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Abstract
The SARS-CoV-2 pandemic has highlighted existing systemic inequities that adversely affect a variety of communities in the United States. These inequities have a direct and adverse impact on the healthcare of our patient population. While civic engagement has not been cultivated in surgical and anesthesia training, we maintain that it is inherent to the core role of the role of a physician. This is supported by moral imperative, professional responsibility, and a legal obligation. We propose that such civic engagement and social justice activism is a neglected, but necessary aspect of physician training. We propose the implementation of a civic advocacy education agenda across department, community and national platforms. Surgical and anesthesiology residency training needs to evolve to the meet these increasing demands.
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Could application of leader-member exchange theory have saved a residency mentorship program? PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:264-267. [PMID: 32458380 PMCID: PMC7459021 DOI: 10.1007/s40037-020-00584-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Mentorship may offer protégés numerous benefits including improved self-esteem, increased interest in research, and/or enhanced productivity. Without proper planning, reflection, and evaluation, however, mentorship programs may result in undesirable consequences. In this paper we describe a mentorship program designed to improve psychosocial support and professional development for residents, that while initially successful, was terminated due to perceptions of inequity that led to strife among residents and ultimately created a toxic learning climate. Leader-member exchange theory provides a lens through which to view our program's failure and to offer some potential solutions to mitigate such challenges for other programs. Leader-member exchange theory focuses on the importance of relationships, communication, and awareness of biases to optimize interactions between dyads such as a mentor and a protégé. We highlight opportunities during the stranger, acquaintance, and mature partnership phases that could have helped to save a residency mentorship program.
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Affecting the Global Burden of Surgical Disease: Incorporating Surgical Training into International Missions: A Systematic Review. J PAK MED ASSOC 2019; 69(Suppl 1):S51-S57. [PMID: 30697020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The global burden of surgical disease is immense. Increasingly in the past several decades, international humanitarian medical missions have become more popular as a method of managing the sheer volume of patients requiring medical care worldwide. Medical education programmes have also had an increase in interest amongst medical students and surgical residents to participate in missions during training. The current review was planned to present the current body of literature on international experiences in residency training programmes. It comprised relevant literatur obtained from Medline (ubMed) using Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. A total of 15 publications were reviewed with each falling into one of the threeidentified categories:programme design (goals/objectives), ethics, and post-experience analysis. The benefits of providing international missions opportunities for surgical trainees cannot be understated.
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Professionalism: A Core Competency, but What Does it Mean? A Survey of Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2018; 75:601-605. [PMID: 29111163 DOI: 10.1016/j.jsurg.2017.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Professionalism is 1 of the 6 core competencies of the Accreditation Council of Graduate Medical Education. Despite its obvious importance, it is poorly defined in the literature and an understanding of its meaning has not been evaluated on surgical trainees. The American College of Surgeons (ACS) has previously published tenets of surgical professionalism. However, surgery residents may not share similar views on professionalism as those of the ACS. DESIGN Surgical residents of all levels at 2 surgery residencies located in the same city were interviewed regarding their personal definitions, thoughts, and experiences regarding professionalism during their training. They were then queried regarding 20 points of professionalism as outlined by the ACS tenets of professionalism. SETTING The study utilized the surgery residencies at William Beaumont Army Medical Center and Texas Tech University Health Science Center in El Paso, Texas. PARTICIPANTS All general surgery residents at each program were invited to participate in the study. Eighteen residents volunteered to take the survey and be interviewed. RESULTS The definitions of professionalism centered on clinical competence. Surgery residents conveyed experiences with both professional and unprofessional behavior. Seven of the 20 ACS tenets of professionalism were unanimously agreed upon. There were key differences between resident definitions and those as outlined by the ACS. The least agreed upon ACS tenets of professionalism include professionalism education, public education, and public health. CONCLUSIONS Surgical trainees express personal experiences in both professional and unprofessional behavior. Their definitions of professionalism are not as expansive as those of the ACS and seem to focus on patient and colleague interaction. Due to the lack of congruency, a tailored curriculum for professionalism based upon ACS tenets appears warranted.
