Evaluating a Longitudinal Ethics Curriculum for Pediatric Residents Using ACGME Milestones

John Kotula, MD – Assistant Professor of Pediatrics, Division of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital; Brandi Scully, MD – Assistant Professor of Pediatrics, Department of Pediatric Cardiovascular Surgery, Johns Hopkins All Children's Hospital; Mara DiBartolomeo – Assistant Professor of Pediatrics, Maternal, Fetal, and Neonatal Institute, Johns Hopkins All Children's Hospital; Liz Savic, BS – Residency Program Coordinator, Department of Graduate Medical Education, Johns Hopkins All Children's Hospital; Akshata Hopkins – Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Johns Hopkins All Children's Hospital

Abstract:

Background: The ACGME requires pediatric residency programs to evaluate trainees in professionalism and ethics, yet most programs lack a structured ethics curriculum. Since 2020, we have developed a three-year longitudinal, milestone-based ethics curriculum using Kern’s six-step approach. Delivered annually through a leadership program at our institution, the curriculum allows residents to engage with the material outside of clinical duties. The primary objective was to assess the curriculum’s impact on resident self-efficacy at each ACGME milestone level in ethical principles. The secondary objective was to explore how the curriculum shapes residents' approach to resolving ethical dilemmas through narrative reflection.

Curriculum Design and Evaluation: The curriculum aligns with the ACGME Pediatric Milestone 2.0 in Professionalism and Ethics (Prof 2), with session objectives tailored to residents’ training levels. A targeted needs assessment, incorporating the ABP bioethics bibliography and resident educational preferences, informed the curriculum. Case-based learning and simulation were implemented to enhance engagement.

Residents completed pre- and post-session surveys assessing self-efficacy at each milestone level using a 5-point Likert scale. Mean score differences were analyzed to evaluate changes in self-efficacy. Additionally, qualitative analysis of residents’ narrative reflections explored ethical dilemmas encountered, moral conflicts described, and resolution strategies employed.

Results: Resident-reported self-efficacy improved across all milestone levels, with some gains reaching statistical significance. Ongoing qualitative analysis of reflective writing will provide further insight into how the curriculum influences residents’ ethical reasoning and decision-making.

Conclusion: These findings suggest that a structured, milestone-based ethics curriculum may enhance pediatric residents' confidence and competency in ethical decision-making.

Keywords: Pediatric ethics, Ethics curriculum, ACGME Milestone in Ethical Principles