title: Ethical issues identified by obstetrics and gynecology learners through a novel ethics curriculum.
abstract: OBJECTIVE
  Obstetrics and gynecology (ob/gyn) is fraught with bioethical issues, the professional significance of which may vary based on clinical experience. Our objective was to utilize our novel ethics curriculum to identify ethics and professionalism issues highlighted by ob/gyn learners and to compare responses between learner levels to further inform curricular development.
  
  
  METHODS
  We introduced an integrated and dynamic ob/gyn ethics and professionalism curriculum and mixed methods analysis of 181 resulting written reflections (case observation and assessments) from third-year medical students and from first- to fourth-year ob/gyn residents. Content was compared by learner level using basic thematic analysis and summary statistics.
  
  
  RESULTS
  Within the 7 major ethics and professionalism domains, learners wrote most frequently about miscellaneous ob/gyn issues such as periviability and abortion (22% of students, 20% of residents) and problematic treatment decisions (20% of students, 19% of residents) rather than professional duty, communication, justice, student-/resident-specific issues, or quality of care. The most commonly discussed ob/gyn area by both learner groups was obstetrics rather than gynecology, gynecologic oncology, or reproductive endocrinology and infertility, although residents were more likely to discuss obstetrics-related concerns than students (65% vs 48%; P = .04) and students wrote about gynecologic oncology-related concerns more frequently than residents (25% vs 6%; P = .002). In their reflections, sources of ethical value (eg, the 4 classic ethics principles, professional guidelines, and consequentialism) were cited more frequently and in greater number by students than by residents (82% of students cited at least 1 source of ethical value vs 65% of residents; P = .01). Residents disagreed more frequently with the ethical propriety of clinical management than did students (67% vs 43%; P = .005).
  
  
  CONCLUSIONS
  Our study introduces an innovative and dynamic approach to an ob/gyn ethics and professionalism curriculum that highlights important learner-identified ethics and professionalism issues both specific to ob/gyn and common to clinical medicine. Findings will help ob/gyn educators best utilize and refine this flexible curriculum such that it is appropriately focused on topics relevant to each learner level.
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: rachel-mejia@uiowa.edu.
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Mejia
authors.affiliation: Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Shinkunas
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Ginny L
authors.initials: GL
authors.lastname: Ryan
mesh_terms: D000066491:Clinical Decision-Making; D003479:Curriculum; D026690:Ethics, Clinical / Q000193:education*; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007484:Iowa; D009774:Obstetrics / Q000193:education*; D011247:Pregnancy; D000068616:Professionalism; D013337:Students, Medical
keywords: bioethics; gynecology; medical education; obstetrics; professional competence