Ethics issues identified by obstetrics and gynecology learners

This study evaluated a specific ethics and professionalism curriculum whereby medical students and residents provided a written assessment on various ethical issues encountered during their Ob/Gyn rotations. Our goal with this study was to retrospectively evaluate the content of reflections written by medical students and resident physicians and compare content and issues identified by each learner level. Our ultimate goal is to use these data to refine and improve the ethics and professionalism curriculum for Ob/Gyn medical learners

‘They need to tell you and not just do it’: Veteran and physician perspectives on point-of-care research in VA

Point-of-care research (POCr) is part of a larger effort to advance the Veterans Health Administration (VHA) as a learning health system. It has the potential to improve health care outcomes and drive down costs of research by evaluating “in-use” medications and therapies. However, patients and physicians must be inclined to participate in this type of research. There is a need to assess patient and physician willingness, decision making, and methods of informed consent with respect to patient and physician participation in POCr. An exploratory study was conducted involving three focus groups, two with VA patients (n=8) and one with physicians (n=6) affiliated with a Midwestern VA Health Care System, to explore attitudes and preferences towards issues in POCr. Emerging themes were captured through qualitative content analysis. Four primary themes emerged from the focus group data: (1) a qualified willingness to participate in POCr; (2) the doctor-patient relationship as a context for POCr; (3) transparency and choice in POCr participation; and (4) protecting patient confidentiality and privacy. Our exploratory study among VA physicians and patients suggests that POCr may be perceived as intervening or undermining the physician-patient relationship in cases where randomization supplants doctor-patient decision making, or where a waiver of informed consent may diminish the need for physician-patient interaction. Informed consent is important in POCr because it offers a way for patients and physicians to establish rapport and trust, particularly in cases where randomization removes the need for clinical decision making.</p

A valued voice: A qualitative analysis of parental decision‐making preferences in emergent paediatric surgery

Abstract Introduction Shared decision‐making, with an emphasis on patient autonomy, is often advised in healthcare decision‐making. However, this may be difficult to implement in emergent settings. We have previously demonstrated that when considering emergent operations for their children, parents prefer surgeon guidance as opposed to shared decision‐making. Here, we interviewed parents of paediatric patients who had undergone emergent operations to better understand parental decision‐making preferences. Methods Parents of paediatric patients who underwent surgery over the past 5 years at a University‐based, tertiary children's hospital for cancer, an emergent operation while in the neonatal intensive care unit (NICU) or extracorporeal membrane oxygenation (ECMO) were invited to complete a 60‐min semi‐structured interview. Interviews were digitally recorded and transcribed verbatim. Thematic content analysis was performed via deductive and inductive analysis. An iterative approach to thematic sampling/data analysis was used. Results Thematic saturation was achieved after 12 interviews (4 cancer, 5 NICU and 3 ECMO). Five common themes were identified: (1) recommendations from surgeons are valuable; (2) ‘lifesaving mode’: parents felt there were no decisions to be made; (3) effective ways of obtaining information about treatment; (4) shared decision‐making as a ‘dialogue’ or ‘discussion’ and (5) parents as a ‘valued voice’ to advocate for their children. Conclusions When engaging in decision‐making regarding emergent surgical procedures for their children, parents value a surgeon's recommendation. Parents felt that discussion or dialogue with surgeons defined shared decision‐making, and they believed that the opportunity to ask questions gave them a ‘valued voice’, even when they felt there were no decisions to be made. Patient or Public Contribution For this study, we interviewed parents of paediatric patients who had undergone emergent operations to better understand parental decision‐making preferences. Parents thus provided all the data for the study