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Tripathy SK, Jain M, Sen RK. Ethical Practice for Postgraduate Students in Orthopedics: Nurturing Professionalism and Patient Care. Indian J Orthop 2023; 57:1735-1743. [PMID: 37881284 PMCID: PMC10593642 DOI: 10.1007/s43465-023-00994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 10/27/2023]
Abstract
Background In the domain of orthopedics, ethical practice significantly influences professionalism and the quality of patient care delivered by postgraduate students. This narrative review aimed to investigate the implementation and impact of an ethics-centric curriculum tailored for orthopedic postgraduate students. Methods The proposed curriculum incorporates methodologies such as case-based learning, interactive discussions, and dedicated mentoring sessions, focusing on the unique ethical challenges encountered in orthopedics. Results Introducing the curriculum provided postgraduate students with a robust foundation in ethical principles, enhancing effective communication, and fostering better doctor-patient relationships. Consequently, the students displayed an increased aptitude in navigating intricate ethical dilemmas in their clinical practice. Conclusion There is a crucial need for continuous ethics education in orthopedics. Creating a supportive learning environment is essential to cultivate professionalism and promote patient-centered care. This study underscores the transformative potential of ethics training in molding orthopedic professionals who are both competent and deeply committed to maintaining the highest ethical standards.
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Affiliation(s)
- Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019 India
| | - Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019 India
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Berger AS, Niedra E, Brooks SG, Ahmed WS, Ginsburg S. Teaching Professionalism in Postgraduate Medical Education: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:938-946. [PMID: 31517687 DOI: 10.1097/acm.0000000000002987] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE This systematic review sought to summarize published professionalism curricula in postgraduate medical education (PGME) and identify best practices for teaching professionalism. METHOD Three databases (MEDLINE, Embase, ERIC) were searched for articles published from 1980 through September 7, 2017. English-language articles were included if they (1) described an educational intervention addressing professionalism, (2) included postgraduate medical trainees, and (3) evaluated professionalism outcomes. RESULTS Of 3,383 articles identified, 50 were included in the review. The majority evaluated pre- and posttests for a single group (24, 48%). Three (6%) were randomized controlled trials. The most common teaching modality was small-group discussions (28, 56%); other methods included didactics, reflection, and simulations. Half (25, 50%) used multiple modalities. The professionalism topics most commonly addressed were professional values/behavior (42, 84%) and physician well-being (23, 46%). Most studies measured self-reported outcomes (attitude and behavior change) (27, 54%). Eight (16%) evaluated observed behavior and 3 (6%) evaluated patient outcomes. Of 35 studies that evaluated statistical significance, 20 (57%) reported statistically significant positive effects. Interventions targeting improvements in knowledge were most often effective (8/12, 67%). Curriculum duration was not associated with effectiveness. The 45 quantitative studies were of moderate quality (Medical Education Research Study Quality Instrument mean score = 10.3). CONCLUSIONS Many published curricula addressing professionalism in PGME are effective. Significant heterogeneity in curricular design and outcomes assessed made it difficult to synthesize results to identify best practices. Future work should build upon these curricula to improve the quality and validity of professionalism teaching tools.
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Affiliation(s)
- Arielle S Berger
- A.S. Berger is a lecturer, Internal Medicine (Geriatrics), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-7896-3638. E. Niedra is a physician, Baycrest Health Sciences, Toronto, Ontario, Canada. S.G. Brooks is a first-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. W.S. Ahmed is a second-year resident, Internal Medicine, University of Toronto, Toronto, Ontario, Canada. S. Ginsburg is professor, Internal Medicine (Respirology), and scientist, Wilson Centre, University of Toronto, Toronto, Ontario, Canada
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de la Garza S, Phuoc V, Throneberry S, Blumenthal-Barby J, McCullough L, Coverdale J. Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:520-525. [PMID: 27644429 DOI: 10.1007/s40596-016-0608-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/12/2016] [Indexed: 05/17/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Moon MR, Hughes MT, Chen JY, Khaira K, Lipsett P, Carrese JA. Ethics skills laboratory experience for surgery interns. JOURNAL OF SURGICAL EDUCATION 2014; 71:829-38. [PMID: 25012607 DOI: 10.1016/j.jsurg.2014.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/11/2014] [Accepted: 03/24/2014] [Indexed: 05/17/2023]
Abstract
INTRODUCTION AND PURPOSE Ethics curricula are nearly universal in residency training programs, but the content and delivery methods are not well described, and there is still a relative paucity of literature evaluating the effect of ethics curricula. Several commentators have called for more ethics curriculum development at the postgraduate level, and specifically in surgery training. We detail our development and implementation of a clinical ethics curriculum for surgery interns. METHODS We developed curricula and simulated patient cases for 2 core clinical ethics skills--breaking bad news and obtaining informed consent. Educational sessions for each topic included (1) framework development (discussion of interns' current experience, development of a consensus framework for ethical practice, and comparison with established frameworks) and (2) practice with simulated patient followed by peer and faculty feedback. At the beginning and end of each session, we administered a test of confidence and knowledge about the topics to assess the effect of the sessions. RESULTS A total of 98 surgical interns participated in the ethics skills laboratory from Spring 2008 to Spring 2011. We identified significant improvement in confidence regarding the appropriate content of informed consent (<0.001) and capacity to break bad news (<0.001). We also identified significant improvement in overall knowledge regarding informed consent (<0.01), capacity assessment (<0.05), and breaking bad news (0.001). Regarding specific components of informed consent, capacity assessment, and breaking bad news, significant improvement was shown in some areas, while we failed to improve knowledge in others. CONCLUSIONS Through faculty-facilitated small group discussion, surgery interns were able to develop frameworks for ethical practice that paralleled established frameworks. Skills-based training in clinical ethics resulted in an increase in knowledge scores and self-reported confidence. Evaluation of 4 annual cohorts of surgery interns demonstrates significant successes and some areas for improvement in this educational intervention.
