Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Ethics and professionalism education during neonatal–perinatal fellowship training in the United States

Journal of Perinatology volume 35, pages 875–879 (2015)Cite this article

Subjects

Abstract

Objective:

The objectives of this study were to determine the perceived adequacy of ethics and professionalism education for neonatal–perinatal fellows in the United States, and to measure confidence of fellows and recent graduates when navigating ethical issues.

Study Design:

Neonatal–Perinatal Fellowship Directors, fellows and recent graduates were surveyed regarding the quality and type of such education during training, and perceived confidence of fellows/graduates in confronting ethical dilemmas.

Result:

Forty-six of 97 Directors (47%) and 82 of 444 fellows/graduates (18%) completed the surveys. Over 97% of respondents agreed that ethics training is ‘important/very important’. Only 63% of Directors and 37% of fellows/graduates rated ethics education as ‘excellent/very good’ (P=0.004). While 96% of Directors reported teaching of ethics, only 70% of fellows/graduates reported such teaching (P<0.001). Teaching methods and their perceived effectiveness varied widely.

Conclusion:

Training in ethics and professionalism for fellows is important, yet currently insufficient; a more standardized curriculum may be beneficial to ensure that trainees achieve competency.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Sulmasy DP, Geller G, Levine DM, Faden RR . A randomized trial of ethics education for medical house officers. J Med Ethics 1993; 19: 157–163.

    Article  CAS  Google Scholar 

  2. Hafferty F, Franks R . The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 1994; 69: 861–871.

    Article  CAS  Google Scholar 

  3. Mattick K, Bligh J . Teaching and assessing medical ethics: where are we now? J Med Ethics 2006; 32 (3): 181–185.

    Article  CAS  Google Scholar 

  4. Eckles R, Meslin EM, Gaffney M, Helft PR . Medical ethics education: where are we? Where should we be going? A review. Acad Med 2005; 80: 1143–1152.

    Article  Google Scholar 

  5. Bolin J . Strategies for incorporating professional ethics education in graduate medical programs. Am J Bioeth 2006; 6: 35–36.

    Article  Google Scholar 

  6. de Blacam C, Vercler CJ . Teaching ethics and professionalism in plastic surgery: a systematic review. Ann Plast Surg 2014; 72 (4): 484–488.

    CAS  PubMed  Google Scholar 

  7. Kesselheim JC, Johnson J, Joffe S . Pediatricians’ reports of their education in ethics. Arch Pediatr Adolesc Med 2008; 162 (4): 368–373.

    Article  Google Scholar 

  8. Accreditation Council for Graduate Medical Education. General competencies. http://acgme.org/acgmeweb/Portals/0/PDFs/commonguide/IVA5e_EducationalProgram_ACGMECompetencies_Professionalism_Explanation.pdf (accessed 30 January 2014).

  9. Walsh Lang C, Smith PJ, Friedman Ross L . Ethics and professionalism in the pediatric curriculum: a survey of pediatric program directors. Pediatrics 2009; 124: 1143–1151.

    Article  Google Scholar 

  10. Cook AF, Sobotka SA, Ross LF . Teaching and assessment of ethics and professionalism: a survey of pediatric program directors. Acad Pediatr 2013; 13 (6): 570–576.

    Article  Google Scholar 

  11. Salih Z, Boyle D . Ethics education in neonatal–perinatal medicine in the United States. Semin Perinatol 2009; 33: 397–404.

    Article  Google Scholar 

  12. Davis D, Doucet H . A curriculum for teaching clinical ethics in neonatal-perinatal medicine. Ann R Coll Physicians Surg Can 1996; 29: 45–48.

    CAS  PubMed  Google Scholar 

  13. Stirrat G . Education in ethics. Clin Perinatol 2003; 30: 1–15.

    Article  Google Scholar 

  14. Hellman J . Development of a teaching curriculum in neonatology fellowship training 2006, http://www.utoronto.ca/pgme/documents/curricula/neonatal_curr2.pdf (accessed 30 January 2014).

  15. Daboval T, Moore GP, Rohde K, Moreau K, Ferretti E . Teaching ethics in neonatal and perinatal medicine: what is happening in Canada? Paediatr Child Health 2014; 19 (1): e6–e10.

    Article  Google Scholar 

  16. Adam MB, Diekema DS, Mercurio MR (eds). American Academy of Pediatrics Bioethics Resident Curriculum: Case-Based Teaching Guides. http://www.aap.org/sections/bioethics/default.cfm (accessed 3 October 2014).

  17. American Board of Pediatrics Program Directors Committee Association of Pediatric Program Directors Teaching and Assessing Professionalism: A Program Director’s Guide. American Board of Pediatrics Foundation: Chapel Hill, NC, USA, 2008, www.appd.org/professionalism.pdf (accessed 3 October 2014).

  18. Gisondi MA, Smith-Coggins R, Harter PM, Soltysik RC, Yarnold PR . Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas. Acad Emerg Med 2004; 11 (9): 931–937.

    Article  Google Scholar 

  19. Lamiani G, Meyer EC, Browning DM, Brodsky D . Analysis of enacted difficult conversations in neonatal intensive care. J Perinatol 2009; 29 (4): 310–316.

    Article  CAS  Google Scholar 

  20. Meyer EC, Brodsky D, Hansen AR, Lamiani G, Sellers DE, Browning DM . An interdisciplinary, family-focused approach to relational learning in neonatal intensive care. J Perinatol 2010; 31 (3): 212–219.

    Article  Google Scholar 

  21. Antes AL, Murphy ST, Waples EP, Mumford MD, Brown RP, Connelly S et al. A meta-analysis of ethics instruction effectiveness in the sciences. Ethics Behav 2009; 19 (5): 379–402.

    Article  Google Scholar 

  22. Daboval T, Ferretti E, Moore GP . Innovative holistic teaching in a Canadian Neonatal Perinatal Medicine Residency Program. Hastings Cent Rep 2014; 44 (6): 21–25.

    Article  Google Scholar 

  23. American Society for Bioethics and Humanities Clinical Ethics Task Force Improving Competencies in Clinical Ethics Consultation: An Education Guide. American Society for Bioethics and Humanities: Glenview, 2009.

Download references

Acknowledgements

We thank Dara Brodsky, MD for her thoughtful review of earlier manuscript drafts, as well as the AAP Section on Perinatal Medicine groups (Trainee and Early Career Neonatologist and Organization of Neonatal Training Program Directors) for help with accessing the respective listerservs and distributing this study. We also thank Peter W. Forbes, MA for assistance with statistical analysis; this work was conducted with statistical support from Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05 and financial contributions from Harvard University and its affiliated academic health care centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the National Institutes of Health. No external funding was secured for this study. The authors have no financial relationships relevant to this article to disclose.

Author information

Authors and Affiliations

  1. Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    C L Cummings & S Sayeed

  2. Division of Neonatal-Perinatal Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA

    G M Geis

  3. Dana-Farber/Boston Children’s Center for Cancer and Blood Disorders, Boston, MA, USA

    J C Kesselheim

Authors
  1. C L Cummings
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G M Geis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J C Kesselheim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Sayeed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C L Cummings.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Journal of Perinatology website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cummings, C., Geis, G., Kesselheim, J. et al. Ethics and professionalism education during neonatal–perinatal fellowship training in the United States. J Perinatol 35, 875–879 (2015). https://doi.org/10.1038/jp.2015.70

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2015.70

This article is cited by

Search

Advanced search

Quick links