Background: The best pedagogical approach to teaching medical ethics is unknown and widely variable across medical school curricula in the United States. Active learning, reflective practice, informal discourse, and peer-led teaching methods have been widely supported as recent advances in medical education. Using a bottom-up teaching approach builds on medical trainees’ own moral thinking and emotion to promote awareness and shared decision-making in navigating everyday ethical considerations confronted in the clinical setting. Objective: Our study objective was to outline our methodology of grassroots efforts in developing an innovative, student-derived longitudinal program to enhance teaching in medical ethics for interested medical students. Methods: Through the development of a 4-year interactive medical ethics curriculum, interested medical students were provided the opportunity to enhance their own moral and ethical identities in the clinical setting through a peer-derived longitudinal curriculum including the following components: lunch-and-learn didactic sessions, peer-facilitated ethics presentations, faculty-student mentorship sessions, student ethics committee discussions, hospital ethics committee and pastoral care shadowing, and an ethics capstone scholarly project. The curriculum places emphasis on small group narrative discussion and collaboration with peers and faculty mentors about ethical considerations in everyday clinical decision-making and provides an intellectual space to self-reflect, explore moral and professional values, and mature one’s own professional communication skills. Results: The Leadership through Ethics (LTE) program is now in its fourth year with 14 faculty-clinician ethics facilitators and 65 active student participants on track for a distinction in medical ethics upon graduation. Early student narrative feedback showed recurrent themes on positive curricular components including (1) clinician mentorship is key, (2) peer discussion and reflection relatable to the wards is effective, and (3) hands-on and interactive clinical training adds value. As a result of the peer-driven initiative, the program has been awarded recognition as a graduate-level certification for sustainable expansion of the grassroots curriculum for trainees in the clinical setting. Conclusions: Grassroots medical ethics education emphasizes experiential learning and peer-to-peer informal discourse of everyday ethical considerations in the health care setting. Student engagement in curricular development, reflective practice in clinical settings, and peer-assisted learning are strategies to enhance clinical ethics education. The Leadership through Ethics program augments and has the potential to transform traditional teaching methodology in bioethics education for motivated students by offering protected small group discussion time, a safe environment, and guidance from ethics facilitators to reflect on shared experiences in clinical ethics and to gain more robust, hands-on ethics training in the clinical setting.

In comparison to their heterosexual peers, lesbian, gay, and bisexual (LGB) student-athletes encounter substantial challenges during their intercollegiate and professional athletic careers including detrimental stereotypes, harassment, and discrimination. Such non-inclusive environments promoted throughout the current Western culture of sport are notably associated with higher incidences of mental health and substance use disorders among LGB athletes across youth, collegiate, and professional sports. There have been significant gains at the collegiate level to address LGB-inclusive practices aimed towards administrators, educators, coaches, and student-athletes; however, there is currently no literature that addresses the unique role of the sports medicine team. As first-line healthcare providers for student-athletes, sports medicine physicians and athletic trainers are uniquely positioned to support collegiate LGB athletes through affirming sexual identity, recognizing distinctive health risks, and advocating inclusivity within the athletic training room. By examining major themes of concern among current LGB student-athlete experiences across the unique setting of US colleges and universities, this review article aims to further identify opportunities for sports medicine providers to promote positive health outcomes and improve the overall wellness of collegiate LGB student-athletes.

Background: There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum.Methods: In January 2018, following the successful implementation of a peer-led, grassroots medical ethics curriculum, student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received (41% overall response rate) among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/(D) MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum.Results: The majority of respondents were female (333, 59.3%), white (326, 58.0%) and mid-20s in age (340, 60.5%). Almost half of respondents (47%) reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students (28%) were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods.Conclusions: The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos.

Context: Interest in the relationship between psychology and the outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR) continues to grow as variable rates of return to preinjury level of activity continue to be observed. Evidence Acquisition: Articles were collected from peer-reviewed sources available on PubMed using a combination of search terms, including psychology, resilience, mental health, recovery, and anterior cruciate ligament reconstruction. Further evaluation of the included bibliographies were used to expand the evidence. Study Design: Clinical review. Level of Evidence: Level 4. Results: General mental health and wellbeing, in addition to a host of unique psychological traits (self-efficacy, resilience, psychological readiness and distress, pain catastrophizing, locus of control, and kinesiophobia) have been demonstrated convincingly to affect treatment outcomes. Moreover, compelling evidence suggests that a number of these traits may be modifiable. Although the effect of resilience on outcomes of orthopaedic surgical procedures has been studied extensively, there is very limited information linking this unique psychological trait to the outcomes of ACLR. Similarly, the available information related to other parameters, such as pain catastrophizing, is limited with respect to the existence of adequately sized cohorts capable of accommodating more rigorous and compelling analyses. A better understanding of the specific mechanisms through which psychological traits influence outcomes can inform future interventions intended to improve rates of return to preinjury level of activity after ACLR. Conclusion: The impact of psychology on patients’ responses to ACL injury and treatment represents a promising avenue for improving low rates of return to preinjury activity levels among certain cohorts. Future research into these areas should focus on specific effects of targeted interventions on known, modifiable risk factors that commonly contribute to suboptimal clinical outcomes. Strength-of-Recommendation Taxonomy (SORT): B.

Training of compassionate and empathetic physicians requires commitment by educators to make it a priority. Chaplains typically have time and training to effectively demonstrate compassionate care ...