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Affiliation(s)
- Margaret R Moon
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Mark T Hughes
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jiin-Yu Chen
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Kiran Khaira
- National College of Natural Medicine, Portland, Oregon
| | - Pamela Lipsett
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph A Carrese
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Brannon JK. Nontraumatic osteonecrosis of the femoral head: endoscopic visualization of its avascular burden. Orthopedics 2012; 35:e1314-22. [PMID: 22955395 DOI: 10.3928/01477447-20120822-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the intraosseous use of a flexible endoscope during core decompression in identifying avascular bone in the femoral head that did not meet magnetic resonance imaging diagnostic criteria for osteonecrosis. The flexible endoscope was used to visually examine and locate avascular bone in the entire core track. A high-speed burr was then used to debride the avascular bone. This debridement process was continued until a host bed of porous bleeding cancellous bone was observed, comprising thorough debridement of the femoral head. Autologous cancellous bone graft was then packed into the residual cavity and stabilized. Ten patients (13 hips total) with an average age of 49 years (range, 34-58 years) were included in the study. Eight patients were fully ambulatory at 3 weeks (range, 1-3 weeks). For all 13 hips, the mean preoperative Harris Hip Score was 43 (range, 30-75) and improved to a mean of 93 (range, 60-100) postoperatively. Eighty-five percent of patients (11 of 13 hips) demonstrated a good to excellent outcome at a minimum 2-year follow-up (range, 27-45 months). Flexible intraosseous endoscopy helped identify avascular bone that did not appear on the preoperative magnetic resonance imaging, safely widen the surgical margins of the core decompression track, and achieve thorough debridement of the femoral head using a minimally invasive technique.
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Kesselheim JC, McMahon GT, Joffe S. Development of a Test of Residents' Ethics Knowledge for Pediatrics (TREK-P). J Grad Med Educ 2012; 4:242-5. [PMID: 23730449 PMCID: PMC3399620 DOI: 10.4300/jgme-d-11-00280.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/12/2011] [Accepted: 01/16/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Professionalism is one of the Accreditation Council for Graduate Medical Education's core competencies. Residency programs must teach residents about ethical principles, which is an essential component of professionalism. OBJECTIVES We aimed to formally develop a valid and reliable test of ethics knowledge that effectively discriminated among learners in pediatric residency training and to improve methods for measuring outcomes of resident education in medical ethics. METHODS We created an instrument with 36 true/false questions that tested knowledge in several domains of pediatric ethics: professionalism, adolescent medicine, genetic testing and diagnosis, neonatology, end-of-life decisions, and decision making for minors. All questions and their correct answers were derived from published statements from the American Academy of Pediatrics Committee on Bioethics. We invited a range of participants from novices to experts to complete the test. We evaluated the instrument's reliability and explored item discrimination, omitting 13 items with the least discriminatory power. Score differences between the 3 categories of examinees were evaluated. RESULTS The 23-item test, completed by 54 participants, demonstrated good internal reliability (Kuder-Richardson 20 statistic = 0.73). The test was moderately difficult and had a mean overall score of 17.3 (±3.3 standard deviation). Performance appropriately improved with degree of expertise: median scores for medical students, postgraduate year-3 residents, and ethicists were 15 (65%, range, 11-19), 19 (83%, range, 14-23), and 22 (96%, range, 20-23), respectively. Ethicists' scores were significantly higher than those of medical students (P < .001) and residents (P = .007). Moreover, residents performed significantly better than medical students (P = .001). CONCLUSIONS We developed a standardized instrument, entitled Test of Residents' Ethics Knowledge for Pediatrics (TREK-P), to evaluate residents' knowledge of pediatric ethics. The TREK-P is easy to administer, reliably discriminates among learners, and highlights content areas in which knowledge may be deficient.
