Katie Watson

Teaching antenatal counseling skills to neonatal providers

Counseling a family confronted with the birth of a periviable neonate is one of the most difficult tasks that a neonatologist must perform. The neonatologists goal is to facilitate an informed, collaborative decision about whether life-sustaining therapies are in the best interest of this baby. Neonatologists are trained to provide families with a detailed account of the morbidity and mortality data they believe are necessary to facilitate a truly informed decision. Yet these complicated and intensely emotional conversations require advanced communication and counseling skills that our current fellowship-training strategies are not adequately providing. We review educational models for training neonatology fellows to provide antenatal counseling at the threshold of viability. We believe that training aimed at teaching these skills should be incorporated into the neonatal-perinatal medicine fellowship. The optimal approaches for teaching these skills remain uncertain, and there is a need for continued innovation and outcomes-based research.

The essential role of medical ethics education in achieving professionalism: the Romanell Report.

This article—the Romanell Report—offers an analysis of the current state of medical ethics education in the United States, focusing in particular on its essential role in cultivating professionalism among medical learners. Education in ethics has become an integral part of medical education and training over the past three decades and has received particular attention in recent years because of the increasing emphasis placed on professional formation by accrediting bodies such as the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education. Yet, despite the development of standards, milestones, and competencies related to professionalism, there is no consensus about the specific goals of medical ethics education, the essential knowledge and skills expected of learners, the best pedagogical methods and processes for implementation, and optimal strategies for assessment. Moreover, the quality, extent, and focus of medical ethics instruction vary, particularly at the graduate medical education level. Although variation in methods of instruction and assessment may be appropriate, ultimately medical ethics education must address the overarching articulated expectations of the major accrediting organizations. With the aim of aiding medical ethics educators in meeting these expectations, the Romanell Report describes current practices in ethics education and offers guidance in several areas: educational goals and objectives, teaching methods, assessment strategies, and other challenges and opportunities (including course structure and faculty development). The report concludes by proposing an agenda for future research.

Neonatology consultations for preterm labour beyond the grey zone: reconceptualising our goals.

1.Feinberg School of Medicine, Northwestern University, Chicago, IL, USA2.Walter Reed National Military Medical Center, Bethesda, MD, USACorrespondenceTheophil A. Stokes, Department of Pediatrics, Walter ReedNational Military Medical Center, 8901 Wisconsin Ave.,Bethesda, MD 20889, USA.Tel.: +301-319-6428 |Fax: +301-295-6173 |Email: theophil.stokes@usuhs.eduReceived23 January 2015; accepted 27 January 2015DOI:10.1111/apa.12955

Documenting moral agency: a qualitative analysis of abortion decision making for fetal indications

OBJECTIVES We explored whether the decision-making process of women aborting a pregnancy for a fetal indication fit common medical ethical frameworks. STUDY DESIGN We applied three ethical frameworks (principlism, care ethics, and narrative ethics) in a secondary analysis of 30 qualitative interviews from women choosing 2nd trimester abortion for fetal indications. RESULTS All 30 women offered reasoning consistent with one or more ethical frameworks. Principlism themes included avoidance of personal suffering (autonomy), and sparing a child a poor quality of life and painful medical interventions (beneficence/non-maleficence). Care ethics reasoning included relational considerations of family needs and resources, and narrative ethics reasoning contextualized this experience into the patients life story. CONCLUSIONS This populations universal application of commonly accepted medical ethical frameworks supports the position that patients choosing fetal indication abortions should be treated as moral decision-makers and given the same respect as patients making decisions about other medical procedures. IMPLICATIONS These findings suggest recent political efforts blocking abortion access should be reframed as attempts to undermine the moral decision-making of women.

Publishing Clinical Cases: Who Owns the Story? Is the Patient's Consent Needed?

Patient stories are the bread and butter of clinical teaching. Whether the format is the “Clinical Problem-Solving” series in the New England Journal of Medicine, “Grand Rounds” in JAMA, or “Case Presentations” in PM&R, almost every medical journal has a category that highlights the patient’s story. Invariably, the story is told from the perspective of a clinician for the edification of clinicians. The role of the patient, however, is much more variable. No doubt, the patient is the plot device and the object of inquiry. What is less certain is whether the patient contributes to the narrative shaping, provides consent for the telling, or participates in altering details to protect privacy. (A notable exception is the “Clinical Crossroads” series in JAMA, which not only includes a case presentation and expert discussant but also must incorporate the patient’s voice) [1]. Despite the prominence of the patient story in clinical teaching, surprisingly little consensus exists about publication standards for patient consent when a case study or story is presented. There have been some notable attempts to address this issue, such as the International Committee of Medical Editors (a consortium of member international biomedical journals), which first published standards for managing patient privacy in their Uniform Requirements for Manuscripts in 1995 and updated their recommendations in April 2010 [2,3]. However, not all biomedical journals have adopted these standards, nor are all journals “biomedical.” Several areas of uncertainty remain. Specifically, journals have varying standards about when to seek the patient’s consent, how one should alter details of the story to protect a patient or family member’s identity, and when details cannot be altered without fundamentally altering the essential “truth” of the story. Even if we agree that patient consent and participation are desirable, when is it permissible to proceed without consent? For example, when contact with the patient has been lost? When difficult interpersonal dynamics, such as unresolved anger, ongoing litigation, or cognitive or psychic illness exist? I am pleased that this issue was brought forward by Dr Jennifer Zumsteg, who took me up on my standing offer to send me an e-mail with responses or ideas for columns. Dr Zumsteg is an acting instructor/senior fellow in the Department of Rehabilitation Medicine at the University of Washington in Seattle. She summarized her concerns as follows:

It is time to combat abortion stigma

People who have abortions have been silenced in a way that impoverishes our abortion debate, says Katie Watson.