Abstracts - Bioethics/Medical Education

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    A Student-Developed Rubric to Assess the Usefulness of Faculty Learning Objectives
    K. Colyer, N. Fazel, M. Lien, J. Maxwell, A. Jakeman, J. Tollefson, K. Wong, A. Hanson, R. O’Bannon, and L. Adkison
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    Medical students are regularly asked to evaluate faculty teaching. The assessment tool was developed by the faculty and administration and feedback is provided to faculty and administration. At the end of each section, students comment about learning objective provided for lectures and comments often speak to the lack of usefulness of these objectives for learning assistance. Faculty are requested to update objectives and many do so; however, comments remain similar from section to section. The purpose of this project was for students to develop a rubric to assess the faculty learning objectives. The study team participated in several focus groups to evaluate learning objectives and developed a list of descriptors that was refined over several iterations. Interrater reliability was determined by a test-retest method to further establish reliability. Cronbach’s alpha, the measure of internal consistency for continuous items such as Likert scales, was 0.82 indicating good consistency of responses. Second year students were randomly assigned to rate the “usefulness” of learning objectives for one day during two sections using a five-point Likert scale. Approximately 12 students evaluated each lecture. A description of each scale point was provided with examples for each objective rated. The mean score and standard deviation for each lecture and all the lectures presented by each lecturer. Graphical data were prepared for each lecturer. Results demonstrate that most lecturers provide “somewhat useful” to “useful” objectives. A few lecturers need to review their objectives to better align them with the material presented.


    A Presumed Consent System of Organ Donation
    W. Engle and J. Wasserman
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    Each year, far more people are added to the Official Organ Transplant Waiting List than are taken off of it. After years of growing demand and relatively little gains in supply, organ scarcity is reaching epidemic proportions. As of November 2012, there were 116,402 Americans on the national organ waiting list, with about 10,000 of those individuals requiring multiple transplants. Over 6,000 individuals die each year waiting for a transplant. This increasing disparity raises significant ethical and practical questions concerning who gets the limited number of available organs. The purpose of this project is to establish a system of presumed consent organ donation as both practically and ethically superior to a system of presumed non-consent. I first demonstrate the need for a larger organ supply and the inability for the current system to produce a sufficient number of organs. Secondly, I provide details of alternative systems, assess why presumed consent is the best choice, and discuss how it could be implemented. Finally, I evaluate the ethical aspects of this proposal, observe the benefits it would provide to society, and counter several arguments against presumed consent. I conclude through this work that presumed consent is a preferable system both practically and ethically.


    Assessment of Modern Medical Mission Trip: A Patient's View
    R. Kahle and D. McCandless
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    The purpose of this paper is to examine the possible limitations of providing money solely for medical care instead of incorporating preventative measures as well as education during medical mission trips. Few studies address the possible improvements of medical mission trips and where the issues of health decline truly lie. By only spending money directly on the medical treatment of the mission trip, the source of illness is not addressed. By viewing medical mission trips from a more holistic approach and incorporating an educational portion, the money invested could be used to prevent further negligible medical issues such as hygiene and sanitation conditions. This could drastically reduce the number of reoccurring patients and thus more efforts could be provided to those who are very ill. To investigate the effectiveness of the modern medical mission trip model, I used qualitative narratives in addition to quantitative survey questions directed towards Guatemalan patients. These questions included the number of repetitive patients, sanitation conditions, and patient satisfaction from their interaction with medical mission team. Although the data did not reveal any significant correlation between sanitation conditions and medical outcomes, it did show a trend that indicated that those Guatemalan patients who had access to safe drinking water went to the hospital or clinic with different medical symptoms while those who did not have access to safe drinking water went to medical clinics with the same medical conditions such as parasites and diarrhea.


    Elective Acceptance: On the Unethical Nature of Routine Infant Circumcision
    B. Priest and D. Sommer
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106 and Children's Mercy Hospital

    The practice of routine infant circumcision (RIC) is not new, but it is currently undergoing a fiercely contested ethical examination. Medical associations worldwide have taken up positions in the debate. This dispute has culminated in an excessive amount of confusion, founded on a lack of education on the topic. Without clear direction from American medical institutions, parents are often compelled by healthcare providers to make unnecessary and uninformed decisions. Without disputing entirely the use of circumcision for the treatment of certain diseases, I oppose the use of routine circumcisions as a preventative form of medicine. My goal with this thesis has been to provide a comprehensive examination of the clinical and ethical considerations revolving around routine infant circumcision. My argument centers around three main points. First of all, the evidence surrounding any medical benefit of RIC is conflicting at best and, therefore, does not outweigh the risk. Most medical associations in the world have agreed that RIC is a violation of human rights and that it is not necessary. Second, circumcising a baby boy infringes on his innate human rights of personhood and liberty. Finally, even if it was proven that the benefits outweighed the risks, RIC should still not be performed because the breach of autonomy is a matter of justice that should not be violated. The ethical dilemmas surrounding RIC are real, and I argue that it is an unethical practice that needs to be discussed.


    Ethical Considerations Surrounding the Ashley Treatment: The Story of Ashley X
    D. Sivakumar and G. Flanagan
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106 and the Center for Practical Bioethics.

    This theoretical thesis addresses the ethical discrepancies in the consideration of growth attenuation and breast bud removal as non-emergent procedures administered to severely disabled children. While high dose estrogen therapy and bilateral breast bud removal pose significant ethical concerns as demonstrated by the application of Immanuel Kant’s First and Second Formulations of the Categorical Imperative and the Best Interest Principle, a partial hysterectomy would be appropriate given the long-term risks. Examining the case of Ashley X and the resulting Ashley Treatment through the lens of different ethical values, individuals condoning growth attenuation and breast bud removal components of the Ashley Treatment have reached some troublesome conclusions. The objective of this literature review and analysis of growth attenuation treatments in severely disabled children is to establish the ethical boundaries against such treatments without the proper legal and clinical safeguards.