Clinical ethics training needs among pediatricians and pediatric residents in Ethiopia: conference-based cross-sectional survey

Abstract

BACKGROUND: Pediatricians encounter ethically challenging cases in clinical practice throughout the world. In Ethiopia, ethically distressing pediatric cases are heightened by limited resources, lack of ethical frameworks to guide clinical care and withdrawal of supportive therapies, absence of child protection laws, and dearth of trained ethics consultants or institutional ethics committees providing clinical ethics consultation. Ethics training remains limited in undergraduate medical programs and absent in the resident curriculum at most institutions. METHODS: Annual Conference on March 2023 was conducted using a self-administered, clinical ethics needs assessment. Data were checked, cleaned, and entered into SPSS for analysis. The magnitude and the association between the different variables in relation to the outcome was measured and a 95% confidence interval (CI) and P values below 0.05 was considered statistically significant. RESULTS: A total of 200 participants completed the survey (response rate 92% of conference attendees). Most of the study participants (85.8%) felt their clinical ethics trainings were inadequate to address the ethical challenges they faced frequently. Furthermore, 58% reported no established/formal method to address ethical concern in their respective Hospitals. Most common ethical dilemmas faced by participants included refusal of treatment by patient/family, disagreement between the healthcare team and patient/family, withholding/withdrawing life-prolonging measures (70%, 59.5%, 51.5%). Most participants (89.5%) wanted additional training. The common areas of interest for further training were withholding/withdrawing life-prolonging measures, refusal of treatment by patient/family and legal issues (45%, 46.5%, 40% respectively). CONCLUSION: Ethiopian pediatricians and pediatric residents perceive that their training on clinical ethics is inadequate to address the ethical challenges they face in their daily practice. Creation of culturally relevant, pediatric-specific ethics educational programs for Ethiopian pediatricians is much needed.