The ETHICS OSCE:
Standardized Patient Scenarios for Teaching and Evaluating Bioethics

Produced by E.F.P.O
(Educating Future Physicians for Ontario)
Component 3

Peter A. Singer, MD, MPH, FRCPC
Centre for Bioethics, and Department of Medicine
University of Toronto

Anja K. Robb
Department of Family and Community Medicine
University of Toronto
December 1994

This WWW Version is made available in conjunction with the University at Buffalo Center for Clinical Ethics and Humanities in Health Care. Technical questions should be referred to Dr. Jack Freer jfreer@buffalo.edu. Questions about content should be referred to Dr. Peter Singer peter.singer@utoronto.ca.
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Introduction

This booklet and accompanying videotape contain 14 standardized patient scenarios for teaching and evaluating bioethics. It is part of the Ethics OSCE Project which is funded by Educating Future Physicians for Ontario (EFPO). This material is not copyrighted and may be freely reproduced for educational purposes.

NOTE: To obtain a paper version of this manual and the accompanying videotape, please send your request, with a cheque for $60 (US), $75 (CDN) payable to: "University of Toronto - SPP" and mailed to:
Diana Tabak
Standardized Patient Program
Centre for Research in Education
200 Elizabeth Street
1 Eaton S., Room 565
Toronto, Ontario, Canada M5G 2C4

Our main purpose is to provide the materials that will enable you to train standardized patients at your own institution to portray these bioethics scenarios.

We have found these scenarios useful for teaching bioethics to medical students, interns and residents, and practicing clinicians. We use them as pedagogic probes to stimulate a discussion of the particular ethical issue on which they are based. If you do not have access to standardized patients, the videotaped scenarios may suffice. Please note that the videotaped scenarios were not intended to be "perfect" interviews.

We have also used the stations for evaluation of bioethics in objective structured clinical examinations (OSCEs). Our experience has been published in the literature. Publications to date include:

  1. Cohen R, Singer PA, Rothman AI, Robb A. Assessing competency to address ethical issues in medicine. Academic Medicine 1991; 66: 14-5.
  2. Singer PA, Cohen R, Robb A, Rothman A. The Ethics Objective Structured Clinical Examination. Clinical Research 1992; 40: 618A.
  3. Singer PA, Cohen R, Robb A, Rothman A. The Ethics Objective Clinical Examination (OSCE). Journal of General Internal Medicine 1993; 8: 23-8.
  4. Singer PA, Robb A, Cohen R, Norman G, Turnbull J. The Ethics Objective Structured Clinical Examination. Clinical Research 1993; 41: 564A.
  5. Singer PA, Robb A, Cohen R, Norman G, Turnbull J. The Ethics Objective Structured Clinical Examination. Clinical and Investigative Medicine 1993; Supplement to Vol. 16(4): B12A.
  6. Singer PA, Robb A, Cohen R, Norman J. Evaluation of a Multicentre Ethics Objective Structured Clinical Examination. Journal of General Internal Medicine 1994; 9: 690-2.
  7. Singer PA, Robb A, Cohen R, Norman G, Turnbull J. Students From Different Medical Schools Differ in Ethical Abilities. Journal of General Internal Medicine 1994; 9(4): 82A.
  8. Singer PA, Robb A, Cohen R, Norman G, Turnbull J. Students from Different Medical Schools Differ in Ethical Abilities. Clinical and Investigative Medicine 1994; Supplement to Vol. 17: B83A.
  9. Singer PA, Robb A, Cohen R, Norman G, Turnbull J. Performance-based assessment of clinical ethics: The ethics objective clinical examination. Academic Medicine 1996; 71: 495-8.
We hope you find this material useful. We would appreciate hearing about your experiences. Our addresses are:
Peter Singer, MD
Centre for Bioethics
University of Toronto
88 College St.
Toronto ON
Canada M5G 1L4
Tel: 416-978-4756
Fax: 416-978-1911
e-mail: peter.singer@utoronto.ca

Anja K. Robb
Assistant Professor & Director
Standardized Patient Program
Centre for Research in Education
200 Elizabeth Street
1 Eaton South, Room 565
Toronto, ON M5G 2C4
phone: 416-978-4102
fax: 416-946-7630
email: anja.robb@utoronto.ca

Table of Contents

Evaluation of Bioethics

Decisions to Forgo Treatment

Nancy B
Candura
Do Not Intubate Me
Do Not Resuscitate My Mother
Cruzan
Malette
Brain Death

Confidentiality


Birth Control Pill
HIV Infection

Truth Telling

Pancreatic Cancer
Alzheimer's Disease
Doctor's Note

Women's Health

Battered Woman
Sexual Impropriety

Video Index

DECISIONS TO FORGO TREATMENT

Nancy B.........................0:00:58
Candura.........................0:10:53
Do Not Intubate Me..............0:20:06
Do Not Resuscitate My Mother....0:29:18
Cruzan..........................0:36:21
Malette.........................0:44:15
Brain Death.....................0:52:54

CONFIDENTIALITY
Birth Control Pill..............1:03:22
HIV Infection...................1:12:00

TRUTH TELLING
Pancreatic Cancer...............1:23:41
Alzheimer's Disease.............1:33:40
Doctor's Note...................1:42:45

WOMEN'S HEALTH
Battered Woman..................1:52:26
Sexual Impropriety..............2:03:09

Last updated 10/18/99
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