Educating researchers: ethics and the protection of human research participants

Graduate students reported practices regarding the issue of informed consent and maintaining of data confidentiality in a developing country

Research involving human subjects requires strict adherence to ethical principles, including informed consent and assuring data confidentiality. Herein, a questionnaire was utilized to assess compliance of graduate students who conduct research involving human subjects in Jordan with proper practices related to informed consent and maintaining of data confidentiality. Among the 251 respondents, 55.4% were from health-related fields, 61.4% undertook research involving humans, and 48.6% did research requiring institutional review board approval. Only 37.1% of respondents reported exposure to research ethics education during their graduate study. Satisfactory adherence to informed consent practices was reported at rates of 56.0%-67.5%. Satisfactory adherence to practices related to data confidentiality and study participants' anonymity was reported at rates of 67.3%-74.7%. Sharing of data or samples with others was reported at a rate of 24.3%. The rates of adherence to proper informed consent practices and practices that maintain data confidentiality were less than ideal. Significant policy changes need to be implemented to address these issues.

Attitudes and practices of public health academics towards research funding from for-profit organizations: cross-sectional survey

Objectives

The growing trend of for-profit organization (FPO)-funded university research is concerning because resultant potential conflicts of interest might lead to biases in methods, results, and interpretation. For public health academic programmes, receiving funds from FPOs whose products have negative health implications may be particularly problematic.

Methods

A cross-sectional survey assessed attitudes and practices of public health academics towards accepting funding from FPOs. The sampling frame included universities in five world regions offering a graduate degree in public health; 166 academics responded. Descriptive, bivariate, and logistic regression analyses were conducted.

Results

Over half of respondents were in favour of accepting funding from FPOs; attitudes differed by world region and gender but not by rank, contract status, % salary offset required, primary identity, or exposure to an ethics course. In the last 5 years, almost 20% of respondents had received funding from a FPO. Sixty per cent of respondents agreed that there was potential for bias in seven aspects of the research process, when funds were from FPOs.

Conclusions

Globally, public health academics should increase dialogue around the potential harms of research and practice funded by FPOs.

Electronic supplementary material

The online version of this article (10.1007/s00038-020-01416-0) contains supplementary material, which is available to authorized users.

Feasibility of an ethics and professionalism curriculum for faculty in obstetrics and gynecology: a pilot study

OBJECTIVE

There have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.

METHODS

An ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person session, the participants voluntarily completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.

RESULTS

Twenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.

CONCLUSION

This pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty.

A trial of a reproductive ethics and law curriculum for obstetrics and gynaecology residents

OBJECTIVE

Prior ethics educational interventions for residents have shown improvement in confidence and knowledge scores strictly in an internal medical resident population. Baseline knowledge and attitudes regarding reproductive ethics and law of obstetrics and gynaecology (ob/gyn) residents were assessed via a survey. Then, after completion of a 20-h curriculum for the residents, the residents were resurveyed in order to assess impact of the curriculum.

METHODS

An online survey with both multiple-choice and open-ended questions was administered to residents both prior to and after curriculum completion.

RESULTS

A total of 39 residents (85% of the total ob/gyn residents) completed the survey. 67% of respondents thought ethics was very important in clinical practice, but only 3% considered themselves very familiar with medical ethics. Respondents were asked five case-based questions to assess baseline knowledge and only 10% answered all questions correctly prior to the curriculum. After the residents completed the curriculum, 31 subjects (79% of the original 39 resident respondents) responded to the same survey. 52% of respondents answered all five questions correctly and 31% considered themselves very familiar with medical ethics.

CONCLUSIONS

Despite the importance placed on reproductive ethics and law by survey respondents including its impact on their clinical practices, there continues to be a deficiency in formal ethics education in ob/gyn. Our curriculum demonstrated both improvement in confidence as well as knowledge of residents towards issues of reproductive ethics and law.

Responsible conduct of research in communication sciences and disorders: faculty and student perceptions

PURPOSE

Two Web-based surveys (Surveys I and II) were used to assess perceptions of faculty and students in Communication Sciences and Disorders (CSD) regarding the responsible conduct of research (RCR).

