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22.02.2024 | Perspective

Fetal Cardiology Bioethics: An Innovative New Curriculum for Cardiology Trainees

verfasst von: Lynne E. Nield, Maya Dahan, Vitor Guerra, Sonila Mustafa, Nanette Okun, Lindsay Freud, Ra K. Han, Roxanne Kirsch

Erschienen in: Pediatric Cardiology | Ausgabe 4/2024

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Abstract

Decision-making in fetal cardiology is fraught with ethical issues yet education in bioethics for trainees is limited or nonexistent. In this innovation report, we describe the development of a fetal cardiology bioethics curriculum designed to address this gap. The curriculum was developed to supplement the core curriculum for cardiology fellows and fetal cardiology subspecialty trainees. The series combines didactic and interactive teaching modalities and contains 5 key components: (1) introduction to bioethics and its role in fetal cardiology, (2) counseling and pathways for compassionate terminal care, (3) case vignette-based ethical analysis and discussion cases, (4) fetal counseling considerations for shared decision-making and recommendations, (5) facilitated communications role play. The curriculum was refined using session evaluations from end users. This report describes the innovative curriculum as a starting point for further incorporation and study of bioethical education in pediatric cardiology and fetal training programs.

* For a fulsome description of the principlist framework see: Beauchamp TL, Childress JF. Principles of biomedical ethics. (2001) 23. The framework was designed to give equal credence to all four principles and not as a hierarchical or menu selection of applied principles. This has commonly been misconstrued in practice. For additional discussion see also: Kirsch R, Kofarnus M, Madrigal V. Ethics in Pediatric Cardiology and Congenital Heart Disease. (2019) 24.

Maulik D, Nanda NC, Maulik D, Vilchez G (2017) A brief history of fetal echocardiography and its impact on the management of congenital heart disease. Echocardiography 34(12):1760–1767CrossRefPubMed

Doğan V, Yeşil Ş, Kayalı Ş, Beken S, Özgür S, Ertuğrul İ et al (2015) Regression of symptomatic multiple cardiac rhabdomyomas associated with tuberous sclerosis complex in a newborn receiving everolimus. J Trop Pediatr 61(1):74–77CrossRefPubMed

Park H, Chang CS, Choi SJ, Oh SY, Roh CR (2019) Sirolimus therapy for fetal cardiac rhabdomyoma in a pregnant woman with tuberous sclerosis. Obstet Gynecol Sci 62(4):280–284CrossRefPubMedPubMedCentral

Freud LR, Wilkins-Haug LE, Beroukhim RS, LaFranchi T, Phoon CK, Glickstein JS et al (2021) Effect of in utero non-steroidal anti-inflammatory drug therapy for severe Ebstein anomaly or tricuspid valve dysplasia (NSAID therapy for fetal ebstein anomaly). Am J Cardiol 141:106–112CrossRefPubMed

Tulzer A, Arzt W, Gitter R, Sames-Dolzer E, Kreuzer M, Mair R et al (2022) Valvuloplasty in 103 fetuses with critical aortic stenosis: outcome and new predictors for postnatal circulation. Ultrasound Obstet Gynecol 59(5):633–641CrossRefPubMedPubMedCentral

Balkin EM, Kirkpatrick JN, Kaufman B, Swetz KM, Sleeper LA, Wolfe J et al (2017) Pediatric cardiology provider attitudes about palliative care: a multicenter survey study. Pediatr Cardiol 38(7):1324–1331CrossRefPubMed

Blume ED, Kirsch R, Cousino MK, Walter JK, Steiner JM, Miller TA et al (2023) Palliative care across the life Span for children with heart disease: a scientific statement from the American heart association. Circ Cardiovasc Qual Outcomes 16(2):e000114CrossRefPubMedPubMedCentral

Vacheron A (1994) Ethics and cardiology. Arch Mal Coeur Vaiss 87(6):783–789PubMed

Mavroudis CD (2011) Foetal cardiac intervention: an ethical perspective. Cardiol Young 21(Suppl 2):141–147CrossRefPubMed

10.

Kawataki M (1999) Ethical issues and decision-making in fetal cardiology. Pediatr Int 41(6):733–736CrossRefPubMed

11.

Martens AM, Lim CC, Kelly M, Haxel CS, Ronai C, Chiu JS (2023) Evaluating how Physician attitudes may affect practice in fetal cardiac counseling. Pediatr Cardiol. https://doi.org/10.1007/s00246-023-03210-0CrossRefPubMedPubMedCentral

12.

