Ethical issues identified by obstetrics and gynecology learners through a novel ethics curriculum


      Obstetrics and gynecology (ob/gyn) is fraught with bioethical issues, the professional significance of which may vary based on clinical experience. Our objective was to utilize our novel ethics curriculum to identify ethics and professionalism issues highlighted by ob/gyn learners and to compare responses between learner levels to further inform curricular development.

      Study Design

      We introduced an integrated and dynamic ob/gyn ethics and professionalism curriculum and mixed methods analysis of 181 resulting written reflections (case observation and assessments) from third-year medical students and from first- to fourth-year ob/gyn residents. Content was compared by learner level using basic thematic analysis and summary statistics.


      Within the 7 major ethics and professionalism domains, learners wrote most frequently about miscellaneous ob/gyn issues such as periviability and abortion (22% of students, 20% of residents) and problematic treatment decisions (20% of students, 19% of residents) rather than professional duty, communication, justice, student-/resident-specific issues, or quality of care. The most commonly discussed ob/gyn area by both learner groups was obstetrics rather than gynecology, gynecologic oncology, or reproductive endocrinology and infertility, although residents were more likely to discuss obstetrics-related concerns than students (65% vs 48%; P = .04) and students wrote about gynecologic oncology-related concerns more frequently than residents (25% vs 6%; P = .002). In their reflections, sources of ethical value (eg, the 4 classic ethics principles, professional guidelines, and consequentialism) were cited more frequently and in greater number by students than by residents (82% of students cited at least 1 source of ethical value vs 65% of residents; P = .01). Residents disagreed more frequently with the ethical propriety of clinical management than did students (67% vs 43%; P = .005).


      Our study introduces an innovative and dynamic approach to an ob/gyn ethics and professionalism curriculum that highlights important learner-identified ethics and professionalism issues both specific to ob/gyn and common to clinical medicine. Findings will help ob/gyn educators best utilize and refine this flexible curriculum such that it is appropriately focused on topics relevant to each learner level.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Weiss R.L.
        • Green H.K.
        • Geppert C.
        • Warner T.
        The positive role of professionalism and ethics training in medical education: a comparison of medical student and resident perspectives.
        Acad Psychiatry. 2004; 28: 170-182
        • Dubois J.M.
        • Burkemper J.
        Ethics education in US medical schools: a study of syllabi.
        Acad Med. 2002; 77: 432-437
        • Lehmann L.S.
        • Kasoff W.S.
        • Koch P.
        • Federman D.D.
        A survey of medical ethics education at US and Canadian medical schools.
        Acad Med. 2004; 79: 682-689
        • Persad G.C.
        • Elder L.
        • Sedig L.
        • Flores L.
        • Emanuel E.J.
        The current state of medical school education in bioethics, health law, and health economics.
        J Law Med Ethics. 2008; 36: 89-94
        • Ten Have H.
        • Essed G.
        An experimental case-conference program for obstetrics and gynecology clinical students.
        J Med Ethics. 1989; 15: 94-98
        • Olthuis G.
        • Dukel L.
        What do medical students experience as moral problems during their obstetrics and gynecology clerkship?.
        J Med Ethics. 2008; 34: e2
        • Cohn F.G.
        • Shapiro J.
        • Lie D.A.
        • Boker J.
        • Stephens F.
        • Leung L.A.
        Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing.
        Acad Med. 2009; 84: 587-596
        • Singer P.A.
        • Pellegrino E.D.
        • Siegler M.
        Clinical ethics revisited.
        BMC Med Ethics. 2001; 2: 1
        • Chamberlain J.E.
        • Nisker J.A.
        Residents’ attitudes to training in ethics in Canadian obstetrics and gynecology programs.
        Obstet Gynecol. 1995; 85: 783-786
        • Byrne J.
        • Straub H.
        • Digiovanni L.
        • Chor J.
        Evaluation of ethics education in obstetrics and gynecology residency programs.
        Am J Obstet Gynecol. 2015; 212: 397.e1-397.e8
        • Kaldjian L.C.
        • Rosenbaum M.E.
        • Shinkunas L.A.
        • et al.
        Through students’ eyes: ethical and professional issues identified by third-year medical students during clerkships.
        J Med Ethics. 2012; 38: 130-132
        • Hsieh H.F.
        • Shannon S.E.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • Caldicott C.V.
        • Faber-Langendoen K.
        Deception, discrimination, and fear of reprisal: lessons in ethics from third-year medical students.
        Acad Med. 2005; 80: 866-873
        • Cain J.M.
        • Elkins T.
        • Bernard P.F.
        The status of ethics education in obstetrics and gynecology.
        Obstet Gynecol. 1994; 83 (31–20)