| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Education |
1 Department of Radiology, New England Medical Center, Tufts University School
of Medicine, 750 Washington St., Box 388, Boston
2 Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston,
MA 02114.
Received October 29, 2003; accepted after revision April 5, 2004.
Address correspondence to M. J. Homer.
With the rapid and continuous introduction of new technologies and techniques in diagnostic and interventional radiology, the radiology resident must master an ever-expanding knowledge base during the 4-year residency program. The resident is expected to develop a level of competence, resulting in board certification. However, successful medical practice also depends on competency in nonmedical areas such as cost-containment, medical–legal issues, business acumen, effective communication, professionalism, and ethics.
The Accreditation Council for Graduate Medical Education (ACGME) has required that the education of residents comprise both interpretive and noninterpretive skills. In 1999, it defined six general competencies that must be incorporated into every residency program. These competencies include patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, systems-base practice, and professionalism. Professionalism includes a commitment to ethics principles including the providing or withholding of clinical care, confidentiality of patient information, informed consent, and business practices. The ACGME mandated that by June 30, 2002, these core competencies must be part of the residency curriculum for programs to achieve continued accreditation [1].
Challenge
The inclusion of medical ethics into the residency curriculum has been advocated as a necessary component in the training of the modern physician [2–4]. However, the incorporation of ethics teaching in the radiology residency program poses significant challenges to academic departments. Programs may not have faculty who possess formal training in the teaching of ethics. Even if a staff member has taken ethics courses at the undergraduate or graduate level, these courses may not have specifically addressed medical ethics. To compound the problem, we realize that even if the course pertained to medical ethics, the topics may not be relevant to ethics issues that are specific to the practice of radiology. For example, although issues such as cloning and end-of-life decisions are important medical ethics issues, they do not typically confront the radiologist in daily clinical practice. Added to this challenge is the paucity of resource material available to assist in the creation and introduction of an ethics component in a radiology residency program.
Videotapes
In response to the requirement to incorporate the six noninterpretive skills into the radiology residency program, members from the American College of Radiology (ACR) and the Association of Program Directors in Radiology (APDR) developed seven video-tapes. These are intended to be used to address the mandate of the ACGME. The experience of using these videotapes has been reported, and the videotapes have been shown to be an effective way to address the ACGME requirements [5].
Survey
Although viewing the videotapes was already incorporated into our residency program, the director of the program wanted to expand the ethics component, and a member of our staff was asked to create a series of presentations specifically addressing ethics issues that might confront the radiologist in practice. This assignment proved to be interesting yet daunting because the staff member chosen had an interest in ethics but no formal training in the area.
We conducted an e-mail survey to learn how radiology residency programs responded to the mandate to include the teaching of ethics. Our purpose was twofold: to get a sense of the current state of ethics education in radiology residency programs and to learn possible effective strategies that might be suitable for use in our program to enhance our own curriculum.
We developed a questionnaire (Appendix 1) to ascertain whether the teaching of ethics was included in radiology residency programs and the ways in which it was implemented. The names of all accredited radiology residency programs in the United States were compiled from the ACGME Green Book [6], from the the American Medical Association–Fellowship and Residency Electronic Interactive Database Web site [6], and from queries to an Internet search engine. These sources provided us with the e-mail addresses for either the program directors or the residency programs themselves. We then attached our survey to a brief e-mail explaining its purpose, and the recipients were invited to respond.
|
Our search yielded a total of 193 accredited radiology residency programs in the United States. Of these, we could identify the e-mail addresses of 162 program directors. From this group, 119 surveys were successfully delivered. We received 37 complete responses for a response rate of 31%. Although the number of responses was not large enough to allow us to draw any statistically significant conclusions, some trends are clearly evident from the results. We are unaware of any similar survey focusing on the manner in which ethics is taught in radiology residency programs, so our data can serve as the basis for further investigation.
A variety of different methods was used by residency programs to incorporate ethics teaching into the curricula. In 10 programs, lectures were given either by the attending staff (n = 5) or by visiting staff (n = 5). The ACR ethics videotape was shown in 15 programs. In four of these programs, the ACR videotape was the only source of ethics training for the residents. A total of 15 program directors indicated that ethics was addressed in either formal (n = 4) or informal (n = 11) discussions. Four directors relied on hospital or university ethics programs or a prepared ethics module. Fourteen programs had no ethics education.
