Transcript Dr.Yasmin Wajahat

Ethics Curriculum for
Postgraduates in Ob-Gyn
By
Dr. Yasmin Wajahat
PG Diploma in Biomedical Ethics, CBEC, SIUT
Associate 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
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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:
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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
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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
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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
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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
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Morning meeting
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Service ward round (small group discussion)
- four in a month.
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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:
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Didactic lectures
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Interactive discussion
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Case scenarios / case discussion
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Students’ presentation
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Guest speaker sessions
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Planned sessions
Session 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
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
by
an
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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.
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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:
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
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