Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
University Hospitals of Morecambe Bay Foundation Trust, Lancaster, UK.
Med Teach. 2020 Jan;42(1):92-100. doi: 10.1080/0142159X.2019.1665636. Epub 2019 Sep 26.
Foundation doctors (FDs) encounter a wide range of ethical and legal issues during their first two years of work. Despite ethics being a key part of most modern undergraduate curricula, FDs can struggle with the issues they see. This study is based on results from an on-line survey answered by 479 UK FDs regarding their medical law and ethics learning needs, and their undergraduate training in this area. Over two-thirds stated they would wish to receive MEL training as an FD on self-discharge against medical advice (∼71%), sedating patients (∼70%), decision making in emergency medicine (∼67%), and withholding and withdrawing treatment (∼66%). Over half of all respondents want MEL training during their Foundation Programme on DNACPR orders (∼63%), dealing with patients with suicidal intent (∼59%), Mental Health Act (∼55%), Deprivation of Liberty Safeguards (∼54%), and end of life care (∼53%). We therefore propose a minimum curriculum for ethics and law training for FDs based on these topics, as well as cases brought by the FDs themselves.
住院医师(FDs)在工作的头两年会遇到各种各样的伦理和法律问题。尽管伦理是大多数现代本科课程的重要组成部分,但FDs可能会在他们看到的问题上感到困惑。这项研究基于一项在线调查的结果,该调查由 479 名英国 FDs 回答,内容涉及他们的医学法律和伦理学习需求,以及他们在这方面的本科培训。超过三分之二的人表示,他们希望在成为 FD 后接受 MEL 培训,内容涉及自行出院、违背医嘱(约 71%)、给患者镇静(约 70%)、急诊决策(约 67%)以及拒绝治疗或停止治疗(约 66%)。超过一半的受访者希望在基础课程中接受 MEL 培训,内容涉及 DNACPR 医嘱(约 63%)、处理有自杀倾向的患者(约 59%)、精神卫生法(约 55%)、自由限制保障措施(约 54%)以及临终关怀(约 53%)。因此,我们根据这些主题以及 FDs 自身提出的案例,为 FDs 的伦理和法律培训制定了一个最低课程。