This article argues that because racial inequalities are embedded in American society, as well as in medicine, more evidence-based investigation of the effects and implications of affirmative action is needed. Residency training programs should also seek ways to recruit medical students from underrepresented groups and to create effective mentorship programs.

It is inevitable that physicians in training will be exposed to behavior by supervising physicians that the trainees find unethical. By nature these events are rare. It is imperative within any residency training program that resident physicians have immediate access to a meaningful review process in cases of moral conflict with supervising physicians. Here, I discuss the reasons why this issue must be recognized and what it entails. Most important, I discuss the procedural steps that are (...) essential for the training program to make this a meaningful safety mechanism in residency training. This issue is central to promoting conscious development of professionalism in clinical training. Physicians in training, especially resident physicians, need to be taught to value and protect their own professional integrity. The responsibility for fulfilling this ethical duty falls on the individual residency programs as well as the administrative organizations that regulate residency training. Thus, ensuring this process of review is an organizational ethical imperative. Availability of this process is fundamental to promoting and ensuring ethical behavior by all participants in residency training. (shrink)

BackgroundThe emphasis on ethics and professionalism in medical education continues to increase. Indeed, in the United States the ACGME will require residency programs to include professionalism training in all curricula by 2007. Most courses focus on cases generated by the course instructors rather than on cases generated by the trainees. To date, however, there has been no assessment of the utility of these two case discussion formats. In order to determine the utility of instructor-generated cases (IGCs) versus resident-generated (...) cases (RGCs) in ethics and professionalism training, the author developed an innovative course that included both case formats. The IGCs were landmark cases and cases from the experience of the course instructors, while the RGCs were selected by the residents themselves. Residents were then surveyed to assess the strengths and weaknesses of each format.ResultsOf twenty-two second and third year residents, fourteen completed surveys (response rate 64%). Residents were nearly evenly split in preferring RGCs (38%), IGCs (31%), or not preferring one to the other (31%). 29% stated that they learn more from the RGCs, 21% stated that they learn more from the IGCs, and 50% stated that they did not find a difference in their learning based on format. In general, residents surveyed prefer a mix of formats. Residents tended to find the RGCs more relevant and interesting, and felt the IGCs were necessary to ensure adequate breadth of cases and concepts.ConclusionBased on our relatively small sample at a single institution, we believe that educators should consider incorporating both instructor-generated and resident-generated cases in their ethics and professionalism curricula, and should evaluate the utility of such a model at their own institution. Further work is needed to illuminate other potential improvements in ethics and professionalism education. (shrink)

Through qualitative surveys, a team of law students, law professors, physicians, and residents explored the perceptions of neurology residents towards referral to appropriate legal resources in an academic training program. Respondents reported feeling uncomfortable screening their patients for health-harming legal needs, which many attributed to a lack of training in this area. These findings indicate that neurology residents would benefit from training on screening for social factors that may be impacting their patients’ health.

The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within (...) all postgraduate specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation. (shrink)

Ethically complex and challenging cases confront health care professionals in neonatal‐perinatal medicine more often than in most other subspecialties in medicine. Neonatologists regularly encounter situations where crucial life‐or‐death decisions need to be made in the best interest of an infant and its family. While physicians and their professional societies seem to dictate this best interest standard by weighing the risk of mortality and morbidities, parents may have other perspectives to be considered.Our review of programs for teaching ethics in Canadian neonatal‐perinatal (...) residency programs has revealed that 90 percent of them incorporated formal and informal medical ethics education, meeting the Royal College of Physician and Surgeons of Canada requirements, but that the teaching strategies, topics covered, and time devoted to teaching ethics are not standardized. Lectures and case presentations—the pedagogic strategy used by most programs—are not ideal for teaching communication skills. We propose, therefore, a holistic approach to teaching and training that imparts (1) a traditional understanding of ethical theory and reasoning, (2) advanced skills in communication and counseling, and (3) a disposition to engage in self‐reflection and to be aware of the emotional and spiritual dimensions of neonatal‐perinatal medicine. (shrink)

