Incorporating Spirituality into Health Sciences Education.

Researchers are beginning to collect empiric data about coping mechanisms of health science students. Yet, there is an important aspect of coping with stress that is only partially addressed in health sciences curricula: students' spiritual well-being. In this essay, we describe a course in spirituality and health care that we offered to fourth-year medical students, as well as a small empirical study we conducted to assess students' spiritual needs and practices. We then offer reflections on the broad applicability of this work to students in the health sciences more generally, including suggestions for curriculum interventions that may ensure students' success.

Assessing challenges in end-of-life conversations with elderly patients with multiple morbidities.

INTRODUCTION: This study reports on physicians' experiences in conducting end-of-life conversations with elderly patients who suffered from multiple co-morbidities (MCM). Our hypothesis was that both the lack of prognostic certainty and the lack of good communication tools contributed to physicians' discomfort with conducting EOL conversations with patients and families of patients with these conditions especially when compared with patients and families of patients who had a single, clear terminal diagnosis (e.g. pancreatic cancer). METHODS: Focus group questions were semi-structured and explored three general themes: (1) differences between having an end-of-life conversation with patients/families with MCM versus those with a single, terminal diagnosis; (2) timing of the end-of-life conversation; and (3) approaches to the end-of-life conversation. RESULTS: Three themes emerged: (1) It is more difficult for them to have EOL conversations with patients with MCM and their families, as opposed to conversations with families and patients who have a clear, terminal diagnosis. (2) In deciding when to raise the subject of EOL care, participants reported that they rely on a number of physical and/or social signs to prompt these discussions. Yet a major reason for the difficulty that providers face in initiating these discussions with MCM patients and families is that there is a lack of a clear threshold or prompting event. (3) Participants mentioned three types of approaches to initiating EOL conversations: (a) direct approach, (b) indirect approach, (c) collaborative approach. CONCLUSION: Prognostic indicies and communication scripts may better prepare physicians to facilitate end-of-life conversations with MCM patients/families.

Women and contraception in research: a pilot study.

BACKGROUND: There are no data on women's willingness to participate in clinical trials as a function of real or perceived reproductive risk. Further, it is unknown whether the requirement for contraception or the common practice of limiting women's contraceptive choices influences their willingness to participate in research. The uncertainty about women's preferences on these matters remains a barrier for recruiting women to and retaining women as subjects in clinical trials. METHODS: We developed a pilot study to determine women's willingness to participate in research with contraceptive requirements by looking at the three most common types of reversible contraceptives: hormonal contraception, barrier contraception, and intrauterine contraception. This study tested the hypotheses that restrictions on contraceptive choice impact women's willingness to participate in research and that the impact of contraceptive choice differs depending on women's perception of risk. RESULTS: Women's willingness to participate in the proposed study decreased overall as reproductive risk increased. In addition, requirements for specific contraceptive methods negatively impacted women's reported willingness to participate in the research studies in our survey. CONCLUSIONS: Results suggest that requirements for specific contraceptive methods negatively impacted women's reported willingness to participate in research. If confirmed in a larger sample, the negative effect of contraceptive limitations on women's willingness to participate in research would be of importance to clinical investigators and to institutional review boards (IRBs), as most adult biomedical research has as an explicit goal the equitable recruitment of women of childbearing potential.

iPLEDGE allegiance to the pill: evaluation of year 1 of a birth defect prevention and monitoring system.

The United States Food and Drug Administration (FDA), in collaboration with pharmaceutical manufacturers, have recently implemented a heavily revised risk-management program for patients on isotretinoin (Accutane), a drug with known and pronounced teratogenic effects. This revised risk management plan places significant burdens on both providers and patients in the hopes of achieving its goal of reducing fetal exposure to isotretinoin. The main focus of this paper is to discuss the burdens of various aspects of the program in relationship to potential corresponding benefits. In particular, we evaluate the pregnancy rates of women on isotretinoin therapy compared with that of the general population and the rate changes based on the risk management programs. Additionally, we investigate whether the benefits of the program for women have increased as the benefits have risen. We devote special attention to the ethical implications of the intent of the program and to an analysis of the ethical justification of the restrictions placed on women of childbearing potential (WCP) as it compares to the risk-benefit relationship of using isotretinoin.

Comparison of online and traditional ethics education: a pilot study.

INTRODUCTION: This research note describes a pilot study that tested the feasibility measures for ascertaining whether students in an online ethics course learn as much as, less than, or more than students enrolled in a traditional (classroom) ethics course. METHODS: Participating students in both the online and traditional courses completed a Technology Survey to measure possible group differences in terms of their familiarity and comfort level with using a computer, and a Richness of Experience Survey to garner their perceptions of the learning environment of the course. Students' academic performance in the two classes were also compared. RESULTS: The Technology Survey revealed no statistically significant differences between the two groups at the .05 level on any of the items, with the exception of the item about the convenience of attending class. The groups did not differ in terms of their performance on any of the academic performance criteria, although the descriptive data were suggestive. Finally, the data from the Richness of Experience Survey also showed no distinction between the groups. CONCLUSION: Because the number of participants is very small, this analysis had low power. The descriptive data presented indicate that further research into differences on the essay portion of the exam may be warranted.

Ethics education for allied health students: an evaluation of student performance.

We analyzed student performance in an interdisciplinary, Web-based course in health care ethics at a university-based school of allied health. Student performance was measured according to students' 1) degree status, 2) clinical hour requirement during the semester in which they took the ethics course, 3) total credit hours during the semester in which they took the ethics course, and 4) clinical and credit hours combined. Statistical analyses were performed to examine curricular and extracurricular predictors of student performance. Only the number of credit hours in which students were enrolled while taking the ethics course demonstrated a statistically significant difference in mean student performance, and this difference was only detected on the final examination and written assignments. When developing an ethics course for allied health students, course components such as conceptual difficulty, reading and writing assignments, and student workload may need to be adjusted according to students' curricular responsibilities.

Reflections on teaching health care ethics on the web.

As web instruction becomes more and more prevalent at universities across the country, instructors of ethics are being encouraged to develop online courses to meet the needs of a diverse array of students. Web instruction is often viewed as a cost-saving technique, where large numbers of students can be reached by distance education in an effort to conserve classroom and instructor resources. In practice. however, the reverse is often true: online courses require more of faculty time and effort than do many traditional classes. Based on personal experience teaching an online course in health care ethics for students in the Allied Health Professions, it is evident that there are both benefits and challenges in teaching online courses, particularly in ethics. Examples of benefits are (1) the asynchronous nature of web instruction allows students to progress through the course at their own pace and at times that are convenient given their clinical responsibilities; (2) web courses allow for a standardization of content and quality of instruction over a diversity of programs; and (3) examples can be tailored to the differing experiences of students in the course. Some challenges to teaching online ethics courses include (1) the fact that online instruction benefits visual learners and disadvantages those lacking good reading comprehension or strong writing skills; (2) developing meaningful student-student and student-instructor interaction; and (3) teaching ethics involves teaching a process rather than a product. Allowing students to apply their knowledge to real-world cases in their disciplines and encouraging them to share experiences from clinical practice is an effective way to meet several of these challenges. Building an online community is another good way to increase the interaction of students and their engagement with the material.