Miller Bonnie M
Professor of medical education and administration and of clinical surgery at Vanderbilt University School of Medicine in Nashville, Tennessee, and serves as the senior associate dean for health sciences education, and serves as executive vice president physician for educational affairs at Vanderbilt University Medical Center.
AMA J Ethics. 2017 Jun 1;19(6):537-543. doi: 10.1001/journalofethics.2017.19.6.ecas1-1706.
In this scenario, a medical student, Lauren, experiences moral distress because she feels that learning to perform a procedure on a patient who requested not to be used for "practice" puts her own interests above the patient's. Lauren might also worry that the resident physician is misrepresenting her abilities. The resident physician could help alleviate Lauren's distress and align her interests with the patient's by more clearly explaining the training situation to the patient and seeking the patient's approval. Lauren might also manage the situation by assuring the patient of the resident's supervisory role. This article argues that trainees should have the opportunities to practice procedures and difficult conversations in simulated settings and that institutions should support a culture of "speaking up" to ensure patients' and learners' safety.
在这种情况下，医学生劳伦经历了道德困扰，因为她觉得在一位要求不被用于“练习”的患者身上学习操作程序，是将自己的利益置于患者利益之上。劳伦可能还担心住院医师对她的能力做出不实陈述。住院医师可以通过向患者更清楚地解释培训情况并寻求患者的同意，来帮助减轻劳伦的困扰，并使她的利益与患者的利益保持一致。劳伦也可以通过向患者保证住院医师的监督作用来处理这种情况。本文认为，实习生应有机会在模拟环境中练习操作程序和进行艰难对话，并且机构应支持一种“直言不讳 ”的文化，以确保患者和学习者的安全。
