Abstracts

Rationale: Clinicians and medical educators from numerous specialties including neurology have advocated formal ethical training as part of all residency curricula. The Accreditation Council for Graduate Medical Education (ACGME) has mandated that every residency curriculum must include ethics education. In 2000 and 2012 the American Academy of Neurology published pilot ethics curricula specifically designed for neurology residents.Methods: •Developed list of key topics from AAN’s 2000 and 2012 ethics curricula, matched to actual clinical cases (e.g. genetic testing in MERRF, cross-cultural competence in a new diagnosis of epilepsy, the difficult patient with psychogenic seizures) •Developed 2 key cases (first seizure of life resulting in new diagnosis of glioblastoma multiforme, family meeting following cardiac arrest and myoclonic status) into simulation sessions utilizing professional actors •Residents participated in introductory simulation sessions, then monthly bioethics case discussion groups •Pre- and post-curriculum multiple choice quiz assessed ability of residents to manage ethically complex clinical cases. •Pre- and post-curriculum survey asked residents to self-assess their comfort (on 1-10 scale) in discussing and managing ethically complex cases. •Pre-/post-curriculum quiz scores and survey results compared as matched pairs using Wilcoxon signed-rank test. •Attendance at ethics discussion sessions measured and compared to attendance at non-ethics noon conferences as matched pairs using Wilcoxon signed-rank test. •p-value of <0.05 taken as threshold for statistical significance. •Approved by Columbia IRBResults: •13 bioethics sessions over 9 months (1.4 sessions per month). •Average attendance of 73.5% at ethics discussions, as compared to 61.7% for non-ethics noon conferences (p=0.04) (fig). •Pre- and post-curriculum quiz assessing management of ethically complex cases: each class improved scores (table). Average score on quiz improved from 75.8% pre-curriculum to 88.6% post-curriculum (p=0.02). •Self-assessed comfort discussing ethically complex cases improved from 6.42 pre-curriculum to 7.38 post-curriculum on 10 point scale (p=0.03). •Self-assessed comfort managing ethically complex cases trended toward improvement from 6.46 pre-curriculum to 7.04 post-curriculum but did not reach statistical significance (p=0.07).Conclusions: •Extremely popular with residents, as indicated by the above-average rates of attendance at ethics noon conferences. •Over the course of curriculum residents improved in their ability to analyze ethically complex cases as indicated by improved quiz scores and self-assessed comfort in discussing cases. •Self-assessed comfort in managing ethically complex cases trended toward improvement. •Assessment limited by lack of control group, as all residents participated in curriculum. •Next steps will be to incorporate more simulation sessions, and to perform randomized control trial, with control group receiving only routine clinical and didactic training and intervention group participating in bioethics curriculum.