Byrne J, Straub H, DiGiovanni L, Chor J (2015) Evaluation of ethics education in obstetrics and gynecology residency programs. Am J Obstet Gynecol 212(3):397.e1–8CrossRefPubMed

13.

Daboval T, Ferretti E, Moussa A, van Manen M, Moore GP, Srinivasan G et al (2019) Needs assessment of ethics and communication teaching for neonatal perinatal medicine programs in Canada. Paediatr Child Health 24(3):e116–e124CrossRefPubMed

14.

Cummings CL, Geis GM, Kesselheim JC, Sayeed S (2015) Ethics and professionalism education during neonatal-perinatal fellowship training in the United States. J Perinatol 35(10):875–879CrossRefPubMed

15.

Keelan JA, Moon Grady AJ, Arya B, Donofrio MT, Schidlow DN, Tacy TA et al (2022) Current state of fetal heart disease counseling and training: room for improvement? : Endorsed by the fetal heart society. Pediatr Cardiol 43(7):1548–1558CrossRefPubMed

16.

Canada RCoPaSo. Obstetrics and Gynecology Competencies 2019. https://www.royalcollege.ca/ca/en/ibd-search.html?specialty=royal-college%3Aibd%2Fspecialty%2Fobstetrics-and-gynecology&subspecialty=&special-program=&afc-diploma=.

17.

Canada RCoPaSo. Pediatric Cardiology Competencies 2020. https://www.royalcollege.ca/ca/en/ibd-search.html?specialty=&subspecialty=royal-college%3Aibd%2Fsubspecialty%2Fcardiology&special-program=&afc-diploma=.

18.

Canada RCoPaSo. Perinatal-Neonatal Medicine Competencies 2021. https://www.royalcollege.ca/ca/en/ibd-search.html?specialty=&subspecialty=royal-college%3Aibd%2Fsubspecialty%2Fneonatal-perinatal-medicine&special-program=&afc-diploma=.

19.

Nield L. Canadian Cardiologist Survey of Ethics Education.

20.

Spencer J (2003) Learning and teaching in the clinical environment. BMJ 326(7389):591–594CrossRefPubMedPubMedCentral

21.

Antiel RM, Flake AW, Collura CA, Johnson MP, Rintoul NE, Lantos JD et al (2017) Weighing the social and ethical considerations of maternal-fetal surgery. Pediatrics. https://doi.org/10.1542/peds.2017-0608CrossRefPubMed

22.

Adams NE (2015) Bloom’s taxonomy of cognitive learning objectives. J Med Libr Assoc 103(3):152–153CrossRefPubMedPubMedCentral

23.

Beauchamp TL, Childress JF. (2001) Principles of biomedical ethics: Oxford University Press.

24.

Kirsch R, Kofarnus M, Madrigal V. (2019) Ethics in Pediatric Cardiology and Congenital Heart Disease. In: Wernovsky G, Anderson R, Kumar K, Mussatto K, Redington A, Tweddell J, editors. Anderson’s Pediatric Cardiology. Fourth Edition ed. Philadelphia: Elsevier.

25.

Morell E, Moynihan K, Wolfe J, Blume ED (2019) Palliative care and paediatric cardiology: current evidence and future directions. Lancet Child Adolesc Health 3(7):502–510CrossRefPubMed

26.

Boissy A, Windover AK, Bokar D, Karafa M, Neuendorf K, Frankel RM et al (2016) Communication skills training for physicians improves patient satisfaction. J Gen Intern Med 31(7):755–761CrossRefPubMedPubMedCentral

27.

Dubler NN, Liebman CB. (2011) Bioethics mediation: a guide to shaping shared solutions: Vanderbilt University Press.

28.

Bush RAB, Folger JP. (2004) The promise of mediation: The transformative approach to conflict. Wiley.

29.

Jonsen AR, Alexander S, Swazey JP, Reich WT, Veatch RM, Callahan D et al (1993) Special supplement: the birth of bioethics. Hastings Cent Rep 23(6):S1–S16CrossRefPubMed

30.

Allen LM, Hay M, Palermo C (2022) Evaluation in health professions education-Is measuring outcomes enough? Med Educ 56(1):127–136CrossRefPubMed

Titel: Fetal Cardiology Bioethics: An Innovative New Curriculum for Cardiology Trainees
verfasst von: Lynne E. Nield
Maya Dahan
Vitor Guerra
Sonila Mustafa
Nanette Okun
Lindsay Freud
Ra K. Han
Roxanne Kirsch
Publikationsdatum: 22.02.2024
Verlag: Springer US
Erschienen in: Pediatric Cardiology / Ausgabe 4/2024
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-024-03431-x

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