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Zuckerman JD, Holder JP, Mercuri JJ, Phillips DP, Egol KA. Teaching professionalism in orthopaedic surgery residency programs. J Bone Joint Surg Am 2012; 94:e51. [PMID: 22517397 DOI: 10.2106/jbjs.k.00504] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Joseph D Zuckerman
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 East 17th Street, 14th Floor, New York, NY 10003, USA. joseph.zuckerman@ nyumc.org
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Grossman E, Posner MC, Angelos P. Ethics education in surgical residency: Past, present, and future. Surgery 2010; 147:114-9. [DOI: 10.1016/j.surg.2009.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 04/06/2009] [Indexed: 11/30/2022]
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Helft PR, Eckles RE, Torbeck L. Ethics education in surgical residency programs: a review of the literature. JOURNAL OF SURGICAL EDUCATION 2009; 66:35-42. [PMID: 19215896 DOI: 10.1016/j.jsurg.2008.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 10/09/2008] [Indexed: 05/17/2023]
Abstract
Although ethics education in undergraduate medical school curricula has become essentially universal, and because ethics and professionalism have become integral parts of competency-based curricula for residents in nearly all specialties of medicine and surgery, it is not clear to what extent postgraduate surgical training routinely includes ethics education or skills training. Most general surgery residencies do not routinely integrate in-depth ethics skills training and assessment into their didactic curricula. In this article, we review the literature concerning ethics education in postgraduate surgical training programs. The few studies in the literature suggest that ethics education, when integrated in surgical residency curricula, can lead to measurable improvements in resident-centered outcomes, which include knowledge and confidence in handling ethical dilemmas. These curricula may lead to improvements in patient care. These findings suggest that ethics education for surgical residents is valuable but that questions regarding the optimal "dose" of ethics education and training as well as the optimal teaching methods would benefit from extended systematic evaluation and inquiry.
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Affiliation(s)
- Paul R Helft
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Mannino R, Zuelzer W, McDaniel C, Lyckholm L. Advance directives and resuscitation issues in the care of patients in orthopaedic surgery. J Bone Joint Surg Am 2008; 90:2037-42. [PMID: 18762666 DOI: 10.2106/jbjs.g.00779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Rosemarie Mannino
- Division of Hematology/Oncology and Palliative Care, Department of Internal Medicine, P.O. Box 980230, Virginia Commonwealth University, Richmond, VA 23298-0153, USA.
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Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della Valle CJ, Zuckerman JD. Orthopaedic resident-selection criteria. J Bone Joint Surg Am 2002; 84:2090-6. [PMID: 12429773 DOI: 10.2106/00004623-200211000-00026] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Adam D Bernstein
- Department of Orthopedic Surgery, New York University Medical Center, Hospital for Joint Diseases Orthopaedic Institute, 301 East 17th Street, New York, NY 10003, USA.
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Major-Kincade TL, Tyson JE, Kennedy KA. Training pediatric house staff in evidence-based ethics: an exploratory controlled trial. J Perinatol 2001; 21:161-6. [PMID: 11503102 DOI: 10.1038/sj.jp.7200570] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2000] [Accepted: 12/18/2000] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate an educational intervention in evidence-based ethics (emphasizing clinical knowledge, epidemiologic skills, and recognition of ethical issues) administered to house staff before rotating through our neonatal intensive care unit. STUDY DESIGN A controlled trial of 64 pediatric house staff assigned to alternating control and intervention rotations. Questionnaires were administered at the end of the rotation. RESULTS Some benefits of the intervention were observed. However, a large percentage of intervention and control house staff substantially overestimated (>1.25 correct value) predischarge mortality (23% vs. 55% of house staff; p<0.02), mortality or major morbidity (74% vs. 46% of house staff; p=0.04), and cerebral palsy rates (70% vs. 87%; p=0.12). Neither group cited many methodological criteria for evaluating follow-up studies (3.3 vs. 2.4 criteria; p=0.05) or ethical issues considered in treatment recommendations for extremely premature infants (3.1 vs. 2.8 issues; p=0.35). CONCLUSION Improved house staff training in evidence-based ethics is needed.
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Affiliation(s)
- T L Major-Kincade
- UT Southwestern Medical Center at Dallas, Department of Pediatrics, Dallas, TX 77030-1503, USA
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