Baldwin D C, Daugherty S R, Rowley B D
Institute for Ethics, American Medical Association, Chicago, Illinois 60610, USA.
Acad Med. 1998 Nov;73(11):1195-200. doi: 10.1097/00001888-199811000-00019.
To present residents' personal observations of unethical and unprofessional conduct in medicine during their first year of training.
Eight hundred and fifty-seven second-year residents who had previously participated in a study of perceived mistreatment as senior medical students were resurveyed by a three-tiered mail process concerning their experiences during their first postgraduate year, including their personal observations of four types of unethical and unprofessional conduct.
Surveys were returned by 571 residents, for a response rate of 67%. Personal observations of falsification of patient records by others on at least one occasion were reported by 44.5% of the responding residents, while 73.8% reported direct observations of mistreatment of patients. Nearly half of the residents (46.7%) reported that others had taken credit for their work, and 72.8% said they had observed colleagues working in an impaired condition at least once during their first year of training. Over one fourth of the residents (28.6%) stated that they had been required to do something during the year that they believed was immoral, unethical, or personally unacceptable. There was an inverse relationship between the residents' observations of unethical and unprofessional conduct and their overall satisfaction with their first year of training (p < .001).
The residents reported observing several types of unethical and unprofessional conduct among their colleagues and superiors. These findings confirm similar reports among medical students and residents and raise questions about the possible effect of such observations on the ethical principles and behavior of physicians-in-training.
呈现住院医师在培训第一年对医学中不道德和不专业行为的个人观察。
对857名曾作为高年级医学生参与过感知到的虐待情况研究的二年级住院医师，通过三层邮件流程重新调查他们研究生一年级期间的经历，包括他们对四种不道德和不专业行为的个人观察。
571名住院医师回复了调查问卷，回复率为67%。44.5%的回复住院医师报告称至少有一次观察到他人伪造患者记录，而73.8%报告直接观察到患者受到虐待。近一半的住院医师（46.7%）报告称他人将他们的工作成果据为己有，72.8%表示在培训第一年至少有一次观察到同事在身体不适的状态下工作。超过四分之一的住院医师（28.6%）表示在这一年里他们被要求做一些他们认为不道德、不符合伦理或个人无法接受的事情。住院医师对不道德和不专业行为的观察与他们对第一年培训的总体满意度之间存在负相关关系（p < .001）。
住院医师报告观察到同事和上级存在几种不道德和不专业行为。这些发现证实了医学生和住院医师中的类似报告，并引发了关于此类观察对实习医生的伦理原则和行为可能产生的影响的问题。
