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Ethics Curriculum for Postgraduates in Ob-Gyn

By Dr. Yasmin Wajahat

PG Diploma in Biomedical Ethics, CBEC, SIUTAssociate Surgeon

Sobhraj Maternity Hospital, Karachi

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Significance of biomedical ethics education Ethical justifications needed for decisions

within health care practice

A biomedical ethics education is essential to: provide health care professionals with

sufficient knowledge of ethical conceptual frameworks

enable them to make use of these concepts in daily working life

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Need for Biomedical Ethics:

Biomedical ethics constitutes an integral form of medical education

Mandatory discipline world over Still in its nascent form in Islamic Republic of

Pakistan

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Need for Biomedical Ethics:

There is no formal biomedical ethics education at undergraduate level except at one private college in Karachi.

Subject is being taught and learnt sporadically by giving a few informal lectures or conducting discussions

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Need for Biomedical Ethics:

Majority of the postgraduate trainees lack the background knowledge of formal ethics.

They need to be: aware of the different ethical issues prevailing

and being discussed around the globe (e.g. organ donation, persistent vegetative state, abortion, ovum donation)

trained to be able to identify and deal with the upcoming challenging ethical situations using their own moral judgment.

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About Sobhraj Maternity Hospital

Public sector hospital in Karachi, largest city of Sindh Province

Receives patients from urban and rural areas of Sindh and Balochistan

110 bed hospital providing 24 hours emergency care

Average of 200 patients seen daily

Patients belong to vulnerable group

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Training certifications of Sobhraj Maternity Hospital

The institute is recognized by PMDC for 6 month internships

The institute is recognized by CPSP for 2 years DCPS training

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Problems encountered

Busy OPD – overcrowding, less space

Shortage of skilled personnel – 1 doctor to 40 patients

Scarcity of resources

Public expectations and demands

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Ethical issues encountered by doctors

Informed consent Confidentiality Truth telling Privacy Disclosure Professional – Patient relationship

(compassion, tolerance)

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My responsibilities

As a practitioner: Position of Associate Surgeon Run clinics, manage wards and operation

rooms where the trainees assist

As an academician: Education and teaching program of the

trainees Supervision of daily morning meetings

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Aim of the designed curriculum

Build capacity in ethical reasoning skills of young doctors to resolve everyday conflicts

Enable them to relate global issues in terms of our own traditions, upholding our religious, cultural and social roots

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Target group

Fresh interns for duration of 6 months DCPS trainees for period of 2 years

Simultaneously we are training two different groups

The trainees have no background ethical knowledge from undergraduate level

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Objectives

Understand the basic ethical concepts (respect for person, confidentiality, informed consent)

Identify vulnerable patients and deal ethically with them

Take informed consent i.e. involve the patient with family in decision making

Apply the principles of privacy and confidentiality

Conduct literature search and make a presentation on an ethics related topic

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Contents of the curriculum

Introduction to biomedical ethics / oaths with an emphasis on Hippocrates's and Islamic oaths

Informed consent Confidentiality / privacy Case scenarios

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Contents

Due to the ever changing issues related to our field, the contents of the curricula can be modified as and when needed

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Methodology of teaching so as to

Involve students actively Ensure acquisition of knowledge Promote critical thinking Be practical so that the curriculum can be

implemented during working hours

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Teaching will be done during

Morning meeting

Service ward round (small group discussion) - four in a month.

Teaching round (large group discussion) - once in five weeks.

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Morning meeting

Held daily

Will be utilized twice a month for BME sessions lasting 45 minutes

Total number of sessions planned are 12, spanning over a period of 6 months

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Morning meeting

The teaching strategies involved in the morning meeting will be:

Didactic lectures

Interactive discussion

Case scenarios / case discussion

Students’ presentation

Guest speaker sessions

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Planned sessionsSession 1 Introduction to Bioethics; OATHS Didactic lecture; Q&A session in last

15 minutes

Session 2 OATHS; Hippocratic Oath; Islamic Oath Interactive discussion

Session 3 Informed Consent Didactic lecture; Q&A session in last 15 minutes

Session 4 Informed Consent Interactive discussion

Session 5 Confidentiality / Privacy Short lecture followed by an interactive discussion

Session 6 Case Scenario: Contraception Interactive discussion

Session 7 Case Scenario: Abortion / Miscarriage Interactive discussion

Session 8 Case Scenario: Informed Consent Interactive discussion

Session 9 Student’s Presentations Interactive discussion

Session 10 Student’s Presentations Interactive discussion

Session 11 Student’s Presentations Interactive discussion

Session 12 Student’s Presentations Interactive discussion

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Bedside teaching

Small groups – 5 or 6 trainees (4/month) Large groups – all 16 trainees (1 in 5 wks.) At the end of each round Last 15-20 minutes will be utilized The students will be asked to identify any

ethical issues present in patients This will be followed by a discussion

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Assessment of knowledge

Written question related to biomedical ethics will be included in monthly OB-GYN test

It will consist of short descriptions of particular concepts e.g. Definitions Basic ethical principles Elements of informed consent

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Conclusion

Biomedical ethics education is a need of the age

Objectives are kept few and simple

Topics are closely related to clinical practice

Bedside teaching preferred to expose trainees to different ethical issues in patients they are managing

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Conclusion

No extra time will be demanded of the trainees

Once implemented, it will be the teaching program for both, the trainees and the trainers

Liable to be modified & improved as & when the need arises

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Conclusion

Biomedical Ethics Training program has been implemented at Sobhraj Maternity Hospital from February 2007.

A small project related to “informed consent” has been initiated

Aims to train postgraduates to involve and encourage female patients in decision making, prior to their families

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References:

1. Moazam F, Jafarey AM. Pakistan and biomedical ethics: report from a Muslim country. Cambridge Quarterly of Health Care Ethics 2005;14:249-255.

2. Jafarey AM, Farooqui A. Ethical dilemmas and the moral reasoning of medical students. JPMA 2003;53;6.

3. Carmi A, editor. Informed consent. Israel: The International Center for Health, Law and Ethics, University of Haifa; 2003

4. An introduction to bioethics. [online]. Available from: URL: http://sunsite.wits.ac.za/bio/intro1.htm

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Thank You