Ethics and Advanced Communication Simulation Workshop

Royal College accreditation for residency programs requires a structured, discipline-specific curriculum in bioethics, yet there is little data on how this is implemented in practice. The McGill University Health Centre (MUHC) offers a clinical ethics service that ensures a consistent approach to clinical ethics issues, according to an articulated system of critical analysis, and based on institutional values. A simulation-based ethics activity was designed and implemented as a half-day workshop for 1st to 3rd year pediatric residents in December 2012. The setting was the Steinberg (McGill) Medical Simulation Center. Following a didactic session, participants were divided into groups and rotated through 4 simulated scenarios, chosen in an iterative consensus building manner by the clinical ethicist and physician content area experts, based on perceived needs of residents. Each resident led 1 scenario and observed the other 3, with post-scenario debriefing by expert facilitators after each station. At a 5th station, a facilitator introduced principles of reflective practice. Clear learning objectives are defined for each theme/scenario to guide debriefing and help standardize the development of the knowledge, skills and attitudes required for dealing with ethical issues in practice as residents’ exposure to difficult conversations and addressing ethical issues can be quite variable. Following the simulated ethics training, residents were asked to fill out a retrospective pre-post self-evaluation questionnaire, designed to elicit their self-reported comfort and competency regarding ethics analysis and communication skills on each of the ethics themes addressed. Residents overwhelmingly reported improvements in their level of comfort and competency. On evaluation, 100% of participants said they would recommend this session to their fellow residents; 95% said it should be mandatory. The intended result of the ethics simulation workshop was to give residents an opportunity to practice identifying and responding to ethical issues they are likely to encounter in their practice and to be able to communicate difficult messages to families in a sensitive, culturally competent, and caring way. Experiential simulation-based education offered an opportunity to address training gaps and better prepare future physicians with the knowledge, skills and ability to recognize and respond to ethical dimensions of patient care that arise in their training and future practice.