Background: Ethics is at the core of a physician’s professional identity. As internists, we are constantly grappling with medical and moral uncertainty. While ethical action is an integral component of professionalism, most residency programs offer little formal training to systematically explore the ethical dimensions of our work. Medical ethics education can promote moral development and help trainees grapple with moral distress, which can contribute to physician burnout.
Purpose: Our aim was to assess the need for medical ethics education among residents and to create a medical ethics curriculum in the form of an interactive, clinical case-based seminar for internal medicine housestaff.
Description: The goal of our ethics seminars has been to teach residents ethical reasoning by critically thinking through real-life ethical problems using bioethical principles and other tools of ethical analysis. Discussions also emphasized communication and mediation strategies, as these are integral to navigating challenging ethical situations. Seminars utilized ethics consults from our institution and were led by a chief resident along with faculty discussants who had expertise in medical ethics.
Residents were encouraged to identify the case’s central ethical question, apply principles of medical ethics to the clinical situation at hand, identify stakeholders and their individual values and concerns, and ultimately seek paths toward resolution. Faculty members then shared the ethics consultant’s decision-making process and the evidence that substantiated their reasoning. Some of the themes we explored included: informed consent, capacity and guardianship, non-beneficial treatment at the end of life, and shared decision-making. We also discussed stewardship of healthcare resources, the ethics of high value care, and cultural relativism, among other topics.
After each seminar, we surveyed 62 unique transitional-year interns and rotating residents from four different institutions across different training levels. 77% of the 62 residents have experienced moral distress in the course of their training thus far. 83% felt that exposure to ethics education during their residencies was inadequate, and 67% of residents were not sure when to consult an ethicist. 95% of residents felt that the seminars in which they participated expanded their understanding of the specific ethical problems discussed.
Conclusions: Encouraging housestaff to consider the moral dimensions of their clinical decisions can contribute to an essential part of their professional growth into self-aware, compassionate, and justice-minded physicians. Our survey demonstrated that the majority of housestaff felt underprepared to handle challenging ethics issues. Future steps will involve more focused attention on how these seminars can increase residents’ specific knowledge of ethics. We will also seek to understand how medical ethics education may impact physician performance and communication skills as well as patient outcomes.