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Balancing Privacy and Professionalism: A Survey of General Surgery Program Directors on Social Media and Surgical Education. JOURNAL OF SURGICAL EDUCATION 2016; 73:e28-e32. [PMID: 27524278 DOI: 10.1016/j.jsurg.2016.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/28/2016] [Accepted: 07/18/2016] [Indexed: 05/24/2023]
Abstract
PURPOSE Unprofessional behavior is common among surgical residents and faculty surgeons on Facebook. Usage of social media outlets such as Facebook and Twitter is growing at exponential rates, so it is imperative that surgery program directors (PDs) focus on professionalism within social media, and develop guidelines for their trainees and surgical colleagues. Our study focuses on the surgery PDs current approach to online professionalism within surgical education. METHODS An online survey of general surgery PDs was conducted in October 2015 through the Association for Program Directors in Surgery listserv. Baseline PD demographics, usage and approach to popular social media outlets, existing institutional policies, and formal curricula were assessed. RESULTS A total of 110 PDs responded to the survey (110/259, 42.5% response rate). Social media usage was high among PDs (Facebook 68% and Twitter 40%). PDs frequently viewed the social media profiles of students, residents, and faculty. Overall, 11% of PDs reported lowering the rank or completely removing a residency applicant from the rank order list because of online behavior, and 10% reported formal disciplinary action against a surgical resident because of online behavior. Overall, 68% of respondents agreed that online professionalism is important, and that residents should receive instruction on the safe use of social media. However, most programs did not have formal didactics or known institutional policies in place. CONCLUSIONS Use of social media is high among PDs, and they often view the online behavior of residency applicants, surgical residents, and faculty surgeons. Within surgical education, there needs to be an increased focus on institutional policies and standardized curricula to help educate physicians on social media and online professionalism.
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Ethics and the Treatment of the Mentally Ill, Homeless Person: a Perspective on Psychiatry Resident Training. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:612-616. [PMID: 25895630 DOI: 10.1007/s40596-015-0330-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The authors outline the unique ethical challenges that psychiatry residents face in working with individuals who are homeless and mentally ill. The authors also propose steps to develop effective teaching methods with residents working with these patients. METHODS The authors reviewed literature relevant to the training of psychiatry residents in ethics and treating individuals who are homeless and mentally ill. RESULTS The authors summarize current literature and, with the use of case examples, provide guidelines for effective teaching. CONCLUSIONS Teaching psychiatry residents who are working in the community with individuals who are mentally ill and homeless needs to address a number of unique ethical conflicts that arise in this area. The authors outline approaches to this teaching.
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Considerations of Ethics While Allowing Flexibility for Trainees: The Model and The Rationale for the Model of the Yale Global Mental Health Program. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:731. [PMID: 26423679 DOI: 10.1007/s40596-015-0427-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
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Abstract
The movement of health care workers from countries with resource scarcity and immense need ("source" countries) to areas of resource abundance and greater personal opportunity ("destination" countries) presents a complex set of decisions and relationships that affect the development of international health care systems. We explore the extent to which ethical quandaries arising from this movement are the responsibility of the said actors and the implications of these ethical quandaries for patients, governments, and physicians through the case of Dr. R, a surgeon from Nigeria who is considering working in the United States, where he is being trained to help develop surgical capacity in his country. We suggest how Dr. R, the United States, and Nigeria all contribute to "brain drain" in different but complementary ways.
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The 'L' in PLME: A Broad Approach to Medical Education. RHODE ISLAND MEDICAL JOURNAL (2013) 2015; 98:23-25. [PMID: 26125474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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GMC's supposedly independent training review included secret meetings with politicians. BMJ 2015; 350:h2400. [PMID: 25953326 DOI: 10.1136/bmj.h2400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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A time of renewal. THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY 2014; 111:54. [PMID: 25255685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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American Board of Internal Medicine and the maintenance of transparency. Mayo Clin Proc 2014; 89:1021. [PMID: 24996239 DOI: 10.1016/j.mayocp.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
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In reply--American Board of Internal Medicine and the maintenance of transparency. Mayo Clin Proc 2014; 89:1021-3. [PMID: 24996238 DOI: 10.1016/j.mayocp.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/04/2014] [Indexed: 11/28/2022]
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Multi-institutional study of self-reported attitudes and behaviors of general surgery residents about ethical academic practices in test taking. JOURNAL OF SURGICAL EDUCATION 2013; 70:777-781. [PMID: 24209654 DOI: 10.1016/j.jsurg.2013.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/02/2013] [Accepted: 09/02/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE Correlation exists between people who engage in academic dishonesty as students and unethical behavior once in practice. Previously, we assessed the attitudes of general surgery residents and ethical practices in test taking at a single institution. Most residents had not participated in activities they felt were unethical, yet what constituted unethical behavior was unclear. We sought to verify these results in a multi-institutional study. METHODS A scenario-based survey describing potentially unethical activities related to the American Board of Surgery In-training Examination (ABSITE) was administered. Participants were asked about their knowledge of or participation in the activities and whether the activity was unethical. Program directors were surveyed about the use of ABSITE results for resident evaluation and promotion. RESULTS Ten programs participated in the study. The resident response rate was 67% (186/277). Of the respondents, 43% felt that memorizing questions to study for future examinations was unethical and 50% felt that using questions another resident memorized was unethical. Most felt that buying (86%) or selling (79%) questions was unethical. Significantly more senior than junior residents have memorized (30% vs 16%; p = 0.04) or used questions others memorized (33% vs 12%; p = 0.002) to study for future ABSITE examinations and know of other residents who have done so (42% vs 20%; p = 0.004). Most programs used results of the ABSITE in promotion (80%) and set minimum score expectations and consequences (70%). CONCLUSION Similar to our single-institution study, residents had not participated in activities they felt to be unethical; however the definition of what constitutes cheating remains unclear. Differences were identified between senior and junior residents with regard to memorizing questions for study. Cheating and unethical behavior is not always clear to the learner and represents an area for further education.
