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Jennifer Cohn Kesselheim, MD, MBE; Judith Johnson, JD; Steven Joffe, MD, MPH

Arch Pediatr Adolesc Med. 2008;162(4):368-373.

Objective  To study pediatricians' assessments of the quality of their ethics education, the impact of various learning methods, and their confidence in confronting ethical dilemmas arising in pediatric practice.

Design  Cross-sectional survey.

Participants  Two hundred fifty physicians who completed pediatric or medicine/pediatric residency programs in 2004 were randomly selected from the American Medical Association Physician Masterfile. Evaluable responses were received from 150 of 215 eligible pediatricians (70%).

Results  Of 150 respondents, 44.7% rated their ethics education during residency as fair or poor. More than 80% reported that informal discussions with fellow residents and attending physicians had a moderate or major effect on their ethics education, whereas 53.3% reported that formal teaching conferences had a moderate or major impact. Most respondents (>60%) reported confidence in addressing 4 of 23 ethical challenges, a moderate proportion (40%-60%) reported confidence in addressing 8 of 23 ethical challenges, and fewer (<40%) reported confidence in addressing 11 of the ethical challenges. Areas associated with low confidence included ethics in end-of-life care and research ethics.

Conclusions  Efforts are needed to augment formal and informal ethics teaching during residency. Additional studies at both the individual physician and residency program levels are needed to improve the ethics education that pediatricians-in-training receive.

Author Affiliations: Department of Pediatric Oncology, Dana-Farber Cancer Institute (Drs Kesselheim and Joffe), and the Department of Medicine (Drs Kesselheim and Joffe) and the Office of Ethics (Ms Johnson), Children's Hospital Boston, Boston, Massachusetts.

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