Truly intensive clinical ethics immersion at the Washington Hospital Center

Opportunities for practical, hospital-based training in those skills demanded by clinical ethics consultation (CEC) have been limited. Given the number of individuals who provide part-time CEC, greater access to condensed, practical training such as the clinical ethics immersion course offered by the Washington Hospital Center, is necessary. Two participants in the initial cohort evaluate their CE training at a busy, urban referral center, exploring prior expectations, perceptions of its utility and suggestions for improvement. Such training will prove valuable not only for bioethicists who lack practical CEC experience "at the bedside" but also for ethics consultants whose ethics services have a low consult volume who wish to sharpen their skills.     

Gorbachev's performance at the Washington summit: An ideological dilemma

Studies in East European Thought -     

Training in clinical ethics consultation: the Washington Hospital Center course

How can one be trained to enter the evolving field of clinical ethics consultation? The classroom is not the proper place to teach clinical ethics consultation; it is best done in a clinical setting. The author maps the elements that might be included in an apprenticeship, and sets out propositions for debate regarding the training needed for clinical ethics consultants and directors of clinical ethics consultation services. I was invited to be an observer of the first Intensive Course in Clinical Ethics at the Washington Hospital Center (WHC). I had no input into the planning. Having been present at a meeting of the Clinical Ethics Consultation Affinity Group of the American Society of Bioethics and Humanities (ASBH) when the issue of a lack of training programs was discussed, I was acutely aware of the need. Knowing how popular the various four-day intensive courses in bioethics have been, held at Georgetown University first, and then in Seattle and locations in the Midwest, it seemed time to have a four-day intensive course that was devoted to clinical ethics. The differences between bioethics and clinical ethics is substantial and largely unappreciated by those in bioethics. So when the WHC team agreed to take on the task of offering an intensive in clinical ethics, it was an important step for the field.     

美国乔治华盛顿大学医学中心POM医学人才培养模式调查

美国乔治华盛顿大学医学中心POM医学人才培养模式颇具特色,其优点值得借鉴.通过赴美实地调查,总结并梳理了POM的设计理念、实施结构、导师制度、反馈体系、评估方法等主要特点,并简要评论了POM对我国医学教育改革在文化和技术方面的借鉴性意义.     

A Needs Assessment of Transgendered People of Color Living in Washington,DC

SUMMARY

A needs assessment (N = 248) conducted in Washington, DC, revealed that trans-gendered people of color are at high risk for HIV/AIDS, substance abuse, suicide and violence/crime victimization. Overall HIV prevalence was 25%, with 32% in natal males (MTFs, i.e., male-to-females). Four predictors for HIV positive status were identified through logistic regression-male sex at birth, a history of substance abuse, sexual assault, and unemployment. Substance abuse was found in nearly half the sample (48%) but only half of those (51%) had sought treatment for it. Thirty-eight percent reported experiencing suicidal ideation, with 63% of those attributing it to their gender issues. Of those with suicidal ideation, nearly half (49%, or 16% of the entire sample), went on to make attempt(s) to kill themselves. Forty-three percent had been victims of violence or crime, including 13% who had been sexually assaulted.

Knowledge of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association was quite low (9%) and associated with white race, any higher education beyond high school, and access to sex reassignment surgery (SRS). Access to SRS, defined as obtaining vaginoplasties for natal males and chest surgeries for natal females, was just 4%. White race (versus all other races, p < .001) and female at birth (versus male, p < .01) were significantly associated with access to SRS.

Use of hormones at some point during their lives was reported by 51% of participants. Thirty-five percent were currently taking hormones, with 72% acquiring their hormones from friends or on the street. Among natal males, 25% had injected silicone.

Nineteen percent did not have their own living space, and employment, housing and job training were the most commonly-reported immediate needs of the sample. The results of this needs assessment provide evidence of an urgent need for increased medical and social services specific to transgendered people of color living in the District of Columbia.