Ethical and Professional Issues Reported by Medical Students

A recently published article in the Journal of Medical Ethics entitled “Through students’ eyes: ethical and professional issues identified by third-year medical students during clerkships”,  reported on the predominant ethical and professional issues cited by medical students.   Kaldjian and colleagues performed a content analysis of 272 Case Observation and Assessments written by  141 third-year medical students at the University of Iowa Carver College of Medicine.  Their analysis identified 35 subcategories of ethical and professional issues within the following 7 major domains: decisions regarding treatment (31.4%), communication (21.4%), professional duties (18.4%), justice (9.8%), student-specific issues (5.4%), quality of care (3.8%), and miscellaneous (9.8%).  Among the “decisions regarding treatment”, issues included “morality of providing treatment given poor quality of life”, “doctor wants intervention/test but patient or family does not”, and “problems surrounding surrogate decision making”.  Regarding Student Specific Issues, issues included “Learning on patients over their objections or without consent”, “asked to compromise my own ethical standards”, and “not being allowed to see a patient (because I am a student”.   Major Communication Issues included:  “breaking patient confidentiality”, “delivering bad news”, “deliberate lies and deception in context of medical care”.

This article contrasts with a previously article listing the ethical issues reported by medical students from the State University of New York Upstate Medical University:  Caldicott CV, Faber-Langendoen K.  Academic Medicine. 2005;80:866.  In this article, the most common issues were “deliberate lies or deceptions”, “patients’ right to refuse recommended treatment”, and “insistence on futile treatment”.

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