Objective
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.
Results
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).
Conclusion
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
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References
- 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
- Ethics education in US medical schools: a study of syllabi.Acad Med. 2002; 77: 432-437
- A survey of medical ethics education at US and Canadian medical schools.Acad Med. 2004; 79: 682-689
- The current state of medical school education in bioethics, health law, and health economics.J Law Med Ethics. 2008; 36: 89-94
- An experimental case-conference program for obstetrics and gynecology clinical students.J Med Ethics. 1989; 15: 94-98
- What do medical students experience as moral problems during their obstetrics and gynecology clerkship?.J Med Ethics. 2008; 34: e2
- Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing.Acad Med. 2009; 84: 587-596
- Clinical ethics revisited.BMC Med Ethics. 2001; 2: 1
- Residents’ attitudes to training in ethics in Canadian obstetrics and gynecology programs.Obstet Gynecol. 1995; 85: 783-786
- Evaluation of ethics education in obstetrics and gynecology residency programs.Am J Obstet Gynecol. 2015; 212: 397.e1-397.e8
- Through students’ eyes: ethical and professional issues identified by third-year medical students during clerkships.J Med Ethics. 2012; 38: 130-132
- Three approaches to qualitative content analysis.Qual Health Res. 2005; 15: 1277-1288
- Deception, discrimination, and fear of reprisal: lessons in ethics from third-year medical students.Acad Med. 2005; 80: 866-873
- The status of ethics education in obstetrics and gynecology.Obstet Gynecol. 1994; 83 (31–20)
Article Info
Publication History
Published online: July 23, 2015
Accepted:
July 17,
2015
Received in revised form:
June 4,
2015
Received:
March 27,
2015
Footnotes
The authors report no conflict of interest.
Cite this article as: Mejia RB, Shinkunas LA, Ryan GL. Ethical issues identified by obstetrics and gynecology learners through a novel ethics curriculum. Am J Obstet Gynecol 2015;213:867.e1-11.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