In the wake of their heightened role in addressing the emotional challenges of United States soldiers during World War II, American psychiatrists increasingly argued that their knowledge of human nature, based on interpretation of unconscious processes, was a powerful tool in effecting changes in society. As they turned to training an adequate supply of psychiatrists to meet expanding demand, educators in psychiatry residency programs faced questions about whom to entrust with the power of psychiatric interpretation, how educators’ knowledge (...) about trainees’ own unconscious processes should be harnessed, and how much to adhere to strict psychoanalytic doctrine in training. During the 1970s, social and cultural upheavals outside and inside psychiatry began to dismantle the grand claims of the postwar generation of psychiatrists, while shifts in the 1980s led educators to focus more on seemingly objective educational measures. Trainees’ and critics’ serious questioning of authority and structures in American society, and within psychiatry training programs, was perhaps as much of a factor – if not more – in the shift away from an emphasis on the interpretive power of psychoanalysis in favor of more eclectic and ultimately biological approaches in academic psychiatry. (shrink)

A volume in Ethics in Practice Series Editors Robert A. Giacalone, Temple University and Carole L. Jurkiewicz, Louisiana State University Making sure that performance in business enterprise is achieved ethically is no small task. Leaders, managers, and employees at every level of the organization need to utilize systems and processes that support ethical strength, establishing a workplace where responsibility, accountability, and doing the right thing are genuinely valued and practiced. Management can help support ethical performance in workers' daily task actions (...) by underscoring the importance of rules and regulations, while also moving to ensure that employees understand and care about doing what's right. Given that most firms only emphasize compliance in ethics training, there is vast room for additional development. Training people to be less bad is not good enough. With the infusion of mandatory requirements for ethics training programs in some firms and self-imposed initiatives in others, we see a range of deliverables. To advance ethics in practice, a closer look at ethics training in the workplace is warranted. This volume attempts to better understand ethics in organizational settings by taking a focused look at the science of ethics training and best practices, areas for concern, specific techniques, application outcomes, how to cultivate an ethical work environment, and considering where opportunities for additional inquiry reside. Managers and practitioners reading this book will garner specific trends and useful techniques that can inform, guide, and improve their efforts to build ethical awareness and effective ethical decisionmaking within their organizations. Academic scholars will find this book useful, providing insight as to where additional research and empirical work is needed. (shrink)

Medical residency—specialty training after the completion of medical school—is an essential component of medical education and is required in order to be a licensed, independent medical practitioner in most jurisdictions. As things currently stand in the United States, the match between medical school graduates and residency programs is governed by a match between rank-order lists prepared by candidates and residencies alike. An applicant picks a number of residency programs and ranks them according to order of interest. (...) The residency program prepares a similar list, ranking the candidates it most wants in its program. A computer program compares the rankings and makes assignments according to a certain algorithm. Using these lists, the match system assigns approximately 24,000 applicants to approximately 21,000 training positions in pediatrics, obstetrics and gynecology, internal medicine, and the rest. These assignments are then announced to all parties on specific days. The system has been in place since 1952 and is overseen by the National Residency Match Program, a nonprofit organization. This system has several advantages. First of all, it standardizes the timetable for decisions, and applicants are in no position to tie up offers while waiting to hear from other institutions. Institutions are not held captive, either, in making assignments while waiting to hear from particular parties. (shrink)

