Waz W R, Henkind J
Department of Pediatrics, Children's Hospital of Buffalo 14222, USA.
Acad Med. 1995 Nov;70(11):1041-3. doi: 10.1097/00001888-199511000-00025.
To identify ethical dilemmas commonly encountered during pediatrics training as a step toward improving medical ethics curricula for residents.
The authors identified seven recurring topics by reviewing the required case reports on ethical dilemmas experienced by students in the third-year pediatrics clerkship from June 1992 to June 1994 at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. Based on the topics identified, the authors then surveyed pediatrics housestaff in 1993-94 regarding the frequency of encountering the topics, levels of comfort in addressing the topics, role models and resources, and perceived need for improved training.
A total of 214 student essays were reviewed. Thirty-six of 50 residents responded to the survey. In the following list of the seven topics, percentages are given for students who reported the topic, for residents who encountered the topic "very frequently" or "sometimes," and for residents who felt "very comfortable" or "somewhat comfortable" addressing the topic: child abuse or neglect (students reported, 28%, residents encountered, 94%, residents felt comfortable, 86%); use of heroic measures to maintain a terminal patient (20%, 89%, 69%); patient confidentiality (19%, 81%, 92%); resource allocation (12%, 67%, 54%); surrogate decision making (7%, 69%, 75%); patient autonomy (4%, 86%, 69%); and disclosure of information (2%, 69%, 60%). Eighty percent of the residents felt they could not intervene when they disagreed with decisions; 69% felt their training had not prepared them to address ethical dilemmas; 69% thought attending physicians were interested in discussing ethical issues; and 74% desired more training.
Based on their self-reported experiences with topics identified as occurring frequently in pediatrics training, the residents perceived their training to be inadequate and desired more ethics education, but felt that the faculty were willing to assist in that training.
识别儿科培训期间常见的伦理困境，以此作为改进住院医师医学伦理课程的第一步。
作者通过回顾1992年6月至1994年6月在纽约州立大学布法罗医学院和生物医学科学学院三年级儿科实习学生所经历的伦理困境的必需病例报告，确定了七个反复出现的主题。基于所确定的主题，作者随后在1993 - 1994年对儿科住院医师进行了调查，内容包括遇到这些主题的频率、处理这些主题时的舒适程度、榜样和资源以及对改进培训的感知需求。
共审查了214篇学生论文。50名住院医师中有36人回复了调查。在以下七个主题列表中，分别给出了报告该主题的学生、“非常频繁”或“有时”遇到该主题的住院医师以及在处理该主题时“非常舒适”或“有些舒适”的住院医师的百分比：虐待或忽视儿童（学生报告，28%；住院医师遇到，94%；住院医师感觉舒适，86%）；使用英勇措施维持终末期患者生命（20%，89%，69%）；患者保密（19%，81%，92%）；资源分配（12%，67%，54%）；替代决策（7%，69%，75%）；患者自主权（4%，86%，69%）；以及信息披露（2%，69%，60%）。80%的住院医师表示，当他们不同意某些决策时无法进行干预；69%的住院医师觉得他们的培训没有让他们为处理伦理困境做好准备；69%的住院医师认为主治医生有兴趣讨论伦理问题；74%的住院医师希望接受更多培训。
基于住院医师自我报告的在儿科培训中频繁出现的主题的经历，他们认为自己的培训不足，希望接受更多的伦理教育，但觉得教员愿意协助进行这种培训。
