Sources of ethical conflict in medical housestaff training: a qualitative study. Am J Med 2004 Mar 15;116(6):402-7
Date
03/10/2004Pubmed ID
15006589DOI
10.1016/j.amjmed.2003.09.044Scopus ID
2-s2.0-1542284691 (requires institutional sign-in at Scopus site) 60 CitationsAbstract
PURPOSE: Despite increased emphasis on medical ethics and professionalism in medical education, concern about unethical and unprofessional behavior by physicians is widespread. This study sought to identify and classify the range of work-related ethical conflicts experienced by medical house officers.
METHODS: We performed a qualitative study using data from in-depth interviews conducted in 2001 with 31 internal medicine residents in one traditional and one primary care residency. Using the constant comparative method, we explored work-related experiences during housestaff training that involved ethical conflict with patients or colleagues.
RESULTS: The interviews revealed five categories of ethical conflict: concern over telling the truth, respecting patients' wishes, preventing harm, managing the limits of one's competence, and addressing performance of others that is perceived to be inappropriate. Conflicts occurred between residents and attending physicians, patients or families, and other residents. Many of the conflicts were exacerbated by the function of the hierarchical structure in residency training.
CONCLUSIONS: This study provides a classification of work-related ethical conflicts that houseofficers experience, which may be used to improve the working environment for residents and support their professional development. By attending to the challenges that residents face, particularly previously underemphasized conflicts concerning competence and performance, this framework can be used to enhance education in ethics and professionalism.
Author List
Rosenbaum JR, Bradley EH, Holmboe ES, Farrell MH, Krumholz HMMESH terms used to index this publication - Major topics in bold
AdultBeneficence
Clinical Competence
Connecticut
Ethics, Clinical
Female
Humans
Internal Medicine
Internship and Residency
Interprofessional Relations
Male
Patient Participation
Qualitative Research
Truth Disclosure