Recent studies show that psychiatry residents express a relatively greater need for ethics curricula than their colleagues in other specialties. Such studies have been limited in their generalizability because they were conducted at one site. This study of 151 psychiatry residents at seven U.S. psychiatry programs aims to address that limitation. Residents were surveyed on issues pertaining to ethics and professionalism education. Participants were found to support such curricula during training and to value its relevance to the practice of (...) psychiatry. Gender differences and the influence of the “hidden curriculum” on such results merit further study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Training and Other Important Needs for Nursing AssistantsNanci RobinsonTraining of Nursing AssistantsI think the nursing assistant (NA) training programs should be longer. My original course for Long Term Care was four weeks long after that I took an additional two months at a hospital to work on a Med/ Surg floor. So, I have a combined three months of schooling.Personally, I'd like to see certified nursing assistants (...) (CNAs) given more responsibilities. I'd like to see a six-month program to include CPR and capillary blood glucose (CBG) training as well as more in depth anatomy training. I think six months would keep some, who are just looking for money, out of the field and help keep those of us who really want a career in nursing in the field. It would be a better stepping stone for those who plan to go on to a LPN or RN program.I currently have CBG training but my employer will not let me use it. It's disappointing because it's a skill I have that I can't use and it could really help out the nurses. I think if courses were a bit longer, CNAs might be taken a bit more seriously by their employers and respected by their colleagues in the medical field.I was trained in CBG while working for the hospital and received a card like a CPR card to show I was trained. I live and work and was trained in Arkansas. I'm not allowed to do CBGs in the long-term care and rehab facility where I work now, though. However, unless the resident is diabetic we do have to clip and file nails. It took many years for nurses to gain respect and be allowed to do some things that now CNAs do. For example, for many years doctors didn't feel nurses were qualified to even take vital signs. I suppose CNAs will have the same struggle. [End Page 147]"I'm wondering if extending the initial training time would not keep many out of the field, because they need a job with income ASAP." The same could be said for LPN training, could it not? Or even an RN. I don't understand why there is a train of thought that "anyone" should be allowed to be a CNA and as quickly as possible. I can tell when I'm working alongside a Certified Nursing Assistant who is in it because they want to be versus someone who wants the paycheck (not sure why, though, because to be honest Arkansas doesn't pay CNAs all that great, though I suppose for some it might be better than McDonalds). I took a $5 an hour paycut go get back into nursing because it's my passion, and while we all need a paycheck, that should not be the only reason for doing this work."If extending the initial training time would keep many out of the field because they need a job with income ASAP, maybe employer facility-specific follow-up training would seem to be much more feasible for all. A CNA-in-training could be responsible for a lighter than 'normal' shift assignment while under the guidance of a qualified proctor CNA. It could improve efficiency and quality of care in the long run and probably improve retention rate of CNAs, for those administrators that are astute enough to consider the long-term effects of their policies." This might be good—the only problem is that most facilities aren't going to want to absorb any cost this might create by having additional staff for this purpose. Also, on the job training is not appreciated by employers as much as what might be considered actual "education" hours. Most CNAs want to do as much patient care as they can for the nurse—learning to assist with dressing changes, CBGs and other things that would be beneficial for both CNAs and the Nurse.Ensuring there is enough staff and that those staff members are there for the right reasons would do much more to improve the retention rate of NAs or CNAs. (I'm a... (shrink)

Few residency training programmes explicitly require substantive exposure to issues in medical ethics and fewer still have a formal curriculum in this area. Traditional undergraduate medical ethics courses teach preclinical students to identify ethical issues and analyse them at a theoretical level. Residency training, however, is the ideal time to establish the critical behavioural link which makes ethics truly useful in clinical medicine. The General Internal Medicine Residency Training Program at Rhode Island Hospital (...) has developed an integrated, three-year curriculum with the goals of helping residents to perceive ethical issues in clinical practice, to utilise basic philosophical principles in resolving ethical dilemmas and to communicate these issues clearly and sensitively to patients. The curriculum has been well received by residents and has had a hospital-wide impact. We believe that training residents in medical ethics and communication skills is an effective approach to developing physicians' humane qualities. (shrink)

The importance of bioethics education as a valuable tool to be responsive to medicine’s complexities is affirmed by graduate medical education accreditation bodies and professional organizations alike. The Accreditation Council for Graduate Medical Education, the body that accredits the majority of medical residency and fellowship programs in the United States, affirms the importance of ethics training for physicians in training. How this is accomplished is largely left to the prerogative of individual programs to manage, as benchmarks or (...) milestones to ascertain this are not firmly in place. However, there is doubt that significant education in bioethics is being accomplished by individual residency programs. This review searched the PubMed database for relevant articles on the scope and objectives of ethics education in US and Canadian family medicine residency programs. (shrink)

The importance of bioethics education as a valuable tool to be responsive to medicine’s complexities is affirmed by graduate medical education accreditation bodies and professional organizations alike. The Accreditation Council for Graduate Medical Education, the body that accredits the majority of medical residency and fellowship programs in the United States, affirms the importance of ethics training for physicians in training. How this is accomplished is largely left to the prerogative of individual programs to manage, as benchmarks or (...) milestones to ascertain this are not firmly in place. However, there is doubt that significant education in bioethics is being accomplished by individual residency programs. This review searched the PubMed database for relevant articles on the scope and objectives of ethics education in US and Canadian family medicine residency programs. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled (...) multi-center study was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

The “class play” is an annual tradition in residency training programs and medical schools that celebrates the end of the academic year. It is also a locally generated narrative that reveals important components of an institution’s values, culture, and group dynamics. Exploring the class play is a reflexive exercise that allows one to reflect on his or her professional development and place in the department in a structural, historical, and experience-near driven way. In this way, the creation of (...) and examining of the class play may be seen as an opportunity to understand and expand upon medicine’s Hidden Curriculum. (shrink)

