Wiskin Connie, Dowell Jonathan, Hale Catherine
Interactive Studies Unit, 90 Vincent Drive, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK.
University of Dundee, Dundee, UK.
BMC Med Ethics. 2018 Jul 20;19(1):74. doi: 10.1186/s12910-018-0307-0.
On elective students may not always be clear about safeguarding themselves and others. It is important that placements are safe, and ethically grounded. A concern for medical schools is equipping their students for exposure to and response to uncomfortable and/or unfamiliar requests in locations away from home, where their comfort and safety, or that of the patient, may be compromised. This can require legal, ethical, and/or moral reasoning on the part of the student. The goal of this article is to establish what students actually encounter on elective, to inform better preparing students for safe and ethical medical placements. We discuss the implications of our findings, which are arguably applicable to other areas of graduate training, e.g. first medical roles post-qualification.
An anonymised survey exploring clinical and ethical dilemmas on elective was issued across 3 years of returning final year elective medical students. Questions included the prevalence and type of potentially unsafe scenarios encountered, barriers to saying 'no' in unsafe situations, perceived differences between resource poor and developed world settings and the degree to which students refused or consented to participation in events outside of the 'norms' of their own training experience.
Three hundred seventy-nine students participated. 45% were asked to do something "not permissible" at home. 27% were asked to do something they felt "uncomfortable" with, often an invasive clinical task. Half asked to do something not usually permissible were "comfortable". 48% felt it more acceptable to bypass guidelines in developing settings. 27% refused an offer outside their experience.
Of interest are reasons for "going along with" uncomfortable invitations, e.g. "emergency", self-belief in 'capability' and being 'more qualified' than host-personnel. This "best pair of hands available" merits scrutiny. Adverse scenarios were not exclusive to developing settings. We discuss preparing students for decision-making in new contexts, and address whether 'home' processes are too inflexible to prepare students for 'real' medical life? Ethical decision-making and communicating reluctance should be included in elective preparation.
选修的医学生可能并不总是清楚如何保护自己和他人。确保实习环境安全且符合道德规范非常重要。医学院校关注的是，要让学生在远离家乡的地方，有能力应对令人不适和/或不熟悉的要求，因为在这些地方，他们自己或患者的舒适与安全可能会受到影响。这可能需要学生进行法律、伦理和/或道德推理。本文的目的是确定学生在选修实习中实际遇到的情况，以便更好地让学生为安全且符合道德规范的医学实习做好准备。我们讨论了研究结果的影响，这些影响可以说适用于研究生培训的其他领域，例如资格认证后的首个医疗岗位。
对连续三年参加选修实习的最后一年医学生进行了一项匿名调查，以探究临床和伦理困境。问题包括遇到的潜在不安全情况的发生率和类型、在不安全情况下说“不”的障碍、资源匮乏地区和发达国家环境的感知差异，以及学生拒绝或同意参与超出其自身培训经验“规范”的活动的程度。
379名学生参与了调查。45%的学生在家乡被要求做“不被允许”的事情。27%的学生被要求做他们觉得“不舒服”的事情，通常是侵入性临床任务。在被要求做通常不被允许的事情的学生中，有一半表示“愿意接受”。48%的学生认为在发展中地区绕过指导方针更可接受。27%的学生拒绝了超出其经验范围的邀请。
值得关注的是“接受”令人不适邀请的原因，例如“紧急情况”、对自身“能力”的自信以及认为自己比当地工作人员“更有资格”。这种“现有最佳人手”值得审视。不良情况并非发展中地区所独有。我们讨论了让学生为在新环境中做出决策做好准备的问题，并探讨“家乡”的流程是否过于僵化，无法让学生为“真实”的医疗生活做好准备？选修实习准备应包括伦理决策和表达不情愿的沟通。
