Integrating ethics into residency programs:
Michigan helps lead the way
Ethics education soon will be a formalpart of graduate medical
education at the University of Michigan in what is believed
to be a nationwide first in residency programs.
The teaching of ethics — a standard component in medical
school — will be expanded into residents’ rounds,
lectures and sessions with trained “patients.” The
Graduate Medical Education in Ethics Initiative is directed
by Drs. Susan Dorr Goold and David Stern, assistant professors
of internal medicine who have been leaders in developing ethics
in the curriculum for the Medical School.
U-M medical students are exposed to ethics lessons in both the
classroom and clinic. They learn about the wide range of moral
dilemmas they will face as physicians, such as making mistakes,
patient confidentiality, end-of-life issues and religious conflicts.
Ethics education for residents, however, is sporadic, with some
departments taking a more formal approach than others.
Goold believes the U-M is the first medical school in the country
to make ethics education part of the dozens of residencies it
offers. She is pleased it will surface throughout the entire
learning process — in classrooms, hospital hallways and
examining rooms.
“The more you make it separate, the more marginalized it
is, and the less important it is,” Goold says.
That same philosophy is being incorporated into a new Medical
School Ph.D. program known as PIBS — Program in Biomedical
Sciences. PIBS coordinates the first year of studies for graduate
students in 10 doctoral programs. Faculty are just beginning
to structure ethics teaching into the program, which is expected
to draw about 50 students.
One of those involved with designing PIBS is Paul Hollenberg,
chairman of the Department of Pharmacology, where ethics education
has been part of the curriculum for the past two years. The
teaching is relaxed, typically taking place at the end of the
day with students and faculty sharing a pizza while debating
complex moral issues. The objective: Ethics is not to be studied
and memorized only to be cast aside after exams.
“Ethics is something that should be part of your life,”
Hollenberg says.
The graduate programs in PIBS are: Biological Chemistry; Biophysics;
Cell, Developmental and Neural Biology; Cellular and Molecular
Biology; Human Genetics; Microbiology and Immunology; Neuroscience;
Pathology; Pharmacology; and Physiology.
For ethics education in residencies, Goold and her colleagues
will spend this year surveying residency directors and physicians
who have recently completed their residencies about what they
believe should be included in ethics education in terms of skills,
knowledge and attitudes.
Teaching and clinical activities will be offered starting in
2000. A “menu” of educational exercises will be available
for residency directors to choose from when incorporating ethics
into the already stretched days and nights of residents. “We
hope that coordinating efforts across departments will create
a more consistent, higher quality and, perhaps, more efficient
experience in ethics education in all the residency programs
at U-M,” Goold says.
One component of the new program will be “ethics rounds,”
with residents focusing on moral rather than medical dilemmas.
Goold currently conducts monthly ethical rounds in the high-risk
obstetrics clinic, working with the medical staff and their
interactions with patients.
“I try to teach them how to recognize moral issues and
distinguish them from questions of fact. The tendency is to
medicalize everything,” she says.
The new program also will increase the use of standardized,
or simulated, patients — individuals trained to portray
patients in a clinical setting. They currently are used in the
Medical School.
There also will be programs for faculty to develop their teaching
skills in the field of ethics. Some faculty are uncomfortable
discussing ethics because they received no formal education
in the subject themselves, Goold says. The Faculty Group Practice,
made up of U-M faculty who provide clinical care, is funding
Graduate Medical Education in Ethics.
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