An Ethics Case Conference for Teaching Residents an Analytical Approach to Clinical Ethics

Abstract: Educating residents to apply ethical principles in patient care is critical in facilitating achievement of standards in professionalism and accreditation. Few residency ethics curricula emphasize applying an analytical approach to ethics cases in an established and ubiquitous didactic setting in internal medicine residency programs – the morning report case conference.

The aim of our project was to operationalize and assess a resident-led ethics case conference incorporating an established analytical tool in medical ethics. We also hoped to illustrate that resident-selected cases were sufficiently complex and varied to merit in-depth analysis via a uniform approach and be practically relevant for residents’ clinical practice.

We implemented biweekly ethics morning report case conferences from July 2022 to June 2023 in our large, urban internal medicine residency program using a standardized analytical approach analogous to typical clinical reasoning. This approach incorporated the 4-Box Method, a well-known approach to ethical reasoning (Jonsen, Siegler, and Winslade, 2022). We surveyed whether residents felt that the intervention helped them achieve ethics learning objectives, and we coded cases selected by residents for ethical issues addressed.

In 24 ethics morning reports, we received 75 unique post-session survey responses in our program of 215 trainees, yielding a survey response rate of 35%. Over 73% of participants reported that the intervention helped them achieve each of three learning objectives in ethics education. Ninety-two percent of cases addressed >1 ethical issue.

Our novel intervention may be easily integrated into the morning report conference structure across internal medicine residency programs.

Alyssa Kahl – Vanderbilt University Medical Center; Jonathan Lim – Baylor College of Medicine