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In reply-professional responsibility and certifying examinations. Mayo Clin Proc 2013; 88:1035-6. [PMID: 24001497 DOI: 10.1016/j.mayocp.2013.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Trust in residents and board examinations: when sharing crosses the boundary. Mayo Clin Proc 2013; 88:438-41. [PMID: 23639496 PMCID: PMC4862587 DOI: 10.1016/j.mayocp.2013.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/24/2013] [Accepted: 02/04/2013] [Indexed: 11/23/2022]
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The ethics of conducting graduate medical education research on residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:449-53. [PMID: 23425981 DOI: 10.1097/acm.0b013e3182854bef] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The field of graduate medical education (GME) research is attracting increased attention and broader participation. The authors review the special ethical and methodological considerations pertaining to medical education research. Because residents are at once a convenient and captive study population, a risk of coercion exists, making the provision of consent important. The role of the institutional review board (IRB) is often difficult to discern because GME activities can have multiple simultaneous purposes, educational activities may go forward with or without a research component, and the subjects of educational research studies are not patients. The authors provide a road map for researchers with regard to research oversight by the IRB and also address issues related to research quality. The matters of whether educational research studies should have educational value for the study subject and whether to use individual information obtained when residents participate as research subjects are explored.
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Maintaining professionalism in our scholarly activities. Fam Med 2013; 45:58-59. [PMID: 23334975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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The professor really wants me to do my homework: conflicts of interest in educational research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:47-48. [PMID: 22452479 DOI: 10.1080/15265161.2012.656813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Assessing the pedagogical goals of self-testing in evaluating the consultation needs of different student populations. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:41-43. [PMID: 22452476 DOI: 10.1080/15265161.2012.656815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Swabbing students: should universities be allowed to facilitate educational DNA testing? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:32-40. [PMID: 22452475 PMCID: PMC3390747 DOI: 10.1080/15265161.2012.656803] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Recognizing the profound need for greater patient and provider familiarity with personalized genomic medicine, many university instructors are including personalized genotyping as part of their curricula. During seminars and lectures students run polymerase chain reactions on their own DNA or evaluate their experiences using direct-to-consumer genetic testing services subsidized by the university. By testing for genes that may influence behavioral or health-related traits, however, such as alcohol tolerance and cancer susceptibility, certain universities have stirred debate on the ethical concerns raised by educational genotyping. Considering the potential for psychosocial harm and medically relevant outcomes, how far should university-facilitated DNA testing be permitted to go? The analysis here distinguishes among these learning initiatives and critiques their approaches to the ethical concerns raised by educational genotyping.
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MESH Headings
- DNA/analysis
- Education, Medical, Graduate/ethics
- Education, Medical, Graduate/methods
- Education, Medical, Graduate/trends
- Education, Pharmacy, Graduate/ethics
- Education, Pharmacy, Graduate/methods
- Education, Pharmacy, Graduate/trends
- Faculty/standards
- Genetic Predisposition to Disease
- Genetic Research/ethics
- Genetic Testing/ethics
- Genotype
- Humans
- Learning
- Nontherapeutic Human Experimentation/ethics
- Nontherapeutic Human Experimentation/legislation & jurisprudence
- Polymerase Chain Reaction
- Polymorphism, Single Nucleotide
- Sequence Analysis, DNA/ethics
- Students
- Universities/ethics
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Personalized genomic educational testing: what do the undergrads think? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:43-45. [PMID: 22452477 PMCID: PMC3478327 DOI: 10.1080/15265161.2012.656818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Introducing personal genomics to college athletes: potentials and pitfalls. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:45-47. [PMID: 22452478 DOI: 10.1080/15265161.2012.656811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
You are the attending surgeon of a homeless pedestrian who sustained multiple injuries when struck by a car. He died soon after being brought to the emergency department. It is late in the evening. A first-year resident and a medical student have been helping with the failed attempt at resuscitation. The emergency department is empty, except for your case. A central line kit lies on the bed, opened but not used. The junior resident asks your permission for herself and the student to practice the technique of subclavian cauterization and tracheal intubation on the fresh cadaver to get a "feel" for the procedures. There is no medical simulation for these procedures at your medical center. The best ethical response is: A. Tell them to go ahead and practice. B. They can only practice intubation because it leaves no external wounds. C. You should supervise them yourself to assure educational benefit. D. They should wait until you get permission from the medical examiner. E. The present case is not appropriate for educational purposes.
