By Stacey Kusterbeck
Medical students and trainees may receive inadequate ethics education as the result of curricular constraints or because of limited available expertise at their institutions. Ethics podcasts are a potential solution to these challenges. “Podcasts are a way to level the playing field. It’s a way of disseminating information in a free, accessible way people can access at their own pace, as many times as they’d like,” says Tamar Schiff, MD, a postdoctoral fellow in the Division of Medical Ethics in NYU Langone’s Department of Population Health.
Busy medical students already are accustomed to relying on podcasts and other Free Open Access Medical Education (FOAMed) resources (such as blogs and instructional videos) to fill knowledge gaps in all kinds of clinical areas. Schiff and colleagues saw a need to provide medical students with the same kind of resource for ethics education. They created a podcast, “At the Bedside” (part of Core IM, an internal medicine podcast) covering issues in medical ethics and medical humanities.1 “We are trying to fill that niche with our podcast. We are making use of that medium, specifically for medical ethics. This is a way that individual learners, whether students, practicing clinicians, or even educators themselves, can supplement their ethics education,” says Schiff.
Some faculty routinely record ethics lectures and post them online for students to review, and might go a step further and create a podcast. It is a lot more labor-intensive than many realize, however. “Creating a podcast is different from recording lectures in the same way publishing in a medical journal is different from sending out an institution-wide email,” says Schiff.
The At the Bedside team creates podcasts as a passion project outside of their day jobs. “But it is quite time-consuming,” says Schiff. “Any ethicist who’s inspired to make a podcast should go for it. Ethicists could sit down and record a tape and put it out there. But will people find it engaging enough to listen to? To make something that is of high production value and is evidence-based and engaging takes a lot of time and effort.”
To create a high-quality podcast, the At the Bedside team first discusses and vets a concept for each episode. Next, they review relevant literature on the topic and identify some possible interviewees. After conducting the interview with the expert, the team then edits the material, adding in commentary and a discussion of the literature. Lastly, the team sends the draft audio out for feedback. Usually, four to six trainees and practicing clinicians are invited to give input, which helps to make the episodes memorable and succinct. The team also sends the episode to the experts interviewed in each episode and to individuals with ethics expertise for review. This ensures that the information provided is accurate.
The ethics podcasts allow students and faculty from any institution to learn from nationally recognized ethics experts. “The nature of some topics pique people’s interest than others, but it doesn’t make the drier topics any less important,” observes Schiff. For instance, a recent episode covered the ethical considerations of treating friends and family — not a particularly controversial topic, but a common ethical dilemma encountered by clinicians.
Schiff and colleagues have completed almost 20 podcasts to date, aiming to hone in on topics outside of the material covered in typical curricula. Decision-making capacity assessment was the subject of a recent two-part episode. The At the Bedside team intentionally omitted an in-depth discussion of patient autonomy, since that concept is included in basic ethics education. Similarly, another episode covered the nuances of making sure a patient’s code status is truly reflective of their values but omitted basic end-of-life care ethical issues. “We wanted to do a next-level version. We try to raise topics one step beyond what the curriculum covers,” says Schiff.
Even if medical students receive ethics education, they are likely to find the podcast episodes a valuable resource to refer to after they enter clinical practice. “You can learn about ethical dilemmas in the classroom, but it means very little until you experience them firsthand,” says Schiff. New clinicians can turn to evidence-based standards or algorithms to manage clinical conditions. Ethics dilemmas are not as clear-cut. “With ethics, it’s more of a framework approach than it is a specific answer — and balancing the ethical principles, the values of the people involved, and the resources available. And that’s something that clinicians at every stage can benefit from thinking about, and having it reinforced iteratively,” says Schiff.
A central goal of the podcast is to engage people in embedding ethics in their everyday practice. “You don’t need to be an ethicist or even someone who has a passion in medical ethics,” says Schiff. “You do need to be well-versed in clinical ethics and see the ethical issues in every case.”
Reference
1. Schiff T, Hedlin M, Al-Mondhiry J. Listening “At the Bedside”: Podcasts as an emerging tool for medical ethics education. Camb Q Healthc Ethics. 2024;Nov 7:1-12. doi: 10.1017/S0963180124000471. [Online ahead of print].
Medical students and trainees may receive inadequate ethics education as the result of curricular constraints or because of limited available expertise at their institutions. Ethics podcasts are a potential solution to these challenges.
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