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Serrano-Zamago AB, Altamirano-Bustamante MM. Appealing to Tacit Knowledge and Axiology to Enhance Medical Practice in the COVID-19 Pandemic: A Systematic Review and Hermeneutic Bioethical Analysis. Front Public Health 2021; 9:686773. [PMID: 34956997 PMCID: PMC8692268 DOI: 10.3389/fpubh.2021.686773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The pressure of coronavirus disease 2019 (COVID-19) pandemic, epidemiological and demographic changes, personnel-patient relationship in healthcare, and the development of biotechnologies do not go unnoticed by the healthcare professional. Changes are so wide and at a high rate that guidelines and mere scientific knowledge, which are represented by evidence-based medicine, are not sufficient to lead actions, thus the experiential aspects in the configuration of an ethos present as a fundamental part of the resources to deal with critical scenarios, such as a pandemic. In this regard, the recognition of tacit knowledge as a way of teaching and learning skills related to ethical aspects such as principles, virtues, and values, revealed as a fundamental part of the clinical field. The challenge is to strengthen binomial evidence-based medicine and values-based in order to achieve excellence in the health care of the patients and the well-being of the clinical personnel. Method: A 2-fold analysis was conducted taking pediatric endocrinology as an example. First, a systematic review was carried out in electronic databases BIREME, PubMed, and PhilPapers following PEO and PRISMA approaches. A total of 132 articles were garnered. After reading their title and abstract, 30 articles were obtained. Quantitative information was arranged in an Excel database according to three themes: ethics, axiology, and tacit knowledge. A quality criterion that meets our research question was assigned to each article and those which had a quality criterion of 3 (9) were taken to carry out the hermeneutic bioethical analysis, which consisted of three stages, namely naïve reading, codification, and interpretation. The results were analyzed in Atlas.ti. to elucidate the relations between the three main themes in accordance with the objective. Results: Although there was no difference in the frequency of tacit knowledge skills, including cognitive, social, and technical, for medical practice, there is an intrinsic relationship between epistemic and ethical values with cognitive skills, this means that professionals who practice honesty, authenticity and self-control are capable of seeing patients as persons and thus respect their dignity. This suggested that there is a strong partnership between evidence-based medicine and value-based medicine, which reinforced this binomial as the two feet on which medical practice decisions rested. With regard to tacit knowledge in terms of the context of the COVID-19 pandemic, the challenges refer to (1) adapting and learning a new way of establishing trust with the patient and (2) how to capitalize on the new knowledge that new experiences have posed. Discussion: The analysis of ethical-tacit knowledge in medicine is a recent phenomenon and is in full development. Although no references were found that dealt with any of the main topics in pediatric endocrinology, there is an interest in pediatrics to explore and discuss educational strategies in ethics related to its tacit dimension as a vector of enhancement in the clinical practice. Educational strategies ought to take into consideration the development of skills that promote reflection and discussion of experiences, even more vigorously in the context of the COVID-19 pandemic.
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Affiliation(s)
- Ana-Beatriz Serrano-Zamago
- Grupo Transfuncional en Bioética, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.,Master and Doctorate Program in Medical and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - Myriam M Altamirano-Bustamante
- Grupo Transfuncional en Bioética, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.,Unidad de Investigación en Enfermedades Metabólicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Al Qadrah BH, Al-Saleh AM, Al-Sayyari A. Saudi pediatric residents' confidence in handling ethical situations and factors influencing it. Int J Pediatr Adolesc Med 2020; 8:160-164. [PMID: 34350328 PMCID: PMC8319651 DOI: 10.1016/j.ijpam.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/29/2020] [Indexed: 11/27/2022]
Abstract
Background During their residency program, pediatric residents frequently face ethical challenges. The aim of the study is to evaluate the pediatric residents’ knowledge and confidence to handle common ethical dilemmas during their training. Methods This is a survey-based cross-sectional study on all pediatric residents in the largest pediatric training center in Saudi Arabia. The survey had six sections: a) Demographics and self-assessment of religiosity, b) Sources of ethics education, c) Degree of confidence in dealing with ethical challenges in clinical practice, d) Rating of the quality of ethics education during residency, e) Agreement or disagreement regarding ten ethical scenarios, and f) Confidence level in handling 21 different ethical situations. The response to the survey questions was based on a Likert scale; the survey was electronically distributed to all pediatrics residents. Mean knowledge scores and 95% confidence intervals (CI) were calculated for each independent variable to test for associations. Comparisons were made using an independent t-test or an ANOVA test when there were more than two groups. Result Eighty residents responded to the study (85.1% response rate). Over 60% reported that the best source of ethical education for them was through discussions with a senior physician and it was through formal lecturers in 13.8%. One-fifth felt confident in dealing with ethical challenges. Only 2.5% rated the ethics education as “very good/excellent” and 12.5% rated the “support from residency program for ethics education” as being “very good/excellent.” Agreement of more than 80% was only noted for 4 of 10 of the ethical scenarios. Overall, only 16.4% felt “confident/extremely confident” in handling different ethical situations while 38.5% felt “not confident/a little confident” with more confidence among male residents (35.3% versus 18.7% p = 0.01). Marital status, year of residency, religiosity, and source of ethics knowledge had no impact on the level of confidence. Conclusion Overall, the ethics education was considered inadequate. Only one fifth had the confidence in dealing with ethical situations. Gender but not marital status, year of residency, religiosity, or source of ethics knowledge had an impact on the level of confidence in handling ethical situations.
