CONCLUSION

A large-group interdisciplinary panel session can influence medical students' knowledge and future behaviours related to ethics and law in obstetrics and gynaecology. Medical students gave this session a high rating.

Interdisciplinary education: evaluation of a palliative care training intervention for pre-professionals

PURPOSE

Medical education inadequately prepares students for interdisciplinary collaboration, an essential component of palliative care and numerous other areas of clinical practice. This study developed and evaluated an innovative interdisciplinary educational program in palliative care designed to promote interdisciplinary exchange and understanding.

METHOD

The study used a quasi-experimental longitudinal design. Thirty-three medical students (third and fourth year) and 38 social work students (second year of masters degree) were recruited. The intervention group students (21 medical and 24 social work students) participated in a series of four training sessions over four weeks while the control group students received written materials after the study. The curriculum and teaching methods were based on theories of professional socialization and experiential learning. The intervention included experiential methods to promote interdisciplinary interaction to foster communication, exchange of perspectives, and the building of mutual trust and respect. Both groups completed assessments of perceived role understanding, a primary component of effective interdisciplinary teamwork, in palliative care. Self-administered surveys were completed at baseline, intervention completion, and three months later. The intervention group also completed an anonymous evaluation about the interdisciplinary education.

RESULTS

The intervention group demonstrated a significant increase in perceived role understanding compared with the control group. Three-month follow-up data suggested that intervention group subjects maintained gains in perceived role understanding.

CONCLUSION

An interdisciplinary educational intervention improves role understanding early in the process of professional socialization in a pilot program. Further implementation of interdisciplinary education should evaluate the effect on subsequent interdisciplinary practice and the quality of patient care.

Care without chemotherapy: the role of the palliative care team

So--what will be your answer to the medical student? What should you tell Barbara and her family? That's up to you. But whatever you chose, you can be confident that you will be able to provide for her comfort and help her maximize her quality of life. When you share your most honest estimate of her prognosis and help her reframe her hope, you can increase the chance that she will be able to define and accomplish her last goals, bring closure to her life, and do the work that will minimize the pain of her bereaved family. You are not alone in this work: you can enlist hospice and palliative care teams to help you. With their help, you can promise Barbara the same expert care with or without chemotherapy And then . . . it's up to her.

Ethical activism: strategies for empowering medical social workers

Little empirical research examines the extent medical social workers try to change attitudes, norms, expectations, and protocols to create a hospital environment that encourages their participation in ethical deliberations. The researchers developed an ethical activism scale that measured the extent medical social workers engaged in such ethical activism, confirming its reliability from data obtained from a sample of 162 medical social workers in 37 hospitals in the Los Angeles basin. They tested seven hypotheses that probed the extent specific ethics-training, organizational, and demographic variables influence the extent social workers engage in ethical activism. Data strongly suggest the need to expand ethics training to include tactics of ethical activism, since many social workers do not engage in ethical activism. Data also suggest the need to target such training to social workers in hospitals that are relatively unreceptive to social workers' participation in ethical deliberations, since social workers are least likely to engage in ethical activism in such settings.

Solving ethical problems in medical settings during psychological assessment: a decisional model

The unique culture of medical settings impacts the style, pace, and quality of psychological consultation provided in that setting. Matters of life and death and other health emergencies, relationships with the courts, and contact with severely impaired patients are typical events. Medical psychologists (MPs) share many, but not all, of the ethical values that guide provision of services by other medical professionals under such circumstances. This generates the need to develop an interdependent but independent ethical orientation on the part of MPs in all professional activities, including psychological assessment. In this article, background information is presented on values that frequently drive medical treatment that may conflict with the MPs' ethical standards. A model appropriate for use in situations requiring complex decisional processes is reviewed, and vignettes are presented as examples of bioethical problem solving under this systematic decisional framework.

Educating community providers changes beliefs towards caring for the ESRD patient

End-Stage Renal Disease (ESRD) patients often have comorbid conditions necessitating the involvement of multiple professionals from various settings such as dialysis centers, primary care and skilled nursing facilities, group homes, mental health, rehabilitation, and home health care agencies. This provision of services can be fragmented and may be impeded by a lack of knowledge regarding the specific needs of renal patients. "A Caring Community: An Integrated Approach to Meeting the Needs of the Renal Patient" is a multidisciplinary professional education program which has been shown to change the beliefs of community providers regarding ESRD patients. Program attendee survey responses were measured in accordance with a modified Health Belief Model. This report identifies the need and demand for interdisciplinary renal education and the potential benefits of such a community-wide intervention and makes recommendations for future research.

Teaching ethics using small-group, problem-based learning

Ethics is the emphasis of our first-year Introduction to Clinical Medicine-1 course. Introduction to Clinical Medicine-1 uses problem-based learning to involve groups of seven to nine students and two facilitators in realistic clinical cases. The cases emphasize ethics, but also include human behaviour, basic science, clinical medicine, and prevention learning issues. Three cases use written vignettes, while the other three cases feature standardized patients. Groups meet twice for each case. In session one, students read the case introduction, obtain data from the written case or standardized patient, identify the case's ethical problems, formulate learning issues, discuss ways to resolve the moral conflicts, and assign research responsibilities. In session two, students discuss their assigned learning issues and specify and justify clinical actions to address the case's ethical dilemmas. Following three cases, groups write an essay discussing what they learned and describing how they would approach and resolve the case's learning issues.