Foundations of Clinical Care – Second Year

The Center for Biomedical Ethics and Society designed and implemented an ethics curriculum for second-year Vanderbilt Medical School students as part of their Foundations of Clinical Care longitudinal program. The second year is special for Vanderbilt Medical School students because it is typically their first major exposure to clinical rotations.

The ethics curriculum is unique in that the classes are embedded within the clinical rotations, occurring at the midpoint of the Medicine, Surgery, Neurology/Psychiatry, Pediatrics, and Obstetrics/Gynecology rotations. Students receive a “primer” email and set of readings at the start of their rotations to help ready them to identify specialty-specific ethical issues, and then spend 6 weeks in their rotation before that specialty-specific ethics class. This allows students to come to class having already experienced the clinical context of key ethical issues, and then return to the clerkship with another 6 weeks to implement their new understanding of these issues.

The goal of the curriculum is to provide Vanderbilt Medical School students exposure to core ethics competencies as well as a space to discuss clinical medical ethics within the context of the clinical clerkship experiences. Our guiding belief is that learning to reflect on and manage ethical issues in clinical medicine is a career-long endeavor. Beyond just knowing about the principles and theories that guide clinical medical ethics, being able to discuss and converse about these important aspects of patient care is critical in order to develop into master clinicians. In that spirit, we have designed each session within a clinical specialty to provide the foundational knowledge/didactic teaching efficiently, either prior to the session or at the beginning of the session, and devote the majority of each session to interactive discussion and develop competencies relevant to important ethical issues encountered on each clerkship.

This course is directed by Alexander Langerman. The Center faculty members that teach the content for each specialty and the core competencies that this curriculum addresses are as follows:

Medicine (Joseph Fanning): explain the importance of end-of-life conversations and engaging patients and families in advanced care planning discussions

Surgery (Scott Pearson, Allan Peetz, and Brian Drolet): articulate the key components of informed consent for procedures and develop an approach to engage patients and families in the informed consent process

Pediatrics (Jessica Turnbull and Ellen Clayton): devise an ethically-supportable path forward for a pediatric patient within the patient-family-provider triad while accounting for sociocultural norms

OB/Gyn (Kate Payne): identify and articulate the ethical tensions between a woman's autonomy and self-determination, their unborn child's best interests, and their partner's rights

Neuro/Psych (David Conklin and Bruce Jennings): identify the key components of the decision-making capacity assessment and gain confidence while engaging in these assessments