1. 1 Ethics Curriculum for Postgraduates in Ob-Gyn By Dr. Yasmin Wajahat PG Diploma in Biomedical Ethics, CBEC, SIUT Associate Surgeon Sobhraj Maternity Hospital, Karachi

2. 2 Significance of biomedical ethics education Ethical justifications needed for decisions within health care practice A biomedical ethics education is essential to: provide health care professionals with sufficient knowledge of ethical conceptual frameworks enable them to make use of these concepts in daily working life

3. 3 Need for Biomedical Ethics: Biomedical ethics constitutes an integral form of medical education Mandatory discipline world over Still in its nascent form in Islamic Republic of Pakistan

4. 4 Need for Biomedical Ethics: There is no formal biomedical ethics education at undergraduate level except at one private college in Karachi. Subject is being taught and learnt sporadically by giving a few informal lectures or conducting discussions

5. 5 Need for Biomedical Ethics: Majority of the postgraduate trainees lack the background knowledge of formal ethics. They need to be: aware of the different ethical issues prevailing and being discussed around the globe (e.g. organ donation, persistent vegetative state, abortion, ovum donation) trained to be able to identify and deal with the upcoming challenging ethical situations using their own moral judgment.

6. 6 About Sobhraj Maternity Hospital Public sector hospital in Karachi, largest city of Sindh Province Receives patients from urban and rural areas of Sindh and Balochistan 110 bed hospital providing 24 hours emergency care Average of 200 patients seen daily Patients belong to vulnerable group

7. 7 Training certifications of Sobhraj Maternity Hospital The institute is recognized by PMDC for 6 month internships The institute is recognized by CPSP for 2 years DCPS training

8. 8 Problems encountered Busy OPD – overcrowding, less space Shortage of skilled personnel – 1 doctor to 40 patients Scarcity of resources Public expectations and demands

9. 9 Ethical issues encountered by doctors Informed consent Confidentiality Truth telling Privacy Disclosure Professional – Patient relationship (compassion, tolerance)

10. 10 My responsibilities As a practitioner: Position of Associate Surgeon Run clinics, manage wards and operation rooms where the trainees assist As an academician: Education and teaching program of the trainees Supervision of daily morning meetings

11. 11 Aim of the designed curriculum Build capacity in ethical reasoning skills of young doctors to resolve everyday conflicts Enable them to relate global issues in terms of our own traditions, upholding our religious, cultural and social roots

12. 12 Target group Fresh interns for duration of 6 months DCPS trainees for period of 2 years Simultaneously we are training two different groups The trainees have no background ethical knowledge from undergraduate level

13. 13 Objectives Understand the basic ethical concepts (respect for person, confidentiality, informed consent) Identify vulnerable patients and deal ethically with them Take informed consent i.e. involve the patient with family in decision making Apply the principles of privacy and confidentiality Conduct literature search and make a presentation on an ethics related topic

14. 14 Contents of the curriculum Introduction to biomedical ethics / oaths with an emphasis on Hippocrates's and Islamic oaths Informed consent Confidentiality / privacy Case scenarios

15. 15 Contents Due to the ever changing issues related to our field, the contents of the curricula can be modified as and when needed

16. 16 Methodology of teaching so as to Involve students actively Ensure acquisition of knowledge Promote critical thinking Be practical so that the curriculum can be implemented during working hours

17. 17 Teaching will be done during Morning meeting Service ward round (small group discussion) - four in a month. Teaching round (large group discussion) - once in five weeks.

18. 18 Morning meeting Held daily Will be utilized twice a month for BME sessions lasting 45 minutes Total number of sessions planned are 12, spanning over a period of 6 months

19. 19 Morning meeting The teaching strategies involved in the morning meeting will be: Didactic lectures Interactive discussion Case scenarios / case discussion Students’ presentation Guest speaker sessions

20. 20 Planned sessions Session 1Introduction to Bioethics; OATHSDidactic lecture; Q&A session in last 15 minutes Session 2OATHS; Hippocratic Oath; Islamic Oath Interactive discussion Session 3Informed ConsentDidactic lecture; Q&A session in last 15 minutes Session 4Informed ConsentInteractive discussion Session 5Confidentiality / PrivacyShort lecture followed by an interactive discussion Session 6Case Scenario: ContraceptionInteractive discussion Session 7Case Scenario: Abortion / MiscarriageInteractive discussion Session 8Case Scenario: Informed ConsentInteractive discussion Session 9Student’s PresentationsInteractive discussion Session 10Student’s PresentationsInteractive discussion Session 11Student’s PresentationsInteractive discussion Session 12Student’s PresentationsInteractive discussion

21. 21 Bedside teaching Small groups – 5 or 6 trainees (4/month) Large groups – all 16 trainees (1 in 5 wks.) At the end of each round Last 15-20 minutes will be utilized The students will be asked to identify any ethical issues present in patients This will be followed by a discussion

22. 22 Assessment of knowledge Written question related to biomedical ethics will be included in monthly OB-GYN test It will consist of short descriptions of particular concepts e.g. Definitions Basic ethical principles Elements of informed consent

23. 23 Conclusion Biomedical ethics education is a need of the age Objectives are kept few and simple Topics are closely related to clinical practice Bedside teaching preferred to expose trainees to different ethical issues in patients they are managing

24. 24 Conclusion No extra time will be demanded of the trainees Once implemented, it will be the teaching program for both, the trainees and the trainers Liable to be modified & improved as & when the need arises

25. 25 Conclusion Biomedical Ethics Training program has been implemented at Sobhraj Maternity Hospital from February 2007. A small project related to “informed consent” has been initiated Aims to train postgraduates to involve and encourage female patients in decision making, prior to their families

26. 26 References: 1. Moazam F, Jafarey AM. Pakistan and biomedical ethics: report from a Muslim country. Cambridge Quarterly of Health Care Ethics 2005;14:249-255. 2. Jafarey AM, Farooqui A. Ethical dilemmas and the moral reasoning of medical students. JPMA 2003;53;6. 3. Carmi A, editor. Informed consent. Israel: The International Center for Health, Law and Ethics, University of Haifa; 2003 4. An introduction to bioethics. [online]. Available from: URL: http://sunsite.wits.ac.za/bio/intro1.htmhttp://sunsite.wits.ac.za/bio/intro1.htm

27. 27 Thank You