The status of ethics education in obstetrics and gynecology

To establish the present status of ethics education in obstetrics and gynecology, 256 questionnaires were sent to residency (graduate) and student (undergraduate) education programs. One hundred ninety-eight questionnaires were returned. Fifteen programs offered no ethics education; 167 offered resident level courses; 123 offered undergraduate (student) level courses; and 84 offered postgraduate education. The median number of hours offered was 2 undergraduate, 4 graduate, and 2 postgraduate. The courses offered relied primarily on formal lecture presentation, even though this was not considered most effective by the respondents. Most institutions (85%) used more than one format to present ethics material. General ethics principles were covered in 78% of the reporting institutions. Where ethics case histories were used, they were rated higher in efficacy by the respondents. Only 15% of the reporting institutions had any means of measuring outcomes. The issues cited most frequently as critical in a curriculum were abortion, maternal-fetal conflicts, issues surrounding care decisions at the end of life, and informed consent. The few hours dedicated to ethics were small relative to a long list of issues. Obstetric-gynecologic faculty with any training in medical ethics were uncommon (29%). The form of teaching, except in rare circumstances, seemed to lack structure or design and used few of the available reading materials. Recommendations from this survey include the development of a uniform national curriculum for undergraduate and graduate medical ethics, development of evaluation alternatives for ethics education, and encouragement and support for faculty development in medical ethics.