What are the facilitating factors, needs and challenges for creating and implementing an interprofessional ethics education curriculum for learners at the Duke University Schools of Medicine and Nursing, and how might this information be used to advance interprofessional ethics education at our institution?
One of DukeHealth’s strategic goals, consistent with national trends, is to increase interprofessional education (IPE) and practice with the goal of optimizing patient care. Ethics is widely understood to be a foundational component of all health professions (Barlow, Hargreaves, & Gillibrand, 2018; Strawbridge, Barrett, & Barlow, 2014) and has convergent objectives with IPE (Machin et al., 2018). Varying professional perspectives on what is in the patient’s best interest may lead to conflict, which in turn may induce stress and burnout. Teaching students to collaborate and communicate effectively, however, has the potential to create more supportive and resilient communities of health providers, in addition to improving patient care. These reasons compelled us to focus on ethics to advance IPE at Duke. A pilot study, conducted as part of the DukeAhead Certificate Program, explored the nature and extent of classroom-based ethics education in five programs at Duke University Schools of Medicine (SOM) and Nursing (SON) to determine a basis for creating an interprofessional curriculum for ethics education. It was found that ethics was taught exclusively to students in each program as a required part of the curricula. With regard to content, all programs included core ethical principles and explored ethical dilemmas using case studies, four programs included an approach or framework to guide ethical decision making in clinical practice, but only two of the five programs provided opportunities for students to identify their personal values and explore the implications for patient care, and only two programs required students to be familiar with their respective professional codes of ethics to gain insight into values that should guide professional attitudes and behaviors. Similarly, there was variation with regard to learning objectives, pedagogy and assessment. These findings highlight the opportunity to create a more comprehensive ethics curriculum, including an interprofessional component, for use across the programs. Drawing on the results of this study, an approach to interprofessional education for ethics is proposed. This approach would begin with students exploring their personal values, followed by learning about ethical principles and concepts, profession-specific codes of ethics, frameworks for making ethical decisions, and related institutional and legal resources. This phase of the curriculum would be implemented within each professional student group to mitigate logistical challenges relating to scheduling and learning spaces. The interprofessional phase of the curriculum would follow, with students from the different programs coming together in small groups, either virtually or in person, to explore case-based and issue-specific ethical dilemmas relevant to all represented healthcare professions. These interprofessional groups would focus on management and ethical priorities from the perspective of each profession in the process of reaching a resolution to the ethical dilemma. According to Strawbridge et al. (2014), interprofessional debates for ethics foster students’ critical thinking and create awareness of conflicting views regarding decisions that are possible. Finally, debriefing and feedback sessions facilitated by faculty would allow students to discuss their experiences, including what they learned, and how it might influence their future healthcare decisions, as well as how they were affected by the discussion (Machin et al., 2018). One way to implement this approach to ethics education would be through Team-based Learning (TBL). Program specific learning might occur and be evaluated though the readiness assurance tests, and the application phase of TBL would occur in an interprofessional educational setting.
- 2019