West Virginia University Charleston Division Internal Medicine Residency Curriculum

Ethics
Goal & Educational Purpose	Prepare residents to deal appropriately with the ethical, moral and legal dilemmas encountered in the practice of internal medicine. I. To ensure that residents know the current ethical and legal standards regarding decision making capacity, surrogacy, forgoing life support, DNR orders, AD’s. II. To train residents to be skilled communicators, with sensitivity, and able to successful negotiate conflicts and resolutions around ethical problems
Rationale	Increasingly difficulty and frequent problems arise in medicine with advancing technology, aging populations, reactive rather than proactice legal responses, litigious public, shrinking resources and changing cultural/social values. Physicians well trained and schooled in techniques of resolving and avoiding ethical, moral and legal problems will be less frustrated, deliver better care and more prepared to meet the changing health care scene. Advance directives skill is essential to humane care.
Objectives	Define patient autonomy and self-determination, discuss the role of the patient in medical decisions, explain and obtain informed consent; identify the main ethical issues in decisions to withhold or withdraw life support; properly obtain a DNR from a patient/surrogate; explain hospital policy regarding forgoing life support; know what to do with a patient’s AD; judging decision making capacity; distinguish between DNR and AD’s; discuss the ethical issues involved in forgoing artificial nutrition and hydration; define comfort care; evaluate a treatment refusal.
Principal Teaching Methods	Participation in Medical Ethics Advisory Group (MEAG) meeting, attending Institutional Review board (IRB) meetings, participating in MEAG consults, didactic problems as they arise, Utilization Review (UR) meetings, Renal Transplant Diseases meetings.
Mix of diseases, Patient Characteristics, Types of clinical encounters, Procedures and Services	MEAG - meeting when on oncology, nephrology & ambulatory medicine IRB - meeting when on ambulatory medicine, allergy, consult liason service MEAG - consults when on allergy, radiology, and pathology Involvement with attendings, families, nursing and administration when ethical problems arise on patients the residents are caring for
Ancillary Education	Regularly scheduled case based didactic sessions Read ethics section of MKSAP and answer questions Read ACP Ethics Manual, Third edition, c1992 Attendance of seminary mandatory
Evaluation	Resident semi-annual evaluation In-Training Examination scores Certifying Examination scores
Strengths	Proactive hospital policies MEAG Faculty involved in state advance directives development and education Faculty involved in ethics program development for hospital Fully trained ethicist (MD and a PhD) on WVU faculty, participating annually in seminars in Charleston or by interactive television Faculty member is Chairman of IRB Interested general counsel of hospital in these issues
Limitations	Experimental medicine programs are not present to great extent (experimental transplantation to frequently raise these issues) Lack of substantial minority groups and rather monolithic culture limits number of issues raised. Number of ethical consults requested is not great.