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Affiliation(s)
- Bedoor H Al Qadrah
- Department of Pediatrics, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah M Al-Saleh
- Department of Pediatrics, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulla Al-Sayyari
- Department of Medicine, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Watt K, Kirschen MP, Friedlander JA. Evaluating the Inpatient Pediatric Ethical Consultation Service. Hosp Pediatr 2019; 8:157-161. [PMID: 29463566 DOI: 10.1542/hpeds.2017-0107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Pediatric ethical consultation services (ECSs) have been proliferating at medical centers, with little data available on evaluating their implementation. The objective of this study was to evaluate the pediatric ECS and understand the ethical issues occurring within a single quaternary-level pediatric hospital. METHODS A retrospective chart review of documented ethics consultations at a large pediatric hospital from November 2010 to November 2013 was performed and data was abstracted per the US Department of Veterans Affairs' Domains of Ethics in Health Care. An anonymous, prospective survey regarding ethical issues encountered was distributed electronically to ∼3500 inpatient staff from November 2013 through January 2014. Ethical domains, demographics, feelings of distress by staff, and location of occurrence data were collected. These data were compared with formally documented ethics consults from the retrospective chart review and ECS activity during the same period. RESULTS A total of 47 ethics consults were documented between 2010 and 2013, primarily in the domains of end-of-life care (19; 40%) and shared decision-making (17; 36%). Sixty-three staff members (92% female; 42% nurses; 20% attending physicians) logged an encountered ethical issue between November 2013 and January 2014, corresponding to only 5 documented ethics consults in the same time period. Domains included end-of-life care (18; 28.5%), shared decision-making (13; 20.6%), everyday workplace (11; 17.4%), professionalism (8; 12.6%), and resource allocation (7; 11%). Eighty-one percent of subjects reported personal or professional distress. CONCLUSIONS On the basis of this single-center study in which we reviewed formal documentation, we determined that formal pediatric ECSs are underused, particularly for ethical domains that cause staff members moral distress.
