Table 1 Ethical or Professional Issues Encountered During Clinical Training: Coded Themes/Sub-Themes from a National Survey of U.S. Fourth Year Medical Students (N = 144)
Major Coded Themes | Sub-Themesa | Count N (%) |
|---|---|---|
Professional Duties | Disrespectful treatment of patient or family | 15 (35.7) |
Extent or fulfillment of fiduciary responsibilities of healthcare provider | 7 (16.7) | |
Disrespectful remarks to or about colleagues | 4 (9.5) | |
Lack of respectful collaboration with colleagues | 4 (9.5) | |
Lack of self-control | 4 (9.5) | |
Deception, cheating, or misconduct in training | 4 (9.5) | |
Lack of professionalism (not otherwise defined) | 4 (9.5) | |
Subtotal | 42 (29.2) | |
Communication | Inadequate communication | 19 (50.0) |
Deliberate lies and deception in context of medical care | 7 (18.4) | |
Delivering bad news | 5 (13.2) | |
Breaking adult or adolescent patient confidentiality | 4 (10.5) | |
Disclosing medical errors | 3 (7.9) | |
Subtotal | 38 (26.4) | |
Quality of Care | Not meeting standard of care | 17 (63.0) |
Medical errors | 7 (25.9) | |
Treatment of pain | 3 (11.1) | |
Subtotal | 27 (18.8) | |
Student-specific Issues of moral distress | Willingness to ask critical questions or speak up when concerned | 7 (29.2) |
Uncertainties about role and scope of responsibility | 4 (16.7) | |
Role of religious beliefs in medicine | 4 (16.7) | |
Feedback on performance and etiquette | 4 (16.7) | |
Struggle over patients’ lifestyle choices | 3 (12.5) | |
Learning on patients over their objections or without consent | 1 (4.2) | |
Learning on patients without supervision or adequate skills or training | 1 (4.2) | |
Subtotal | 24 (16.7) | |
Decisions Regarding Treatment | Problems surrounding surrogate decision-making | 7 (30.4) |
Physician disagreement with patients/surrogates over interventions | 6 (26.1) | |
Problems surrounding informed consent | 4 (17.4) | |
Decisions related to continuing life-sustaining treatments | 3 (13.0) | |
Unclear decision-making capacity of patient | 2 (8.7) | |
Inter-professional disagreement about patient’s best interests | 1 (4.3) | |
Subtotal | 23 (16.0) | |
Justice | Discriminatory treatment | 7 (36.8) |
Inadequate level of health care | 7 (36.8) | |
Wasteful or excessive level of healthcare | 4 (21.1) | |
Allocation of resources | 1 (5.3) | |
Subtotal | 19 (13.2) | |
Total | 173a | |