Monrouxe Lynn, Shaw Malissa, Rees Charlotte
Professor at the Chang Gung University and the director of the Chang Gung Medical Education Research Centre at Chang Gung Memorial Hospital in Linkou, Taiwan.
Postdoctoral researcher at the Chang Gung Medical Education Research Centre at Chang Gung Memorial Hospital in Linkou, Taiwan.
AMA J Ethics. 2017 Jun 1;19(6):568-577. doi: 10.1001/journalofethics.2017.19.6.medu1-1706.
Medical students often experience professionalism dilemmas (which differ from ethical dilemmas) wherein students sometimes witness and/or participate in patient safety, dignity, and consent lapses. When faced with such dilemmas, students make moral decisions. If students' action (or inaction) runs counter to their perceived moral values-often due to organizational constraints or power hierarchies-they can suffer moral distress, burnout, or a desire to leave the profession. If moral transgressions are rationalized as being for the greater good, moral distress can decrease as dilemmas are experienced more frequently (habituation); if no learner benefit is seen, distress can increase with greater exposure to dilemmas (disturbance). We suggest how medical educators can support students' understandings of ethical dilemmas and facilitate their habits of enacting professionalism: by modeling appropriate resistance behaviors.
医学生经常会遇到专业精神困境（这与伦理困境不同），在这些困境中，学生有时会目睹和/或参与到患者安全、尊严和同意方面的失误中。面对此类困境时，学生会做出道德决策。如果学生的行为（或不作为）违背了他们所认知的道德价值观——这通常是由于组织限制或权力等级制度所致——他们可能会遭受道德困扰、职业倦怠或产生离开该职业的想法。如果道德违规行为被合理化地认为是为了更大的利益，随着困境被更频繁地经历（习惯化），道德困扰可能会减少；如果看不到对学习者有任何益处，随着接触困境的增加，困扰可能会加剧（干扰）。我们提出医学教育工作者可以如何支持学生对伦理困境的理解，并促进他们践行专业精神的习惯：通过树立恰当的抵制行为榜样。
