Impact of a bioethics and humanities program on the educational training of nephrology residents

Modern medical training must integrate not only clinical skills but also ethical and humanistic competencies. In 2013, a structured program in bioethics and humanism was implemented as part of a nephrology residency curriculum. The objective of this study was to evaluate the impact of a 3-year humanism and bioethics program for nephrology residents that focused on improving clinical communication, reducing complaint and lawsuit numbers, increasing patient satisfaction, and supporting decision-making centered on quality of life.

A longitudinal, ambispective cohort (2010-19), our 3-year curriculum delivered weekly 1-h sessions for 6 months/year to 45 residents and was facilitated by three faculty instructors across six core themes. To relate outcomes to the intervention, analyses were anchored to the 2013 launch and compared pre-program (2010-13) versus post-program (2014-19) rates of formal complaints, legal claims, patient satisfaction and maximum benefit discharges.

Formal complaints decreased from 47.8 to 26.0 per year [incidence rate ratio (IRR) 0.54, 95% confidence interval (CI) 0.44-0.67; P < .001; Holm <0.001]. Legal claims were reduced from 4.25 to 0.17 per year (IRR 0.039, 95% CI 0.005-0.295; P = .0016; Holm = 0.0016). Maximum benefit discharges increased from 4.25 to 76.5 per year (IRR 18.0, 95% CI 11.09-29.21; P < .001; Holm <0.001). For satisfaction, the ordinal logistic model showed an odds ratio (OR) of 3.53 (95% CI 1.96-6.38; P < .001; Holm = 0.0001), consistent with the dichotomous sensitivity analysis (≥4 vs ≤3) (OR 4.08, 95% CI 2.16-7.71; P < .000).

The humanism and bioethics program was proven to be an effective and transformative educational tool that promoted ethical, empathetic and patient-centered nephrology practices. The positive impact of this program was evident in both clinical indicators and strengthened medical professionalism.