Pedagogy in Education

               With advances in medical technology and an increasingly diverse patient population, the field’s need for clear ethical reasoning and ability to navigate complex situations is more critical than ever. Anesthesiologists have a wide area of representation in practice including the perioperative areas, operating rooms, such as the intensive care units, chronic pain centers, hospital floors for acute care and emergency rooms(3). Additionally, we play an important role in academic research, medical education, medical boards, administration, leadership, journal review boards, etc. Difficult professional, ethical and communication issues may arise in each of these areas of work and place a moral challenge to our decision making(4). The decisions we make based on our definition of “right or wrong” may affect the well being of our patients, their families, our colleagues, and ourselves. The American Board of Anesthesiology (ABA) has set ‘milestones’ for competency assessment in ethical practice, as well as questions in the ABA board exams. In order to receive board certification, the resident has to display competence in these ‘Ethics and Medico-legal issues’(5). These skills include promoting the basic standards of practice for all residents so they can practice independently after graduation. In order to master these core competencies, a formal ethics curriculum is essential in underpinning and understanding the issues and principles of ethical practice.

               In addition to training programs, the practice of ethics and professionalism is a life long requirement. Dealing with difficult decisions require skill, sensitivity and training. Unfortunately, our training programs lack any formal curriculum that incorporate such cognitive and communication training. The need for formal instruction in bioethics and professionalism is felt at all levels of practice; in a recent survey of trainees and program directors, less than half of the respondent (48%) reported any formal ethics training in their programs, at an average of only 3.8 +- 1.6 hours per year(6). It is a well-known fact that communication gaps and lack of conflict resolution skills are one of the foremost causes of not just poor patient-physician relationships and trust bonds, poor patient satisfaction and outcomes, but also a leading cause of burnout. In the same survey, only 58% of respondents agreed that their residents were capable of managing ethical dilemmas upon graduation.

               Barriers to coping with difficult ethical and moral scenarios in clinical practice include a lack of a structured curriculum, lack of experienced faculty, comfortable in teaching the basic values and principles of ethics and professionalism, application in day-to-day patient care, and lack of devoted time for such training(7). Although most medical school curricula have integrated formal ethics training, such a format is also important in residency training programs(8).