The ethics curriculum at The Herman and Walter Samuelson Children's Hospital at Sinai is a structured curriculum focusing on pediatric clinical ethics for pediatric house staff. The curriculum aims to provide residents with the ability to identify and critically analyze moral considerations in their day-to-day interactions with patients and to enhance their confidence and "ethical proficiency" in difficult clinical encounters.
The curriculum is directed by Dr. Yoram Unguru, a pediatric hematologist/oncologist at the Herman and Walter Samuelson Children's Hospital. Dr. Unguru completed graduate level and postdoctoral training in bioethics and is a faculty member of the Berman Bioethics Institute at Johns Hopkins University.
The dynamic curriculum lends itself to adult learning techniques and is comprised of four elements:
(1) Core topics in bioethics are covered in traditional "frontal lectures," however, the majority of the curriculum is informal and interactive and house staff are encouraged to participate in group discussions.
(2) At the beginning of each academic year, house staff write about an ethical "issue" in clinical practice from their own personal experience. These "cases" serve as the basis for developing a series of educational topics that the residents are both invested and interested in. Examples of topics residents have written about include adolescent refusal of care; drug seeking behavior; refusal of blood products by a Jehovah's Witness; provider-patient-parental disagreement; end-of-life / palliative care / futility; truth-telling (difficult diagnosis); providing care for family members; resource allocation and rationing of care; poor communication among team members.
(3) Ethics rounds: House staff, together with a faculty ethics educator, meet monthly to review an "ethics case." The "cases" come from residents' interactions on the general pediatric ward, PICU, NICU, outpatient clinic and other rotations. Additional sessions are convened at the behest of the house staff on an as needed basis. Discussions focus on conflicting moral obligations using relevant ethical principles to balance the ethical dilemma.
(4) Mentorship: House staff who are interested in ethics are encouraged to lead ethics rounds and to serve as mentors to their fellow interns and residents. Any resident who is interested may also attend Sinai Hospital Ethics Committee meetings, which convene the third Thursday of each month.
Yoram T. Unguru, M.D.