Department of Pediatrics: Educational Projects

Department of Pediatrics at The Johns Hopkins Hospital 2007-10

Dr. Moon is implementing the Clinical Ethics Curriculum for Pediatrics Residents at The Johns Hopkins Hospital. The curriculum includes:

  • Ethics reflection project: Each resident in the Department of Pediatrics is asked to consider a personal clinical experience that seemed important from an ethics perspective. The residents write a brief discussion of the case, identifying its ethical content and explaining its actual resolution. They are asked to consider more optimal outcomes, obstacles to those outcomes and strategies for similar cases. These reflections are submitted twice during training, first in December of the internship year and again mid way through the second year of the three year program. Because of how highly valued this educational experience is by both the trainees and the programs directors in Pediatrics, the narrative reflection exercise has been made a required element of the Pediatrics residency curriculum. The narratives have several intended uses:
    • To orient the residents to ethics via critical reflection on personal experience.
    • To develop an empirical basis to understand the ethics issues that create distress for the residents at different times in their training.
  • Dr. Moon has been able to target teaching to the issues residents raise, again working to keep education relevant and timely. To create a basis for direct and personal mentoring about ethics. Dr. Moon works with individual residents in response to their narratives, first with formative assessment and individualized resources to enhance ethics skills. After the second narrative, the mentoring focuses on review of progress and further development of the individual’s personal practice of ethics. To create academic products for the residents. Residents are encouraged to develop their reflections into academic products. Two were recently published in an academic journal, others may be developed into teaching materials.
  • Ethics Conferences: The purpose of ethics conferences is to reinforce skills in analysis of ethics issues. By using a consistent approach, Dr. Moon works to promote a shared language of ethics in the Children’s’ Center. A shared language is the first step in encouraging discourse. All conferences are interactive, case based and focused on the thought process, not the “right” answer
  • Noon conferences: Targeting issues identified in the narrative project and in observation work in the outpatient setting, noon conferences are case based interactive discussions that teach residents to use a standard system to analyze ethics issues. Examples of cases/topics discussed during noon conferences:
    • Managing the therapeutic alliance
    • Competence as a developmental construct in pediatrics
    • Moral beliefs and clinical care: Questions about right of conscience
    • Futility and preventive ethics
    • Limits of parental autonomy
    • Lying to patients
    • Introduction to conflict resolution
    • Introduction to ethics in research with children and adolescents
  • Attending rounds: Monthly meeting with residents and faculty on the inpatient service to assess a current case that has troubled the team. The analysis follows the same pattern as used in noon conferences. The residents engage in open discussion of the moral obligations, personal and professional values at play and work to analyze the conflict and develop strategies for resolution. Examples of cases/topics discussed during attending rounds:
    • Parents as potential abusers: promoting justice, protecting children
    • Adolescent refusal of care: meaning of consent
    • Difficult parents: therapeutic alliance and professional standards
    • Limits of parental authority: setting boundaries
    • Conflict resolution: focus on development and resolution of conflict with nursing staff
    • Nature and meaning of futility
    • Managing futility discussion
    • Understanding parental choice
    • Competence and adolescent patients
  • Faculty conferences: Several divisions within the Department of Pediatrics have requested ethics conferences for faculty and fellows, independent of the resident teaching program. Focus has ranged from improving faculty interactions around difficult issues to discussion of current topics on subspecialty ethics. The opportunity to teach faculty seems particularly valuable as a way to enhance the environment in which residents learn and practice ethics and to reinforce the shared language goals. Examples of cases/topics discussed during faculty conferences:
    • Communicating a negative prognosis
    • Justice and allocation of resources in the pediatric pulmonary service
    • Futility and quality of life
    • Communicating about ethics: learning from the hard cases
    • Impact of moral beliefs on clinical care in adolescent medicine
    • Autonomy and adolescent patients: recognizing challenges in capacity to consent
    • Ethical issues in HIV disclosure
    • Cases on the limits of parental autonomy
    • Implementing a principle of respect for communities in research

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