L.B. McCullough is professor, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, and ethics scholar, Lenox Hill Hospital, New York, New York.
J. Coverdale is professor, Department of Psychiatry and Behavioral Sciences and Center of Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
Acad Med. 2020 Oct;95(10):1488-1491. doi: 10.1097/ACM.0000000000003434.
In response to the COVID-19 pandemic, the Association of American Medical Colleges has called for a temporary suspension of clinical teaching activities for medical students. Planning for the continued involvement of learners in patient care during this pandemic should include teaching learners professional formation. The authors provide an ethical framework to guide such teaching, based on the ethical principle of beneficence and the professional virtues of courage and self-sacrifice from professional ethics in medicine. The authors show that these concepts support the conclusion that learners are ethically obligated to accept reasonable, but not unreasonable, risk. Based on this ethical framework, the authors provide an account of the process of teaching professional formation that medical educators and academic leaders should implement. Medical educators and academic leaders should embrace the opportunity that the COVID-19 pandemic presents for teaching professional formation. Learners should acquire the conceptual vocabulary of professional formation. Learners should recognize that risk of infection from patients is unavoidable. Learners should become aware of established ethical standards for professional responsibility during epidemics from the history of medicine. Learners should master understandable fear. Medical educators and academic leaders should ensure that didactic teaching of professional formation continues when it becomes justified to end learners' participation in the processes of patient care; topics should include the professionally responsible management of scarce medical resources. The COVID-19 pandemic will not be the last major infectious disease that puts learners at risk. Professional ethics in medicine provides powerful conceptual tools that can be used as an ethical framework to guide medical educators to teach learners, who will bear leadership responsibilities in responses to future pandemics, professional formation.
针对 COVID-19 大流行，美国医学协会呼吁暂时停止医学生的临床教学活动。在这场大流行期间，计划让学习者继续参与患者护理，这应包括教授学习者专业素养。作者提供了一个基于医学伦理中有益原则和勇气与自我牺牲等专业美德的伦理框架来指导这种教学。作者表明，这些概念支持这样的结论，即学习者在道德上有义务接受合理但并非不合理的风险。基于这一伦理框架，作者提供了一个医学教育工作者和学术领导者应该实施的专业素养教学过程的说明。医学教育工作者和学术领导者应该抓住 COVID-19 大流行带来的教授专业素养的机会。学习者应该掌握专业素养形成的概念词汇。学习者应该认识到从感染患者身上感染的风险是不可避免的。学习者应该从医学史中了解到流行病期间专业责任的既定伦理标准。学习者应该掌握可理解的恐惧。当学习者参与患者护理过程变得合理时，医学教育工作者和学术领导者应该确保继续进行专业素养形成的教学；主题应包括对稀缺医疗资源的负责任管理。COVID-19 大流行不会是让学习者面临风险的最后一次重大传染病。医学伦理学提供了强大的概念工具，可以作为一个伦理框架来指导医学教育工作者教导学习者，他们将在未来的大流行应对中承担领导责任，形成专业素养。
