O2055: Ethical Competency Assessment of Pediatric Trainees Before and After Implementation of an Ethics Curriculum Using an Objective Standardized Clinical Examination

Background: Amidst evolving medical advances and professional guidance, clinical decision-making has become a complex endeavor. This is especially challenging for pediatricians who must navigate the values of multiple stakeholders including minors and their legal decision-makers. Ethics education in training is thus not only a necessity but also supports professional identity formation.

Since 1997 the Accreditation Council for Graduate Medical Education requires ethics education for medical trainees. Despite this mandate, many residency programs lack a formalized ethics curriculum. Evaluating professionalism and ethical competency has primarily focused on self-assessments, reinforcing the “hidden curriculum,” and promoting empathic practice. We introduced an ethical-moral dilemma as an Objective Standardized Clinical Examination (OSCE) to compare cognitive and non-cognitive dimensions of third-year residents ethical reasoning abilities before and after the implementation of a formalized ethics curriculum.

Methods: An OSCE scenario was created specifically to evaluate trainees’ theoretical knowledge on ethical and legal practice, empathic skills, and their accountability to the medical profession and society. The case was based on an adolescent who with the support of a parent, refused lifesaving chemotherapy. We conducted the OSCE before the implementation of a formalized ethics curriculum. Residents partook in a formalized ethics curriculum over one year after which we then repeated the simulation to a new set of third-year residents. We developed a performance assessment tool (PAT) to evaluate residents' demonstration of ethical competency. The assessment tool was completed by 2 standardized patients and included dichotomous rating of trainees' actions (done/not done) and 5-point Likert scale rating of observed behaviors. Frequencies and percentages and mean and 95% confidence intervals (CI) was conducted.

Results: Preliminary data from PAT scores of 12 third-year residents who participated in the OSCE before initiation of the curriculum indicated lower than expected scores in several areas. None of the third-year residents communicated the fatality of the condition without treatment. Residents struggled in communicating the standard of decision-making for children. Only 2/12 residents clarified to the family the minor's role of assent, not consent. None of the residents explained parental decision should be based on the best interest of the minor. 10/12 (83%) residents emphasized patient autonomy at the cost of other ethical obligations. They embraced empathic practice, mean 4.08 (CI 3.71-4.46). Post-ethics curriculum scoring is pending.

Conclusion: Our OSCE is a successful modality for innovative ethics education and assessment of knowledge. Our results showed that morally complex cases challenge third-year residents. While they embraced empathic practice skills they struggled balancing professional and ethical obligations. Assessing the gaps in ethical knowledge provides the foundation of devising sensible ethical education for trainees. The practical adaptation of this commonly used medical assessment tool (OSCE) is sustainable and can be easily incorporated into any residency program curriculum to assess ethical knowledge.