Ethics education in family medicine training in the United States: a national survey.

BACKGROUND AND OBJECTIVES: Although professional organizations endorse ethics education in family medicine training, there is little published evidence that ethics teaching occurs. This survey collated data on the aims, content, pedagogical methods, assessment, and barriers relating to formal ethics education in family medicine residency programs in the United States. METHODS: A questionnaire surveyed all 445 family medicine residency programs in the United States. RESULTS: Forty percent of programs responded (178/445). Of these, 95% formally teach at least one ethics topic, 68.2% teach six or more topics, and 7.1% teach all 13 core topics specified in the questionnaire. Programs show variation, providing between zero to 100 hours' ethics education over the 3 years of residency training. Of the responding programs, 3.5% specify well-defined aims for ethics teaching, 25.9% designate overall responsibility for the ethics curriculum to one individual, and 33.5% formally assess ethics competencies. The most frequent barriers to ethics education are finding time in residents' schedules (59.4%) and educator expertise (21.8%). CONCLUSIONS: Considerable variation in ethics education is apparent in both curricular content and delivery among family medicine residency programs in the United States. Additional findings included a lack of specification of explicit curricular aims for ethics teaching allied to ACGME or AAFP competencies, a tendency not to designate one faculty member with lead responsibility for ethics teaching in the residency program, and a lack of formal assessment of ethics competencies. This has occurred in the context of an absence of robust assessment of ethics competencies at board certification level.

The development of the CoRE-Values framework as an aid to ethical decision-making.

BACKGROUND: Ethical analysis frameworks can help to identify the ethical dimensions to clinical care and provide a method for justifying clinical decisions. Published frameworks, however, have some limitations to easy, practical use. AIMS: The aim was to identify a comprehensive yet easy-to-use framework that clarifies ethical decision-making, suitable for use by medical learners and clinical educators. METHOD: A literature search identified published frameworks that define the components of ethical clinical decision-making. On this basis, a new framework, the 'CoRE-Values Compass and Grid' was constructed. This was formally evaluated during a medical school interprofessional teaching session. RESULTS: For 88% of 228 medical and nursing students, the new framework was easy to understand; 85% reported it as easy to use. The framework improved awareness of the ethical dimensions to a clinical scenario for 97% of students and the ability to systematically identify ethical aspects for 83%. Students and instructors reported that the framework helped to link ethics theory with clinical practice. The framework was described as a useful educational tool by 85% of students and 95% of instructors. CONCLUSIONS: The 'CoRE-Values Compass and Grid' is a new framework, shown to aid the systematic identification and consideration of ethical aspects to clinical cases.

The need for medical ethics education in family medicine training.

Professional and accreditation organizations have endorsed medical ethics as a fundamental component of education for family medicine trainees. Yet various obstacles combine to work against the continuation of formal medical ethics education beyond medical school and into residency training. This article reviews the current consensus on the scope and objectives of medical ethics education in the context of family medicine training. The need for, and outcomes of, medical ethics teaching are analyzed on the basis of the available evidence. Recent trends in medical education that potentially influence graduate medical ethics training are also discussed (specifically ethics training in medical schools and the priority given to training in professionalism). This review shows a strong evidence-based need to provide medical ethics education for family physicians in training, a need that is apparent on many levels. The current reliance on medical school ethics education and emphasis on professionalism does not answer this need. A well-constructed course in medical ethics for family medicine trainees can teach an array of competencies stipulated by professional and accreditation agencies as important in the practice of family medicine. Educators must strive to overcome barriers and provide formal medical ethics programs to better prepare family physicians for modern professional roles.