Transforming the ethical behavior of clinicians through pedagogical innovation: sensemaking as a means to promote ethical practice in the face of moral ambiguity

Abstract

Even though there is evidence to suggest that teaching normative ethical theory has limited influence on the ethical behavior of clinicians, typical pedagogy in clinical ethics continues to focus on adherence to professional duties and the principles of biomedical ethics. A sensemaking approach to ethics training has demonstrated promise as an evidence-based pedagogical method to improve ethical reasoning and response. It has been posited that participation in Project ECHO (Extension for Community Health Outcomes) leads to improved sensemaking by clinicians. This study examined the effect of type of ethics training on ethical response self-efficacy scores. Using a series of univariate analyses of variance, the study found that participants of a Health Care Ethics ECHO, who were trained in sensemaking strategies, scored higher than both clinicians who received traditional training in clinical ethics, and clinicians who participated in a traditional Health Care Ethics ECHO, which incorporated normative theory, but not sensemaking (N=172). Clinicians, who participated in the Health Care Ethics ECHO with sensemaking, perceived their ability to recognize and effectively address ethical conflict in practice as significantly higher than those who participated in a traditional Ethics ECHO that did not include sensemaking strategies (p=0.035, mean difference = 0.888, 95% CI= (0.05, 1.172)). The study produced preliminary evidence to support the claim that incorporating sensemaking into clinical ethics training increases the clinician’s ability to respond ethically in practice.