Health care ethics ECHO: Improving ethical response self-efficacy through sense-making

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In clinical practice, evidence suggests that teaching ethics using normative ethical theory has little influence on the ethical actions of providers in practice. Thus, new training methods are needed that improve clinician response to ethical problems. A sensemaking approach to ethics training has demonstrated promise as an evidence-based pedagogical method to improve ethical reasoning and response. Project ECHO (Extension for Community Health Outcomes) is theoretically linked to improved sensemaking. This study examines the effectiveness of ECHO and training in use of sensemaking approaches to ethical response by clinicians. A quasi-experimental design study using univariate linear regression was used to examine the effect of the three types of ethics training on ethical response self-efficacy scores, while controlling for participant characteristics of years in practice, discipline and sex. We found evidence that training in sensemaking through participation in ECHO promotes improved ethical response self-efficacy of clinicians. However, results also suggest that a traditional ECHO format that does not explicitly introduce sensemaking strategies into the training does not result in the same learning outcomes as measured through an ethical response self-efficacy survey. This study found important preliminary results to support use of sensemaking approaches in clinical ethics training.