Neonatal Ethics Teaching Program – Scenario-Oriented Learning in Ethics: Unexpected Birth Malformation

Abstract

Abstract Among the most frequent and challenging scenarios encountered in Neonatal-Perinatal Medicine (NPM) is the delicate interaction necessary after the birth of an infant with an unexpected congenital malformation. Many of these infants are at significant risk of early death, suffering, or long term disabilities. The medical team and the parents are facing difficult decisions about instituting and continuing intensive care treatment or transitioning to palliative care. Trainees must be able to negotiate these complex scenarios utilizing professionalism, communication, and ethical knowledge. To integrate this technique and facilitate these communication competencies at the University of Ottawa, we developed a small group workshop with a standardized patient (SP) called Scenario Oriented Learning in Ethics (SOLE): Unexpected Birth Malformation. The goal of this workshop is to help trainees show improvement in their communication skills and demonstrate appropriate application of ethical principles when they have to interact with parents in delicate, difficult, and ethically charged situations regarding their child. Furthermore, this workshop provides trainees the opportunity to practice and learn how they would interact with a true patient in a given clinical scenario. The SOLE small group workshop with SP is an action-oriented, flexible real-world setting and thought to facilitate reflective practice in adult learners. During the SOLE workshop, an intentional interruption occurs when deemed necessary by the trainee engaged with the SP or sometimes by the supervisor. The supervisor could also interrupt the encounter when the predetermined objectives adapted to the trainee's level of training is accomplished, such as providing information according to the mother's need or to a higher level to negotiate a shared treatment plan with the family. At the end of one rotation between the SP and a trainee (i.e., before starting with a new trainee), the supervisor guides a debriefing, concentrating on learning outcomes. Enough time is provided for participants to verbalize their feelings and completely debrief. At the conclusion of the scenario, the SPs will share their feedback by summarizing two or three points that are valuable to the trainees. This time is also used by participants to summarize and identify their strengths and areas needing improvement in order to be able to become a better communicator and professional.

Keywords

• Communication
• Standardized Patient
• Ethics
• Scenario Oriented Learning
• Neonatal Perinatal Medicine