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Medical Training Initiative for UK hospitals and international medical graduates. Br J Hosp Med (Lond) 2011; 72:66-7. [PMID: 21378611 DOI: 10.12968/hmed.2011.72.2.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Canadian residents teaching and learning psychiatry in Ethiopia: a grounded theory analysis focusing on their experiences. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2010; 34:433-7. [PMID: 21041466 DOI: 10.1176/appi.ap.34.6.433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES The Toronto Addis Ababa Psychiatry Project (TAAPP) is an international collaboration between University of Toronto and Addis Ababa University. University of Toronto psychiatric residents may participate in TAAPP as an elective. The authors explored the Canadian resident experience in a qualitative study of the project. METHODS Eleven residents were interviewed using a semistructured questionnaire. Grounded theory was employed to organize participants' experiences and highlight emerging themes. The computer software NVivo7 was used to facilitate data analysis. RESULTS Participants described gaining competency as health advocates, collaborators, scholars, and teachers. They endorsed increased sensitivity to cross-cultural issues and greater awareness of global health issues, including practical and ethical ramifications of working at an intersection of cultures. Residents gained international perspective psychiatric practice. CONCLUSION The elective provided unique opportunities for acquiring clinical, teaching, collaborative, leadership and advocacy skills. It prompted participants to consider ethical and cross-cultural issues and allowed them to be mentored intensively by Ethiopian and Canadian teachers and peers.
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Mass critical care ethics: black and white, or grey? Fam Med 2010; 42:587-588. [PMID: 20839117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Why academic medical centers should ban drug company gifts to individuals. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:13-15. [PMID: 20077327 DOI: 10.1080/15265160903441061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Contact with pharmaceutical representatives: where does prudence lead? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:11-13. [PMID: 20077326 DOI: 10.1080/15265160903441046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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The pitfalls of misreading: what does "industry funding of medical education" actually say? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:24-25. [PMID: 20077332 DOI: 10.1080/15265160903441038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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The pitfalls of deducing ethics from behavioral economics: why the Association of American Medical Colleges is wrong about pharmaceutical detailing. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:1-8. [PMID: 20077321 DOI: 10.1080/15265160903493088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The Association of American Medical Colleges (AAMC) is urging academic medical centers to ban pharmaceutical detailing. This policy followed from a consideration of behavioral and neuroeconomics research. I argue that this research did not warrant the conclusions drawn from it. Pharmaceutical detailing carries risks of cognitive error for physicians, as do other forms of information exchange. Physicians may overcome such risks; those determined to do so may ethically engage in pharmaceutical detailing. Whether or not they should do so is a prudential judgment about which reasonable people may disagree. The AAMC's ethical condemnation of detailing is unwarranted and will subvert efforts to maintain a realm of physician discretion in clinical work that is increasingly threatened in our present practice environment.
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Avoiding over-deterrence in managing physicians' relationships with industry. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2010; 10:27-29. [PMID: 20077334 DOI: 10.1080/15265160903441129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Industry support of graduate medical education in surgery. Am Surg 2009; 75:395-400. [PMID: 19445290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The role of pharmaceutical and medical device companies ("industry") in graduate medical education (GME) is under debate. We surveyed program directors in general surgery and surgical specialties to determine industry activities in surgical GME. We used an internet-based questionnaire regarding industry marketing and educational activities in surgical programs, and their effects on surgical education. We received 65 responses to 377 requests (17%). Nearly two-thirds reported industry-sponsored meals. Industry-supported travel was infrequent ("never" and "seldom" in 56% of device workshops, 69% of lectures, and 74% of conferences). More than one-half reported support for academic events: paid lecturers and exhibition fees (both 58%), and unrestricted grants (62%). More than one-half (54%) reported industry-sponsored research. One-fourth believed their programs to be dependent on industry for their educational missions. Most disagreed that industry support posed a problem, either in general (55%) or for their program (71%). One-fourth of respondents (25%) advocated profession-wide restrictions of industry involvement with GME. Equal numbers agreed (39%) and disagreed (35%) with the view that pharmaceutical and medical device industries have motivations that are in conflict with those of doctors and their patients. Industry activities are widespread in surgical residencies, with approval of many program directors.
