Fryer-Edwards Kelly, Wilkins M Davis, Baernstein Amy, Braddock Clarence H
Department of Medical History and Ethics, University of Washington School of Medicine, Seattle, Washington 98195, USA.
Acad Med. 2006 Jul;81(7):626-31. doi: 10.1097/01.ACM.0000232412.05024.43.
Although most medical schools teach medical ethics during preclinical years, incorporating these ethics into clinical training remains challenging. During clinical rotations, students' professional behaviors and attitudes are profoundly affected. This project was intended to develop an educational intervention to incorporate medical ethics training as a part of students' professional development within the context of clinical training.
"Ward Ethics" is a series of peer discussions guided by clinical faculty mentors trained in fostering issue identification and strategy development. The sessions described here were conducted during medicine and surgery rotations for third-year medical students at the University of Washington School of Medicine from 1998 to 2003. Thirty clinical faculty participated as facilitators. Written evaluations were collected from students and faculty at each session, and faculty interviews were conducted in 2001.
The data reported are from 24 sessions and 15 faculty interviews from 1999 to 2001. The topics were consistent with prior reports of ethical issues that students encountered. Students reported a variety of learned strategies such as knowing how and when to speak up and transitioning from prioritizing evaluations to focusing on patient care, resulting in their feeling more confident. Faculty reported noticing positive results to their professional development as well.
Medical students in the clinical years face ethically challenging situations. Some circumstances, if left unexamined, may erode students' abilities to maintain and develop appropriate professional behaviors. Students participating in this activity agreed that it served as a way to fight isolation, share stories, and exchange ideas for future problem solving.
尽管大多数医学院校在临床前阶段教授医学伦理学，但将这些伦理学内容融入临床培训仍具有挑战性。在临床轮转期间，学生的职业行为和态度会受到深刻影响。本项目旨在开发一种教育干预措施，将医学伦理学培训纳入学生在临床培训背景下的职业发展中。
“病房伦理学”是一系列由经过培养问题识别和策略制定培训的临床教师导师指导的同伴讨论。这里描述的课程于1998年至2003年在华盛顿大学医学院为三年级医学生进行的医学和外科轮转期间开展。30名临床教师作为促进者参与其中。在每次课程中收集了学生和教师的书面评价，并于2001年对教师进行了访谈。
报告的数据来自1999年至2001年的24次课程和15次教师访谈。主题与之前关于学生遇到的伦理问题的报告一致。学生报告了各种学到的策略，比如知道如何以及何时表达意见，从优先考虑评估转变为专注于患者护理，从而让他们感觉更有信心。教师也报告注意到对他们职业发展的积极影响。
临床阶段的医学生面临具有伦理挑战性的情况。有些情况如果不加以审视，可能会削弱学生维持和培养适当职业行为的能力。参与这项活动的学生一致认为，这是一种对抗孤立、分享故事以及为未来解决问题交流想法的方式。
