Teaching Ethics to Pediatric Residents: A Literature Analysis and Synthesis

Abstract

Background: Ethics education rarely exists in pediatric resident curricula, although ethical conflicts are common in the clinical practice. Ethics education can prepare residents to successfully handle these conflicts.

Aim: We searched for methods in teaching ethics to clinical and especially pediatric residents, and identified recurring barriers to ethics teaching and solutions to overcome them.

Design: Literature from 4 electronic databases with peer-reviewed articles was screened in 3 phases and analyzed. The literature included papers referring to applied methods or recommendations to teaching ethics to clinical residents, and on a second level focusing especially on pediatrics. An analysis and critical appraisal was conducted. Results: 3 231 articles were identified. 96 papers were included. The applied learning theory, the reported teaching approaches, the barriers to teaching ethics and the provided solutions were studied and analyzed.

Conclusions: We recommend case-based ethics education, including lectures, discussion, individual study; regular teaching sessions in groups, under supervision; affiliation to an ethics department, institutional and departmental support; ethics rounds and consultations not as core teaching activity; recurring problems to teaching ethics, primarily deriving from the complexity of residential duties to be addressed in advance; teaching ethics preferably in the first years of residency. We may be cautious generalizing the implementation of results on populations with different cultural backgrounds.

Zusammenfassung

Hintergrund: In den Curricula zur Weiterbildung von Assistenzärzten zu Fachärzten der Pädiatrie finden sich nur selten ethische Inhalte, obwohl es in der Praxis häufig zu ethischen Konflikten kommt. Ethiklehre kann vorbereiten, mit diesen erfolgreich umzugehen.

Ziel: Analyse von Methoden der Ethiklehre in der pädiatrischen Weiterbildung, Identifikation von wiederkehrenden Hindernissen, sowie von Lösungen, um diese zu überwinden.

Methode: Literatur aus 4 elektronischen Datenbanken wurde in 3 Phasen überprüft und analysiert. Artikel mit Bezug auf angewandten Methoden, sowie Empfehlungen für die Ethiklehre in klinischen Weiterbildungscurricula mit dem Schwerpunkt auf Assistenzarztausbildung in der Pädiatrie wurden einbezogen. Die Artikel wurden kritisch durchgesehen und bewertet.

Ergebnisse: 3 231 Artikel wurden identifiziert. 96 Artikel wurden in die Analyse eingeschlossen. Die angewandten Lerntheorien, die berichteten Lehransätze, die Hindernisse für die Lehre der Ethik, sowie publizierte Lösungsvorschläge wurden analysiert.

Schlussfolgerung: Für die pädiatrische Facharztausbildung empfehlen wir fallbasierten Ethikunterricht, darunter Vorträge, Diskussion, individuelles Lernen; regelmäßige Unterrichtsstunden unter Anleitung in Gruppen. Die Kooperation mit einem Institut für Ethik, sowie die institutionelle Unterstützung sind ebenfalls empfehlenswert. Ethik-Runden und -Beratungen sollten nicht die Kernlehrtätigkeit sein. Häufige Probleme, die sich aus der Komplexität der Tätigkeit der pädiatrischen Assistenzärzte ergeben, sollen im Vorfeld von den Lehrenden berücksichtigt werden. Die Ethiklehre könnte vorzugsweise in den ersten Jahren der pädiatrischen Weiterbildung erfolgen. Man soll vorsichtig mit der Umsetzung der Ergebnisse auf Bevölkerungen mit unterschiedlichen kulturellen Hintergründen sein.

Key words

curriculum - pediatrics - ethics - postgraduate education

Schlüsselwörter

Curriculum - Pädiatrie - Ethik - Weiterbildung

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