UM Medical and Nursing Students Launch Joint Forum to Discuss Ethical Dilemmas, Build Relationships

The case of the newborn, conjoined twin girls presented a soul-searching medical dilemma: If surgically separated from her weaker sister, one twin would live. If not, both would die. Yet their devoutly religious and deeply conflicted parents refused to consent to the operation.

Resolving challenging dilemmas is never easy, but as medical students from the Miller School of Medicine and doctoral nursing practice students from the School of Nursing & Health Studies learned in the first joint medical/nursing ethics session held on the Coral Gables campus this month, inter-professional dialogue can enhance teamwork and improve decision making in morally distressing situations.

“The literature is clear that inter-professional clinical training produces better outcomes, so we are thrilled by the opportunity to promote inter-professional education linking medicine, nursing and ethics,” said Robin N. Fiore, Ph.D., Director of Special Ethics Initiatives for UM’s Bioethics Program, who introduced the case of the conjoined twins at the joint session. “Bringing medical students and nursing students together for cooperative learning experiences can enhance mutual respect and collaboration, improve communications and decision making, and potentially reduce moral distress.”

An associate professor of medicine at the Miller School, Fiore facilitated the November 2 session at the invitation of Mary Hooshmand, Ph.D., M.S., RN, assistant clinical professor of nursing. As the southeast Regional Nursing Director for the state’s Children’s Medical Services (CMS), Hooshmand had long talked about the need to forge collaborative relationships between nurses and physicians with the CMS Regional Medical Director, the Miller School’s Jeffrey P. Brosco, M.D., Ph.D., professor of clinical pediatrics and Chair of the Pediatric Bioethics Committee at Jackson Memorial Hospital.

So after joining the nursing school faculty this summer, Hooshmand took a cue from the Institute of Medicine committee report on The Future of Nursing, which UM President Donna E. Shalala chaired, and set out to build those inter-professional relationships at the student level.

“One of the key messages of the IOM report was inter-professional collaboration — how we can no longer work in silos, and how we have to work across professions and be full partners,” Hooshmand said. “That starts on the front lines, which must include the student experience, as well. After all, we are training leaders who will transform health care, so we need to begin the framework for that dialogue at the student level.”

Initially, Hooshmand invited Brosco and Kenneth W. Goodman, Ph.D., the founder and director of the UM Bioethics Program, to meet with her students. Brosco discussed the social determinants of health, and Goodman gave an overall perspective of medical ethics.

But now they and Fiore all hope this month’s successful joint session, in which three medical students and 40 DNP students broke into three groups to discuss how they would handle the case of the conjoined twins, and a second one involving a family disagreement about end-of-life care, is the beginning of regular dialogue between the two groups.

“This is critical,” Brosco said. “There has been a long history of misunderstanding between doctors and nurses on too many occasions. If we can get our doctors and nurses talking to each other from the beginning, we think health care will work a lot better.”

Third-year medical student Brett Van Leer-Greenberg, who attended the inaugural joint session, said he would “absolutely” recommend future gatherings to his classmates. “Sessions like these strengthen the relationships between doctors, nurses and other health care professionals,” he said. “They build trust and direct everyone towards the same goals and, in the end, that will translate to better patient care.”

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