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 $50 (US), $60 (CDN) payable to: Centre for Bioethics, University of Toronto, to:
Ethics OSCE
Centre for Bioethics
University of Toronto
88 College St.
Toronto, Ontario, Canada M5G-1L4

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 Robb
Director, Standardized Patient Program
University of Toronto, Centre for Research in Education
University Health Network - Bell Wing 6th Floor
585 University Avenue
Toronto, Ontario M5G 2C4
Telephone: 416-978-3465
fax: 416-340-3792
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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