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Training pediatric house staff in evidence-based ethics: an exploratory controlled trial
T L Major-Kincade1, J E Tyson, K A Kennedy
1UT Southwestern Medical Center at Dallas, Department of Pediatrics, Dallas, TX 77030-1503, USA.
Objective:
To evaluate an educational intervention in evidence-based ethics (emphasizing clinical knowledge, epidemiologic skills, and recognition of ethical issues) administered to house staff before rotating through our neonatal intensive care unit.
Study Design:
A controlled trial of 64 pediatric house staff assigned to alternating control and intervention rotations. Questionnaires were administered at the end of the rotation.
Results:
Some benefits of the intervention were observed. However, a large percentage of intervention and control house staff substantially overestimated (>1.25 correct value) predischarge mortality (23% vs. 55% of house staff; p<0.02), mortality or major morbidity (74% vs. 46% of house staff; p=0.04), and cerebral palsy rates (70% vs. 87%; p=0.12). Neither group cited many methodological criteria for evaluating follow-up studies (3.3 vs. 2.4 criteria; p=0.05) or ethical issues considered in treatment recommendations for extremely premature infants (3.1 vs. 2.8 issues; p=0.35).
Conclusion:
Improved house staff training in evidence-based ethics is needed.