The Clinical Years Remain An Ethical Quagmire

This is depressing commentary on more than 500 written reports regarding ethically challenging situations brought up by third-year students during a class on ethics, truth-telling and communication.  Major themes included lying, poor team dynamics, medical errors, powerlessness, confidentiality, poor communication, shaming, missed teaching opportunities, uncertainty of student responsibility, and other professionalism lapses.  The authors explored the reasons students did not want to report these lapses:  fear of reprisal, fear of a lower grade, apathy, desire to avoid confrontation, disillusionment with medical practice in general, perception that reporting would not lead to changes, and perception that reporting would be perceived as “whining”.  The authors suggest some (non-evidence-based) actions to change the culture at academic medical centers. — Laura Willett, MD

Myers MF, Herb A. Ethical Dilemmas in Clerkship Rotations. Acad Med. 88(11), November 2013.

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