As fourth-year medical students are keenly aware, formal medical training does not end with graduation from medical school. Instead, most graduates serve three or more years as residents, continuing their medical education while providing a large percentage of the health care received by patients at academic medical centers. An important component of the postgraduate medical curriculum, formally recognized by many medical specialty societies, is continuing examination of the moral dimensions of medical practice. The Bioethics Center and Department of Medical Humanities have, for many years, offered a variety of educational programs for residents and fellows at The Brody School of Medicine and Pitt County Memorial Hospital (PCMH).

Despite its acknowledged value, postgraduate bioethics education confronts major logistical challenges. Residents are typically scattered throughout the medical center, caring for patients in a variety of settings—intensive care units (ICUs), labor and delivery wards, emergency departments, inpatient units, and outpatient clinics, among others. Residency directors struggle to include a lengthy list of "core curriculum" topics in a small number of didactic sessions each week. To address this challenge, our postgraduate teaching in bioethics has used a number of different formats over the years, including "mini-courses" for individual residency programs; case-based ethics discussions at morning report and at regularly scheduled noontime sessions; grand rounds presentations sponsored by clinical departments; and informal discussion of issues during inpatient teaching rounds. As is the case with our undergraduate courses, most of these sessions are co-presented or co-taught by humanities and clinical faculty (see "From the Department" in this issue).

A few examples of our recent and ongoing postgraduate teaching efforts illustrate the range of possibilities. "Conversations in Ethics" is a bi-monthly session organized by PCMH Chaplain Karen Ballard for pediatrics residents and Children’s Hospital staff. It features discussion of ethics cases moderated by Bioethics Center faculty, including Drs. Kenneth De Ville, Loretta Kopelman, John Moskop, and David Resnik. Dr. Resnik meets monthly with family medicine residents and attending physicians for ethics case discussion during the family medicine inpatient team’s morning report; he also participates in inpatient teaching rounds on several clinical services. Dr. Todd Savitt offers a monthly bioethics session for geriatrics fellows and attending physicians. Dr. Kopelman meets periodically with neonatology faculty, residents and neonatal intensive care unit (NICU) staff to discuss ethics issues and cases. In 2000-2001, Dr. Moskop collaborated with family physician Dr. Alvin Lin to offer an eight-session version of the American Medical Association’s Education for Physicians on End-of-Life Care (EPEC) curriculum to family medicine residents. Bioethics faculty have, in recent years, presented grand rounds in the Departments of Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Physical Medicine and Rehabilitation, and Surgery. Through these and other teaching opportunities, we seek to enhance residents’ abilities to understand and address the clinical ethics issues they so frequently confront.