Teachersʼ perceptions of difficulties in teaching ethics in residencies

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Abstract
In 1989 the authors surveyed faculty who were teaching medical ethics in residencies in order to obtain information concerning the goals , formats , topics , and settings of such teaching , as well as the difficulties encountered . Of 163 teachers contacted , 94 ( 58 %) responded and 63 ( 39 %), representing 50 institutions , reported participation in formal ethics teaching programs for residents . The 63 teachers reported using a variety of formats , including ethics rounds , lectures , and incorporating ethics teaching into weekly case-management conferences . Frequently mentioned goals of ethics teaching included improving the residents ' skills in reasoning about ethical decisions and improving the residents ' understanding of the language and concepts of ethics . Thirty-four of the 63 teachers ( 54 %) taught ethics in hospital settings exclusively and 21 ( 33 %) taught both in hospitals and in outpatient clinics or offices . The teachers identified a number of barriers encountered in carrying out such teaching , most of which can be grouped in six categories : ( 1 ) time constraints due to residents ' heavy schedules ; ( 2 ) attitudes of residents that pose obstacles ; ( 3 ) logistical problems associated with teaching in the clinical setting ; ( 4 ) time demands placed on teachers ; ( 5 ) lack of reinforcement for teaching ethics from other faculty ; and ( 6 ) shortcomings in the background and training of faculty for teaching ethics in the clinical setting . The authors conclude that difficulties are commonly encountered and discuss ways to overcome the principal barriers to effective teaching of ethics in the residency years .

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