Zaidi Danish, Blythe Jacob A, Frush Benjamin W, Malone Jay R
Wake Forest School of Medicine, 475 Vine Street, Winston Salem, NC, 27101, USA.
Stanford University School of Medicine, Palo Alto, CA, USA.
HEC Forum. 2020 Jun;32(2):99-109. doi: 10.1007/s10730-020-09400-0.
Three ethical conflicts in particular are paradigmatic of what we define as "clerkship ethics." First, a distinction that differentiates the clerkship student from the practicing physician involves the student's principal role as a learner. The clerkship student must skillfully balance her commitment to her own education against her commitment to patient care in a fashion that may compromise patient care. While the practicing physician can often resolve the tension between these two goods when they come into conflict, the clerkship student is left with a more ambiguous set of choices. Second, evaluative scrutiny during clinical clerkships often forces medical students to balance doing what is morally fitting against the perceived expectations of the medical teams in which they work. Third and finally, a deeply entrenched culture of medical hierarchy presents a particular challenge to innovation and improvement in ethics education during the clerkship years. Students regard faculty as exemplars, but are not provided with the tools to assess when technical medical competence is not matched by moral competence; moreover, these faculty are unlikely to have experienced the ethics education in which students are asked to demonstrate mastery.
特别是有三种伦理冲突是我们所定义的“临床实习伦理”的典型代表。首先，区分临床实习学生和执业医师的一点在于学生作为学习者的主要角色。临床实习学生必须巧妙地平衡自己对自身教育的投入和对患者护理的投入，而这种平衡方式可能会危及患者护理。虽然执业医师在这两种利益发生冲突时通常能够解决其间的紧张关系，但临床实习学生面临的选择则更加模糊。其次，临床实习期间的评估审查常常迫使医学生在做符合道德之事与迎合他们所在医疗团队的预期之间进行权衡。第三也是最后一点，根深蒂固的医学等级制度文化对临床实习阶段的伦理教育创新与改进构成了特殊挑战。学生将教员视为榜样，但却没有获得评估医学技术能力与道德能力不匹配情况的工具；此外，这些教员不太可能经历过要求学生掌握的伦理教育。