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Surgical elective in a developing country: ethics and utility. JOURNAL OF SURGICAL EDUCATION 2009; 66:59-62. [PMID: 19486868 DOI: 10.1016/j.jsurg.2008.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 11/13/2008] [Accepted: 11/23/2008] [Indexed: 05/27/2023]
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Perspective: limiting resident work hours is a moral concern. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:310-314. [PMID: 19240435 DOI: 10.1097/acm.0b013e3181971bf2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The author outlines the cross-cultural and widespread expectation that the moral character of physicians is built on dual possession of skill and compassion. The details of the moral makeup of physicians are often hotly debated in the biomedical literature. Despite a lack of consensus regarding the required aspects of character, the author demonstrates that little debate exists that at a minimum physicians should possess not only knowledge but also a willingness to care for and comfort patients. The primacy of the patient in the physician's life is reflected in the panoply of oaths taken by new physicians despite great variability in other aspects of these oaths. The author details recent worrisome reports demonstrating the erosion of medical trainees' empathy and compassion by long work hours. Further, the continued linkage of these attitude changes and fatigue to poor medical outcomes is a call to action. Changes enacted by the Accreditation Council for Graduate Medical Education to reduce resident work hours are insufficient to achieve the goal of improved patient care while promoting moral development among resident physicians. The debate regarding resident work hours is often framed as an idealistic discussion of placing patients first. However, residents are used as an inexpensive labor force, and efforts to curtail this usage would have a significant economic impact. Economic concerns play a larger part in decision making than is generally discussed. The author calls for further alterations of resident work schedules to improve patient care and ensure the preservation of the moral ethos of medicine.
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Commentary: Knowing it when we see it: reflections on pornography. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:155-156. [PMID: 19174655 DOI: 10.1097/acm.0b013e3181939222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This commentary asks, of what contemporary use is the excavation of a specific incident of sexually intimidating and otherwise inappropriate behavior in medical education's history? The question is posed in response to the accompanying article by Halperin detailing the publication and critical reception of an anatomy textbook that adopted a demeaning attitude toward women and featured pinup style photographs of nude women. The author contends that the generational context of feminist response to this incident and others like it is critical in shaping the current discussion. Today's third-generation feminists recognize the injustice of exploitative or offensive behaviors, but because of a fear of retaliation or negative consequence, they may nonetheless decline to respond in an official or whistle-blowing capacity-despite efforts to normalize appropriate faculty-learner interactions and to provide safe reception for those affected by abuses of power or authority. Revisiting an incident such as the one Halperin recounts reminds readers of both genders and all career stages that violations of professional mores between teacher and learner still occur and that the price of speaking up remains high.
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International medical graduates and global migration of physicians: fairness, equity, and justice. MEDSCAPE JOURNAL OF MEDICINE 2008; 10:284. [PMID: 19242590 PMCID: PMC2643999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
PURPOSE The aim of this study was to identify and qualify the ethical dilemmas faced by pediatric surgery trainees. METHODS An online survey was sent to pediatric surgery trainees graduating between 2005 and 2008. Consent was obtained, and study investigators were blinded to the identity of the respondents during data analysis. RESULTS Of the 40 respondents, only 59% felt they had received adequate training in bioethics to handle ethical issues pertaining to the care of critically ill children. Although 83% of respondents routinely participated in palliative care discussions, 30% of respondents desired to have more opportunities to discuss end-of-life issues with their staff. Moral conflicts were resolved through direct discussions with the medical staff, family, or friends. Despite the presence and awareness of institutional policies on ethical behavior, 58% of respondents did not believe that ethical conflicts were resolved as a result of these policies, whereas 31% of respondents felt that reporting of unethical conduct would result in personal reprisals. CONCLUSION Pediatric surgery trainees face ethical and moral conflicts, but some are fearful of reprisals if these concerns are reported. A neutral forum to raise such issues may facilitate open discussions and eventual resolution of these conflicts.
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Abstract
This article briefly describes the background and status of medical education in the areas of ethics and professionalism. Methods of teaching and assessment are described for medical students, residents, and practitioners within the core competency framework of medical education. Key areas of content for child and adolescent psychiatrists are described.
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