Kassam Aliya, Page Stacey, Lauzon Julie, Hay Rebecca, Coret Marian, Mitchell Ian
Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
J Med Ethics. 2024 Jun 26. doi: 10.1136/jme-2023-108917.
The COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories.
We used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed.
11 residents participated across several programmes. Three main themes emerged from the participants' stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants' journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together.
Cases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics.
Efforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems.
新冠疫情给初级医生（住院医师）的护理和教育带来了新挑战。我们试图了解一年级住院医师的积极和消极经历，并从他们的故事中描述潜在的伦理问题。
我们采用叙事探究（NI）方法，并应用了一个半结构化访谈指南，其中包含与伦理原则以及疫情的积极和消极方面相关的问题。抽样是有目的的。访谈进行了录音和转录。研究团队的三名成员对转录本进行了双重编码以引出主题。通过讨论解决分歧以达成共识。构建了一个带有线索的综合故事。
11名住院医师参与了多个项目。参与者的故事中出现了三个主要主题：（1）在交叉的医疗保健和医学教育系统中导航的复杂性，（2）平衡公共卫生和公共利益与个人利益，以及（3）公平的卫生系统规划/医疗服务提供。在这些主题中，参与者在第一波疫情中的经历通过（1）让我们参与，（2）因为我们看到了治疗责任的必要性，以及（3）我们同舟共济这些线索得以展现。
新冠疫情期间发生的伦理问题案例可作为伦理教学和未来疫情规划的基础。临床伦理原则及其局限性在应用于公共卫生问题时，有助于将临床伦理与公共卫生伦理进行对比。
努力了解住院医师如何应对公共卫生紧急情况以及随之出现的伦理问题，可能会使住院医师培训教育和医疗系统都受益。
