THE ADEQUACY OF MEDICAL-ETHICS EDUCATION IN A PEDIATRICS TRAINING-PROGRAM

Purpose. To identify ethical dilemmas commonly encountered during pedi atrics training as a step toward improving medical ethics curricula fo r residents. Method. The authors identified seven recurring topics by reviewing the required case reports on ethical dilemmas experienced by students in the third-year pediatrics clerkship from June 1992 to Jun e 1994 at the State University of New York at Buffalo School of Medici ne and Biomedical Sciences. Based on the topics identified, the author s then surveyed pediatrics housestaff in 1993-94 regarding the frequen cy of encountering the topics, levels of comfort in addressing the top ics, role models and resources, and perceived need for improved traini ng. Results. A total of 214 student essays were reviewed. Thirty-six o f 50 residents responded to the survey. In the following list of the s even topics, percentages are given for students who reported the topic , for residents who encountered the topic ''very frequently'' or ''som etimes,'' and for residents who felt ''very comfortable'' or ''somewha t comfortable'' addressing the topic: child abuse or neglect (students reported, 28%, residents encountered, 94%, residents felt comfortable , 86%); use of heroic measures to maintain a terminal patient (20%, 89 %, 69%); patient confidentiality (19%, 81%, 92%); resource allocation (12%, 67%, 54%); surrogate decision making (7%, 69%, 75%); patient aut onomy (4%, 86%, 69%); and disclosure of information (2%, 69%, 60%). Ei ghty percent of the residents felt they could not intervene when they disagreed with decisions; 69% felt their training had not prepared the m to address ethical dilemmas; 69% thought attending physicians were i nterested in discussing ethical issues; and 74% desired more training. Conclusion. Based on their self-reported experiences with topics iden tified as occurring frequently in pediatrics training, the residents p erceived their training to be inadequate and desired more ethics educa tion, but felt that the faculty were willing to assist in that trainin g.