How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population.

BACKGROUND: Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group. METHODS: This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used. RESULTS: Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage. CONCLUSIONS: After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

Differences in moral reasoning among medical graduates, graduates with other degrees, and nonprofessional adults.

BACKGROUND: Reasoning and moral action are necessary to resolve day-to-day moral conflicts, and there are certain professions where a greater moral character is expected, e.g., medicine. Thus, it is desirable that medical students develop skills in this field. Some studies have evaluated the level of moral reasoning among medical students; however, there are no comparative studies involving other types of populations. Therefore, the objective of this study was to compare the moral reasoning among medical graduates with that of a group of young graduates with other degrees and of a group of nonprofessional adults. METHODS: An exploratory cross-sectional study was conducted. Pediatric residents and pediatric subspecialty residents at a pediatric hospital were invited to participate, forming the group of "medical graduates". A group of young people from a social program and students with a master's degree in a science from the same pediatric hospital were also invited to participate, comprising the group of "graduates with other degrees". Finally, a group of beneficiaries of a family clinic was invited to participate, which we categorized as "nonprofessionals". To evaluate the differences in moral reasoning between these 3 groups, we applied the Defining Issues Test (DIT), a moral reasoning questionnaire designed by James Rest using Kohlberg's theory of moral development. RESULTS: The moral reasoning of 237 subjects-88 from the "medical graduates" group, 82 from the "graduates with other degrees" group and 67 from the "nonprofessionals" group- was evaluated. We found differences in the profiles of moral development of the groups. The profile of the "nonprofessionals" showed a very high predominance of subjects at the preconventional level, 70%, but only 4.5% at the postconventional level. Among the "medical graduates", we observed 37.5% at the preconventional level and 34% at the postconventional level (X2 p < 0.001); this group had the highest percentage in this category. This large difference could be because the differences in the ages and socioeducational levels of nonprofessionals are much wider than those among medical graduates. However, significant differences were also found when the profiles of medical graduates were compared with those of graduates with other degrees, since the latter demonstrated 56% at the preconventional level and 18% at the postconventional level (X2 test, p = 0.02). CONCLUSIONS: Significant differences were found in moral reasoning among the groups that we evaluated. Among the group of medical graduates, there was a higher percentage of subjects at the postconventional level than among the group of graduates with other degrees and a much higher percentage than among the group of nonprofessionals. Our conclusions give the first evidence that studying medicine seems to influence the development of moral reasoning in its students. Therefore, we consider it relevant to develop educational strategies where the student is involved in simulated but realistic decision-making situations, where there are moral dilemmas to resolve from their early years of training.

Supervivencia en pacientes afectados de enterocolitis neutropénica con sepsis y sus diferentes estadios / Survival of patients with neutropenic enterocolitis and different stage of sepsis

Objetivo: Determinar la supervivencia de los pacientes con enterocolitis neutropénica (ECN) con sepsis y sus diferentes estadios, ingresados en una unidad de cuidados intensivos pediátricos (UCIP). Métodos: Se realizó un estudio de cohortes en pacientes con diagnóstico de ECN, definida en sujetos con quimioterapia reciente, un recuento de neutrófilos totales <500 células/cm3, abdomen agudo y estudio de imagen compatible, que ingresaron en una UCIP. Se clasificó la sepsis de acuerdo con los criterios del «Consenso internacional de sepsis en pediatría», y se realizó a los pacientes un seguimiento hasta el séptimo día de estancia intrahospitalaria, registrándose las defunciones. Análisis estadístico: Se procedió al análisis de la supervivencia según el método de Kaplan-Meier, así como al cálculo de la tasa de riesgo. Resultados: Se seleccionó una muestra total de 64 pacientes, y se registraron 28 (43%) defunciones. La supervivencia registrada al séptimo día de seguimiento fue del 100% en la sepsis, del 92% en la sepsis grave, del 25% en el choque séptico y del 9% en la disfunción orgánica múltiple (p <0,0001). Conclusiones: La sepsis y sus distintos grados repercuten negativamente sobre la mortalidad de los pacientes pediátricos con ECN (AU)

Objective: To determine the survival of oncologic patients with neutropenic enterocolitis (NEC) and different stages of sepsis. Methods: A cohort study was performed in patients with the diagnosis of NEC defined in patients with recent chemotherapy, total neutrophils under 500 cells/cm3, acute abdomen and image compatible cabinet, admitted in a pediatric intensive care unit. Sepsis was classified according to the criteria of the "International pediatric sepsis consensus" were classified and were followed for up to seven days of hospital stay, registering deaths. Statistical analysis: Analysis of survival by Kaplan-Meier estimate of hazard ratio. Results: Total population of 64 patients, presenting 28 (43%) deaths. Survival on the seventh day follow-up was as follows: 100% sepsis, severe sepsis 92%, septic shock 25%, and multiple organ dysfunction 9% (p <0.0001). Conclusions: Sepsis in its different stages has a negative impact on mortality in pediatric patients with NEC (AU)