Department of Medicine: Educational Projects

Berman Institute faculty are heavily involved in ethics education projects in the  Department of Medicine, both at the Johns Hopkins Hospital and the Bayview Medical Center.

Department of Medicine at the Johns Hopkins Hospital:

Dr. Mark Hughes conducts the Clinical Ethics Curriculum for Medicine Residents at Johns Hopkins Hospital. The curriculum includes:

  • Noon Conference: Periodically over the course of the academic year, noon conferences are dedicated to clinically oriented, case-based discussions, during which important ethics topics are reviewed. Residents are invited to help facilitate the discussions.

    Another venue for ethics discussions is Tumulty Rounds, in which a faculty member invites a patient to share their story and residents join in a discussion about aspects of the patient’s care.

  • Ethics Sessions at Intern Report:  Intern report in the Department of Medicine at Johns Hopkins Hospital is directed by the Program Director, Sanjay Desai.  Several sessions are set aside for Dr. Hughes to address ethical issues as they relate to the interns’ new roles as physicians and members of the healthcare team.
  • Advanced skills for informed consent: Dr. Hughes teaches about the interface between ethics and communication skills in a simulated encounter addressing informed consent and shared decision-making. Residents participate in the lab individually, role playing a scenario with a standardized patient, in which they are required to obtain informed consent for an investigational biopsy. Following the videotaped simulated patient encounter, the resident is given feedback on his/her communication skills from the simulated patient and Dr. Hughes.

Department of Medicine at Johns Hopkins Bayview Medical Center:

Dr. Joseph Carrese is implementing the Clinical Ethics Curriculum for Medicine Residents at Johns Hopkins Bayview Medical Center. The curriculum includes:

  • Informed consent and ethics case analysis: During a special rotation for all interns that focuses on communication and interpersonal skills, Dr. Carrese teaches a 3-hour small-group session that addresses informed consent and a method for analyzing cases that present ethics issues. This session is taught monthly for the first 4 months of the academic year. About 5 or 6 interns are included in each session, and over the course of the 4 sessions every intern will have participated in the session. The sessions are case-based and interactive.
  • Ethics morning report: This is an early morning case-based conference is attended by all Hopkins Bayview internal medicine trainees, as well as Johns Hopkins third-year medical students on their clinical clerkship in internal medicine at Hopkins Bayview. A recent case involving an ethics issue is presented by a designated resident. Dr. Carrese leads and facilitates the discussion with the interns, residents, and medical students who are in attendance. Ethics morning report takes place about 7-8 times per year, and focuses on everyday ethics issues that occur in the outpatient setting. (Drs. Carrese and Hughes are co-authors on a paper that emerged from an Ethics Morning Report conference. The paper was published in the February 2010 issue of CHEST, accompanied by an enthusiastic editorial written by the president of the American Thoracic Society. It is titled
  • Ethics for Lunch: This is a noon-time case conference sponsored by the Johns Hopkins Bayview Medical Center Ethics Committee and the Department of Medicine. At this conference an ethics issue is presented and discussed, usually in a case-based format. The conference is interdisciplinary: it is attended by internal medicine trainees and medical students, as well as chaplains, nurses, social workers, nurse practitioners, staff from patient relations, and other hospital staff. This interdisciplinary forum is a great opportunity for internal medicine trainees to interact with and hear the perspectives of their colleagues from other disciplines. Ethics for Lunch takes place about 7-8 times per year.
  • Ethics Consultation: Every month a second- or third-year internal medicine resident is assigned to participate in the ethics consultation process. These residents are involved in all ethics consultations during this rotation, and they participate in the meeting of a subgroup of the 5 ethics committee members assigned to the consultation service for that month. Dr. Carrese reviews with these residents the method for analyzing cases used by the ethics committee (which is the same approach he is teaching to all interns).
  • Support Groups (interns and residents) – Support group takes place once a week and is a year round noon conference with no pre-determined agenda; topics for discussion are determined by trainees in real time. These sessions are facilitated by Dr. Carrese. This venue lends itself to discussion of difficult ethics issues, including the moral distress sometimes experienced by trainees in the course of their training. Examples of some topics that have been addressed include: making mistakes (and how to manage communication with patients/families once a mistake has been made); death of patients; conflicts with colleagues; responsibilities to difficult patients; ethical issues related to cultural differences; physicians’ personal values and whether and how they should enter the medical encounter.

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