Subject(s)
Disabled Children , Hysterectomy , Intellectual Disability , Pain/surgery , Parental Consent , Adolescent , Female , HumansABSTRACT
Informed consent is the single most important concept for understanding decision-making capacity. There is a steady pull in the clinical world to transform capacity into a technical concept that can be tested objectively, usually by calling for a psychiatric consult. This is a classic example of medicalization. In this article I argue that is a mistake, not just unnecessary but wrong, and explain how to normalize capacity assessment. Returning the locus of capacity assessment to the attending, the primary care doctor, and even to ethics consultation in today's environment will require a substantial effort to undo a strong but illusory impression of capacity assessment. Hospital attorneys as well as clinical ethicists with a sophisticated understanding of health law can be in the vanguard of this reorientation.
Subject(s)
Informed Consent , Mental Competency , Primary Health Care , Decision Making , Humans , Physicians , Referral and ConsultationSubject(s)
Cardiac Surgical Procedures/ethics , Hypoplastic Left Heart Syndrome/diagnosis , Parents/psychology , Quality of Life/psychology , Contraindications , Cost of Illness , Hospice and Palliative Care Nursing , Humans , Hypoplastic Left Heart Syndrome/psychology , Infant, Newborn , Male , Parents/education , Prognosis , Risk AssessmentSubject(s)
Child Advocacy/ethics , Decision Making/ethics , Patient Comfort/ethics , Humans , Infant, Newborn , Infant, Premature , PersonhoodSubject(s)
Ethicists , Ethics Consultation , Ethics Committees , Ethics, Clinical , Ethics, Medical , Humans , Referral and ConsultationSubject(s)
Choice Behavior/ethics , Developmental Disabilities/nursing , Dissent and Disputes , Enteral Nutrition , Hospice Care/ethics , Intubation, Gastrointestinal , Parenting , Adolescent , Decision Making/ethics , Enteral Nutrition/ethics , Female , Humans , Mothers , Parenting/psychology , Terminal Care/ethics , Weight LossSubject(s)
Amputation, Surgical/ethics , Ethics Consultation , Foot/surgery , Gangrene/therapy , Ill-Housed Persons , Mental Competency , Treatment Refusal , Anemia/complications , Anemia/therapy , Anti-Bacterial Agents/therapeutic use , Blood Transfusion , Debridement , Ethics Consultation/standards , Foot/parasitology , Foot/pathology , Gangrene/surgery , Humans , Male , Mental Disorders/diagnosis , Myiasis/therapy , Necrosis/surgery , Necrosis/therapy , Paternalism , Psychiatry , Psychomotor Agitation , Referral and ConsultationABSTRACT
The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedical level. The TIME Steering Committee appointed an interdisciplinary task force to explore the fundamentals of PIF and to formulate strategies that would help students develop their professional identity as they transform into physicians. In this article, the authors describe the task force's process for defining PIF and developing a framework, which includes 10 key aspects, 6 domains, and 30 subdomains to characterize the complexity of physician identity. The task force mapped this framework onto three developmental phases of medical education typified by the undergraduate student, the clerkship-level medical student, and the graduating medical student. The task force provided strategies for the promotion and assessment of PIF for each subdomain at each of the three phases, in addition to references and resources. Assessments were suggested for student feedback, curriculum evaluation, and theoretical development. The authors emphasize the importance of longitudinal, formative assessment using a combination of existing assessment methods. Though not unique to the medical profession, PIF is critical to the practice of exemplary medicine and the well-being of patients and physicians.
Subject(s)
Education, Medical, Undergraduate/methods , Education, Premedical/methods , Professional Competence , Self Concept , Social Identification , Humans , Longitudinal Studies , Students, Medical/psychology , Students, Premedical/psychologySubject(s)
Decision Making/ethics , Ethics Consultation/ethics , Morals , Negotiating , Problem Solving , HumansABSTRACT
BACKGROUND: One of the barriers to interprofessional ethics education is a lack of resources that actively engage students in reflection on living an ethical professional life. This project implemented and evaluated an innovative resource for interprofessional ethics education. OBJECTIVES: The objective of this project was to create and evaluate an interprofessional learning activity on professionalism, clinical ethics, and research ethics. DESIGN: The Brewsters is a choose-your-own-adventure novel that addresses professionalism, clinical ethics, and research ethics. For the pilot of the book, a pre-test/post-test design was used. Once implemented across campus, a post-test was used to evaluate student learning in addition to a student satisfaction survey. PARTICIPANTS AND RESEARCH CONTEXT: A total of 755 students in six academic schools in a health science center completed the activity as part of orientation or in coursework. ETHICAL CONSIDERATIONS: The project was approved as exempt by the university's Committee for the Protection of Human Subjects. FINDINGS: The pilot study with 112 students demonstrated a significant increase in student knowledge. The 755 students who participated in the project had relatively high knowledge scores on the post-test and evaluated the activity positively. DISCUSSION: Students who read The Brewsters scored well on the post-test and had the highest scores on clinical ethics. Clinical ethics scores may indicate issues encountered in mass media. CONCLUSION: The Brewsters is an innovative resource for teaching interprofessional ethics and professionalism. Further work is needed to determine whether actual and long-term behavior is affected by the activity.