In seven programs, the residency director assumed the sole responsibility for teaching ethics. Two programs had a faculty member with special training in medical ethics, whereas other programs rotated the teaching of ethics among the faculty. The median number of hours per year spent in the teaching of ethics was 2.25 (range, 1–20).
Thirty-eight percent of the residency program directors (14/37) reported the complete absence of any teaching of ethics in their radiology residency programs. The videotapes created by the ACR and the APDR were used by almost the same number of programs. This use indicates the important role of these tapes in teaching noninterpretive skills. Unfortunately, at the present time, only one of the videotapes is devoted to ethics issues; therefore, during the 4-year residency program, the videotape loses its effectiveness after it is viewed once.
Guidelines
The vehicle for ethics training tailored for our residency program was based on several guidelines. At the outset, it was decided that staff should be included because their experience and opinions, based on years of practice, would provide invaluable input to the residents [7]. Because topics to be discussed had to impact radiologists, articles addressing ethics topics that appeared in the radiology literature would form the basis of the material taught [8–10]. These articles not only identified topics of interest to radiologists but also provided insight into how to address the ethics issues under discussion. Published articles are especially valuable when the staff member has no formal background in teaching ethics. The ethics topics that have been discussed cover a wide range of subjects, including the publication of articles, medical–legal issues, and the medical decision-making process (Appendix 2).
|
A fundamental decision was made to create an interactive experience rather than a didactic one. To give both staff and residents time to consider the ethics issues to be explored, we distributed material to all staff and residents to review several days before the departmental ethics conference. In our teaching program, other than with the journal club, material is never distributed to review before a conference, so this aspect was unique to the ethics discussions. The material was brief and usually presented a scenario that raised ethics problems. Sometimes actual questions were posed for consideration to focus the upcoming discussion. Currently, we have an ethics conference every other month. Each conference lasts approximately 30 min.
Assessment
We assessed our ethics program by soliciting the opinions of our residents with regard to the unique aspects of our ethics conferences. Our residents were asked to complete a brief questionnaire, and of the 16 residents, we received 13 responses (Appendix 3). The questions addressed the fundamental premises of our program. The majority of residents either agreed or strongly agreed with each statement. We interpreted these responses to mean that the fundamental aspects of our ethics conferences, namely an interactive forum with joint participation by both staff and residents, were judged by the residents to be positive features.
|
Insights
During the past 2 years, we have gained insights into the teaching model we have created. Admittedly, the success of the model used in our program is dependent on the creativity of the moderator. Our experience has shown that enough published material is available to generate a multitude of ethics discussions, specifically pertaining to the practicing radiologist. Both staff and residents have found the topics interesting, informative, and sometimes provocative. The topics selected for discussion have motivated our staff to share personal insights with other staff members and residents. Predictably, staff opinions regarding ethics issues differ, but the identification and discussion of these differing points of view may be the most important educational benefits for residents. The participation by staff also encouraged residents to contribute their own insights.
Conclusion
Radiology residency programs have responded to the ACGME mandate to incorporate the teaching of ethics in a variety of ways. However, a survey that we conducted indicated that 38% of programs still offer no teaching of ethics to their radiology residents. The ACR videotape about ethics is used by many programs that do incorporate ethics in the curriculum. At our institution, we created an interactive program to address ethics, which involves both residents and staff. On the basis of the enthusiastic discussions at the sessions, the personal viewpoints offered, and the opportunity for residents to listen to the diversity of staff opinions regarding ethics issues, we believe that we achieved our goal of increasing the ethics component of our radiology residency program. Although our method of incorporating ethics teaching into our residency program may not be suitable for other programs, it may serve as a model on which others can expand.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  J. B. Kruskal, B. Siewert, S. W. Anderson, R. L. Eisenberg, and J. Sosna Managing an Acute Adverse Event in a Radiology Department RadioGraphics, September 1, 2008; 28(5): 1237 - 1250. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Janower Ethics Training for Radiology Residents Am. J. Roentgenol., February 1, 2005; 184(2): 701 - 701. [Full Text] [PDF]
|
|
|
|
|
|
K. H. Vydareny Ethics Education in the Radiology Residency Curriculum Am. J. Roentgenol., September 1, 2004; 183(3): 573 - 573. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
