Christakis D A, Feudtner C
University of Pennsylvania School of Medicine, Philadelphia.
Acad Med. 1993 Apr;68(4):249-54. doi: 10.1097/00001888-199304000-00003.
Many existing ethics curricula fail to address the subtle yet critical ethical issues that medical students confront daily. The authors report on the kinds of dilemmas students face as clinical clerks, using cases that students submitted in 1991-92 during an innovative and well-received ethics class given at a tertiary care hospital as part of the internal medicine clerkship. Analysis of these cases reveals that many dilemmas are intimately tied to the student's unique role on the medical health care team. Recurring themes included the student's pursuit of experience, differing degrees of knowledge and ignorance among team members, and dealing with disagreement within the hierarchical authority structure of the medical team. The authors conclude that some components of ethical education must be participant-driven and developmentally stage-specific, focusing more attention on the kinds of ethical decisions made by medical students as opposed to those made by residents or practicing physicians.
许多现有的伦理学课程未能涉及医学生日常面临的微妙却关键的伦理问题。作者报告了学生作为临床实习医生所面临的各类困境，这些案例是学生在1991 - 1992年期间提交的，当时在一家三级护理医院作为内科实习的一部分，开设了一门创新且广受欢迎的伦理学课程。对这些案例的分析表明，许多困境与学生在医疗保健团队中的独特角色密切相关。反复出现的主题包括学生对经验的追求、团队成员之间不同程度的知识与无知，以及在医疗团队等级权威结构内处理分歧。作者得出结论，伦理教育的某些组成部分必须由参与者驱动且针对特定的发展阶段，更多地关注医学生所做出的伦理决策类型，而非住院医生或执业医生所做出的决策。
