The impact of an ethics curriculum in a longitudinal integrated clerkship: a qualitative study of graduates

Abstract

Background: Little is known about the effectiveness of ethics education in developing knowledge and skills in medical schools that persist into residency and beyond. While previous research has demonstrated that graduates of Longitudinal Integrated Clerkships (LICs) continue practices of patient-centeredness and empathy, to our knowledge, no studies have looked at effect of a medical ethics curriculum integrated into LICs. Methods: In 2011, the University of North Carolina School of Medicine-Asheville initiated an Ethics and Humanism course alongside the LIC. The goals of the program were for students to be able to identify ethical issues as they arose and exercise moral imagination in resolving these issues. Later, practices of mindfulness and writing were added. We conducted a qualitative case study using The Kirkpatrick Model of training evaluation to assess graduates of this course in their capacity to apply those skills in ongoing clinical practice. Semi-structured interviews were conducted, transcribed and independently coded. The Kirkpatrick Model informed the organization of codes into themes. Results: The qualitative analysis reached thematic saturation with review of 22 graduates’ interview transcripts. The findings of this study suggest that the Ethics and Humanism curriculum successfully shaped how respondents approached ethical tensions and the healthcare system more broadly. Furthermore, the interviews revealed that respondents used moral imagination in their approaches to conflict resolution and advocacy projects. Discussion: We found graduates of this ethics curriculum continued to identify ethical dilemmas in their daily clinical practice and using moral imagination to address and resolve conflicts. Our findings suggest that linking ethics education to the clinical curriculum may develop persistent skills in navigating ethical dilemmas and increase graduates’ capacity to be resilient, holistic physicians. The potential benefits of this program in preventing burnout are explored. We believe this demonstrates the value of a dedicated ethics curriculum integrated into an LIC.