238 - A Bottom-Up Approach in Pediatric Ethics Education: Residents Leading Ethics Curriculum Development

Poster Number: 238
Publication Number: 238.333

Allison N. Lyle, SEATTLE CHILDREN'S HOSPITAL, Seattle, WA, United States; Angela M. Quain, University of Michigan, Ann Arbor, MI, United States; Sarah Ali, Indiana University Purdue University Indianapolis (IUPUI), Fishers, IN, United States; Zeynep Salih, IUSM, Indianapolis, IN 46202, IN, United States

Background: Pediatrics residents routinely face ethical dilemmas and moral distress in training. There is no universal formal ethics curriculum for pediatrics residents. Historically, ethics curricula have followed a top-down structure of didactic lectures instead of a bottom-up approach with residents self-identifying educational needs. Few studies have shown meaningful methods in reducing resident moral distress.

Objective: To determine 1) how ethics case discussions and guidance are valued by residents, 2) whether such a program affects ethics knowledge and perceived moral distress and 3) to evaluate residents’ perceived moral distress before, during and after a discussion series.

Design/Methods: Respondents included pediatric and pediatric-combined residents in a mid-sized Midwest program. Five 1-hour sessions were presented over a 5-month period. Each case was identified by a resident and developed under the guidance of an ethicist. Multidisciplinary perspectives were provided by relevant services (such as DCS, risk management) as well as content experts during each session. A Baseline survey (Table 1) was distributed prior to any session. Post-session surveys were distributed on the day of the discussion. A Finale survey was distributed after the completion of the series. Surveys used a Moral Distress Thermometer. Open-ended responses for session improvement were also recorded.

Results: When comparing baseline and finale responses (Table 1), the only significance was increased preparedness to navigate ethical decisions (p=0.004). While not significant, a 10.2% decline was observed in resident moral distress (Table 2). An increase in ethics knowledge is observed but was not significant. There were 85 free text submissions. Residents favored case-based discussions and multidisciplinary input. Residents expressed desire for more sessions, time for small group discussions and legal insight. Satisfaction was high overall with 90.7% of respondents feeling better prepared to address ethical concerns (Table 3).Conclusion(s): Pediatric trainees face ethical dilemmas during training that cause moral distress. Residents feel that understanding ethics is relevant to their practice. While residents desire case-based ethical discussions, this format does not by itself decrease moral distress in this pilot study. This study highlighted ethical concepts where residents desired further education.
Table 1Perceived importance of ethics and moral distress - Baseline (prior to any session) vs Finale (after completion of all sessions)
Table 2Moral Distress Scale - Baseline (Prior to 5-session series) vs Final (After completion of all 5 sessions).