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Affiliation(s)
- Kelsey Watt
- Children's Hospital Colorado, Aurora, Colorado.,Kaiser Permanente, Oakland, California
| | - Matthew P Kirschen
- Departments of Neurology and.,Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joel A Friedlander
- Center for Bioethics and Humanities, University of Colorado, Aurora, Colorado .,Digestive Health Institute.,Aerodigestive Program and.,University of Colorado School of Medicine, Aurora, Colorado; and
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Erdem F, Atalay M. The effect of health transformation policies on the resident physicians' perception of the medical profession in Turkey. Int J Health Plann Manage 2016; 32:189-216. [PMID: 26997337 DOI: 10.1002/hpm.2340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 11/06/2022] Open
Abstract
Although the new changes in the health system in Turkey has resulted in positive implications with respect to the groups that use the healthcare services, it has been singled out for criticism by the professional associations because of its erosive consequences particularly for the medical profession as a whole. The purpose of this study is to explain how the health transformation policies and practices influenced the working conditions and perceptions of the resident physicians in Turkey with regard to the medical profession. A qualitative research design was employed, and the data was collected through document analysis and focus group interview. The common findings highlight that the new practices have had an aggravated effect on the working conditions of the resident physicians, which has resulted in several contentious issues. These include the increased workload, insufficient training and development, economic and social conditions and a heightened number of violent acts against physicians. Negatively, these influence the motivation of the physicians and their perception of the medical profession. This finding suggests that the medical profession is able to be studied as an appropriate case for the phenomenon of deprofessionalization. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ferda Erdem
- Faculty of Economics and Administrative Sciences, Department of Business Administration, Akdeniz University, Antalya, Turkey
| | - Murat Atalay
- Faculty of Economics and Administrative Sciences, Department of Business Administration, Akdeniz University, Antalya, Turkey
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Kadivar M, Mosayebi Z, Asghari F, Zarrini P. Ethical challenges in the neonatal intensive care units: perceptions of physicians and nurses; an Iranian experience. J Med Ethics Hist Med 2015; 8:1. [PMID: 26839675 PMCID: PMC4733541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/24/2015] [Indexed: 11/04/2022] Open
Abstract
The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of Iran. In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians' and nurses' perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations. The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22. Respecting patients' rights and interactions with parents were perceived as the most challenging aspects of neonatal care. There were significant differences between sexes in the domains of the perceived challenges. According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job. The results of our study showed that the most challenging issues were related to patients' rights, interactions with parents, communication and cooperation, and end of life considerations respectively. It can be concluded, therefore, that more attention should be paid to these issues in educational programs and ethics committees of hospitals.
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Affiliation(s)
- Maliheh Kadivar
- Professor, Department of Pediatrics, Division of Neonatology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ziba Mosayebi
- Associate Professor, Department of Pediatrics, Division of Neonatology- Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Asghari
- Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran;
| | - Pari Zarrini
- Neonatologist, Department of Pediatrics, Division of Neonatology- Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Hernández González A, Rodríguez Núñez A, Cambra Lasaosa FJ, Quintero Otero S, Ramil Fraga C, García Palacios MV, Hernández Rastrollo R, Ruiz Extremera MA. [Knowledge of health care ethics in paediatric residents]. An Pediatr (Barc) 2013; 80:106-13. [PMID: 24103240 DOI: 10.1016/j.anpedi.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 06/02/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Bioethics has been recently incorporated in to the educational programs of both medical students and medical residents as part of their curriculum. However, its training based on clinical practice is not well structured. OBJECTIVE To evaluate the knowledge of bioethics in Spanish paediatric residents, and to analyse how this relates to the medical education during graduate and post-graduate training. MATERIAL AND METHODS A questionnaire with 20 multiple choice questions was designed to evaluate the knowledge in basic ethics with potential implications in clinical practice. We evaluated the education received during graduate and post-graduate training, and the main ethical conflicts faced. RESULTS A total of 210 completed questionnaires were received from medical residents in paediatrics from 20 different Spanish hospitals, of whom 47 of these were first year residents (R1), 49 were second year residents (R2), 57 were third year residents (R3), and the remaining 57 were final year residents (R4). The mean number of correct answers was 16.8 out of 20. No differences were found between residents in different years of training, nor were there any differences between the group that had received specific training in bioethics versus those who had not. Residents were more likely to give wrong answers related with informed consent, the law on the freedom of the patient, principles of quality of life, the case analysis system, and the dimension of distributive justice. CONCLUSIONS Limitation of therapeutic efforts was identified as the main ethical problem faced in clinical practice by Spanish residents in paediatrics. Most of the knowledge of bioethics is acquired during graduate training, and improved very little throughout the period of medical residence. Our results suggest that efforts are required in organising and structuring the education in bioethics during the training of residents in paediatrics.
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Affiliation(s)
- A Hernández González
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Puerta del Mar, Cádiz, España.
| | - A Rodríguez Núñez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Clínico Universitario de Santiago, Santiago de Compostela, España
| | - F J Cambra Lasaosa
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, España
| | - S Quintero Otero
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Puerta del Mar, Cádiz, España
| | - C Ramil Fraga
- Unidad de Cuidados Intensivos Pediátricos, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M V García Palacios
- Servicio de Medicina Preventiva, Hospital Universitario Puerta del Mar, Cádiz, España
| | - R Hernández Rastrollo
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Infanta Cristina, Badajoz, España
| | - M A Ruiz Extremera
- Departamento de Pediatría, Hospital Universitario San Cecilio, Granada, España
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