Background/Purpose: An understanding of bioethics and an ability to apply ethical principles in clinical practice should be key components of postgraduate medical training. However, there is no formal bioethics curriculum for Rheumatology residents at the University of Toronto. Instead, the majority of bioethics education is currently delivered via informal role-modelling by staff physicians. The purpose of this study was to determine whether the implementation of a curriculum tailored to the needs of Rheumatology residents, and delivered centrally at the National Rheumatology Residents’ Weekend (NRRW), would increase residents’ self-perceived knowledge of, and competency in, bioethical issues in clinical practice.

Methods: A literature review was performed to identify bioethical issues that were relevant to Rheumatology trainees. Cases were developed based on three of these issues for interactive, small-group sessions that were piloted at the NRRW in Toronto in December 2017. A clinician with bioethics expertise delivered a lecture on a framework for evaluating ethical dilemmas. Rheumatology faculty physicians facilitated case-based discussions of three key bioethical issues—medical assisted in dying (MAID), resource allocation, and relationships with industry—using group role-play as a tool for examining different perspectives surrounding these ethical controversies. Residents were given access to all study materials following the sessions. Pre- and post-knowledge surveys were distributed to participating residents to assess their comfort and knowledge with bioethical topics before and after participation in these sessions. Survey results were analyzed using descriptive statistics.

Results: 41% of attendees at the NRRW completed the needs assessment. 46% were PGY4s and 54% were PGY5s. Most residents agreed that formal training in bioethics was very important (29%) or somewhat important (51%) to rheumatology training, but the majority rated their knowledge as low in core bioethical topics. Residents identified: end of life care and MAID (41%), assessing capacity and substitute decision-making (34%), doctor-patient relationships and boundaries (32%), caring for the non-adherent patient (59%), medical resource allocation (51%), and cross-cultural issues (51%) as topics they wished to learn more about. 22% of attendees completed the post-rounds survey. The majority (91%) felt that the case-based sessions improved their knowledge of a core bioethical topic, and that they would feel more comfortable addressing this topic in clinical practice (86%). There were statistically significant improvements in self-perceived knowledge of, and comfort with, a number of core topics, including those not explicitly covered by the case-based sessions.

Conclusion: The design and implementation of a bioethics curriculum relevant to Rheumatology trainees is an effective means of increasing residents’ self-perceived understanding of, and engagement with, bioethical issues central to the practice of Rheumatology. Further study is required to assess whether or not residents retain knowledge of an ethical framework as presented in such a setting and can apply its principles to clinical practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/bioethics-for-the-rheumatologist-a-needs-assessment-curriculum-development-and-knowledge-assessment-of-bioethical-topics-for-rheumatology-trainees/