METHOD

Survey questions addressed 9 RCR domains thought important to the responsible conduct of research: (a) human subjects protections; (b) research involving animals; (c) publication practices and responsible authorship; (d) mentor/trainee responsibilities; (e) collaborative science; (f) peer review; (g) data acquisition, management, sharing, and ownership; (h) conflicts of interest; and (i) research misconduct. Respondents rated each of 37 topics for importance and for sufficiency of instructional coverage.

RESULTS

Respondents to Survey I were 137 faculty members from 68 (26%) of the 261 graduate programs in CSD. By comparison, 237 students from 39 (15%) programs responded to Survey II. Data about the importance and sufficiency of coverage of each of the 37 items were transformed into z scores to reveal relative ratings among the 37 topics. Data presentations were grouped for topics in each of the 9 RCR domains. Ratings indicated the relatively high importance assigned among the 37 topics by CSD faculty and students. Sufficiency of coverage of those same topics received lower ratings.

CONCLUSIONS

The results of these surveys support the notion that students in CSD perceive that they are receiving information about RCR. The data pertaining to sufficiency of coverage provide a basis for improving instruction in this important aspect of research education.

Enrolling research subjects from clinical practice: ethical and procedural issues in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial is a multi-site effectiveness study funded by the National Institute of Mental Health (NIMH) with the aim of identifying successful, acceptable and cost-effective treatment strategies for outpatients with unremitted depression. With enrollment of 4,041 adults with major depressive disorder (MDD), it is the largest controlled psychiatric treatment study ever undertaken. In the course of developing procedures to ensure that ambitious enrollment goals were met, a number of ethical and practical issues became apparent that underscore the conflicts between effectiveness research and human subject protections. These are delineated as they relate to study design; eligibility criteria; incentives to subjects; investigators and clinical sites; the complementary roles of clinical research coordinators (CRCs) and study clinicians; and recruitment and consent procedures. The STAR*D trial exemplifies the interplay and tension between those strategies that integrate research and clinical aims and roles in the service of enhancing external validity, site participation, and recruitment and retention versus those strategies that differentiate research and clinical treatment in the service of research integrity and human subject protections. We hope that a discussion of these key challenges and dilemmas and how they have been addressed will help inform future discussions concerning design and conduct of ethical effectiveness trials designed to optimize care in real world clinical settings.

Bench-to-bedside review: human subjects research--are more standards needed?

There are many controversial issues surrounding ethics in study design and conduct of human subjects research. In this review we briefly touch on the origin of ethics in clinical research and how the current regulations and standards came into practice. We then discuss current controversies regarding informed consent, conflicts of interest, institutional review boards, and other relevant issues such as innovative procedures and quality improvement projects. The question of whether we need more standards is a very important yet challenging one to which there is no simple answer. We address this question by reviewing and commenting on relevant literature. We conclude that what is needed are not more standards per se, but rather refinement and uniformity of current standards, and their interpretation and application both to protect human subjects and to advance medicine.

Research ethics and consent in the intensive care unit

PURPOSE OF REVIEW

The subject of research ethics and informed consent in the ICU has recently received unprecedented attention during the past year, the reasons for which are reviewed herein.

RECENT FINDINGS

The controversy over research design and informed consent issues in studies conducted by the Acute Respiratory Distress Syndrome Network in the United States have been responsible for much of the attention on research ethics. So has the draft directive to create a harmonization of the provisions governing clinical trials within the European Union. These and other factors have prompted renewed interest in the proper design of clinical trials, the difficulty of obtaining informed consent for research from critically ill patients and their surrogates, conflicts of interest on the part of investigators and their institutions, the need for improving institutional protections for human subjects, and the desirability of clarifying the investigator-subject relationship.

SUMMARY

Clinical trials should compare new therapies with "standard" ones if a standard of care exists. Surrogate consent is required for research involving most critically ill subjects, and state laws in the United States and national statutes in Europe should reflect this requirement. Conflicts of interest should be identified at both the individual and the institutional levels. Institutional review boards should focus on ethical issues after conflicts of interest are evaluated. Making the investigator-subject relationship transparent should help protect subjects.