Posts in Simulation
Ethical Dilemmas, Simulated

My most-cited publication to date describes a research project that I conducted during my Faculty Development Fellowship at Stanford University in 2003, “Assessment of Resident Professionalism Using High-fidelity Simulation of Ethical Dilemmas”. Medical simulation centers are wonderful venues for teaching high-risk tasks in low-stakes environments: the perfect settings for teaching medical ethics.

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In 2003, medical simulation was still a relatively new teaching tool and the options for training seemed endless. I was particularly interested in medical ethics at the time and thought to marry that interest with my medical education training.

The design of the study was simple enough: emergency medicine residents who were managing a simulated clinical case would encounter an unexpected ethical dilemma – not all that dissimilar from day-to-day clinical practice. We designed a “Professionalism Performance Assessment Tool” as a checklist of dichotomous options for management of the case. Trainees either followed ethical and professional standards during their management of the simulated case or they did not, yes or no. A critical action was included in each case.

The ethical dilemmas selected in this 2003 research study are still important topics for trainees to learn about today. Five cases were used to test concepts in key domains: Patient Confidentiality, Informed Consent, Withdrawal of Life-sustaining Treatment, Practicing Procedures on the Recently Dead (Hint: Don’t do this!), and Do-Not-Resuscitate Orders.

I’ll always reflect fondly on this project because it was the first medical education research study that I designed and executed as the principal investigator. Thanks once more to my project mentors at the time, Drs. Rebecca Smith-Coggins and Phillip Harter. (Dr. Harter still co-directs Stanford’s Medical Education Scholarship Fellowship today!)

Read more about the study design, case development, and study outcomes in our article in Academic Emergency Medicine.

May 15, 2019

Co-Authors of Original Article: Rebecca Smith-Coggins, MD – Stanford University, Phillip Harter, MD – Stanford University, Robert C. Soltysik, MS – Veterans Affairs - Chicago Health Care System, Paul R. Yarnold, PhD - Northwestern University