As one of the main competencies, professionalism is to be taught and evaluated during the residency period. The aim of this research is to investigate the professionalism perception among medical residents of Tabriz University of Medical Sciences. This cross-sectional study was conducted in 2017 using Persian Professionalism Questionnaire American Board of Internal Medicine. Probability proportional to size sampling was used to recruit the participants. Data analysis was done using SPSS24 through descriptive and analytical statistics. The mean age of residents (...) was 33.28. About 46% of residents were not familiar with professionalism. Mean of perceived professionalism score by the residents was to be 6.85 ± 1.52. Honor/Integrity dimension with a score of 7.53 ± 2.1 had the highest mean, while professional excellence with a score of 6.2 ± 1.43 had the lowest mean. No statistically significant relationship was observed between residents’ demographic characteristics and perceived professionalism. Medical residents’ professionalism perception was not at an acceptable level. It is necessary to spread the concept of professionalism in the form of formal and informal training programs to promote residents’ professional behaviors. Moreover, it was experienced that peer to peer observation could be used to assess professionalism in the working environment. (shrink)

This arts- based project creatively introduces residents to photography, self-portraiture and narratives to document the longitudinal journey of becoming a family physician. Visual arts and writing can foster reflection: an important skill to cultivate in developing physicians. Unfortunately, arts based programs are lacking in many residency programs. Tools and venues that nourish physician well being and resilience may be important in today’s changing healthcare environment and epidemic of physician burnout. Residents created self-portraits with accompanying narratives throughout their three-year (...) class='Hi'>training. Analysis of the portraits and accompanying narratives completed the assessment. Residents created a body of work that includes 182 creative and deeply personal portraits and narratives. The five most frequent themes of portraits included “Residency is Difficult,” “Hobbies,” “Family,” “Growing as a Doctor,” and “Coping Mechanisms.” Self-portrait photography and reflection gives insight into the journey of becoming a family medicine physician at a deeply personal and professional level. Further partnerships between residency programs and the arts should be explored to promote reflection. (shrink)

Training in ethics and professionalism is a fundamental component of residency education, yet there is little empirical information to guide curricula. The objective of this study is to describe empirically derived ethics objectives for ethics and professionalism training for multiple specialties. Study design is a thematic analysis of documents, semi-structured interviews, and focus groups conducted in a setting of an academic medical center, Veterans Administration, and community hospital training more than 1000 residents. Participants were 84 informants (...) in 13 specialties including residents, program directors, faculty, practicing physicians, and ethics committees. Thematic analysis identified commonalities across informants and specialties. Resident and nonresident informants identified consent, interprofessional relationships, family interactions, communication skills, and end-of-life care as essential components of training. Nonresidents also emphasized formal ethics instruction, resource allocation, and self-monitoring, whereas residents emphasized the learning environment and resident-attending interactions. Conclusions are that empirically derived learning needs for ethics and professionalism included many topics, such as informed consent and resource allocation, relevant for most specialties, providing opportunities for shared curricula and resources. (shrink)

Background Medical Assistance in Dying in Canada came into effect in 2016 with the passing of Bill C-14. As patient interest and requests for MAID continue to evolve in Canada, it is important to understand the attitudes of future providers and the factors that may influence their participation. Attitudes towards physician hastened death in general and the specific provision of MAID are unknown among Canadian residents. This study examined residents’ attitudes towards PHD and MAID, and identified factors that may influence (...) their decision to participate in PHD and provide MAID. Methods A cross-sectional survey was adapted from prior established surveys on MAID to reflect the Canadian setting. All Canadian family medicine programs were invited to participate. The survey was distributed between December 2016 and April 2017. Analysis of the results included descriptive statistics to characterize the survey participants and multivariable logistic regressions to identify factors that may influence residents’ attitudes towards PHD and MAID. Results Overall, 247 residents from 6 family medicine training programs in Canada participated. While residents were most willing to participate in treatment withdrawal, active participation in PHD and MAID by prescription of a lethal drug and lethal injection were less acceptable. Logistic regressions identified religion as a consistent and significant factor impacting residents’ willingness to participate in PHD and MAID. Residents who were not strictly practicing a religion were more likely to be willing to participate in PHD and MAID. Increased clinical exposure to death and dying crudely correlated with increased willingness to participate in PHD and MAID, but when examined in multivariable models, only a few activities had a statistically significant association. Other significant factors included the residents’ sex and location of training. Conclusions Residents are hesitant to provide MAID themselves, with religious faith being a major factor impacting their decision. (shrink)

The American Urological Association (AUA) and American College of Surgeons (ACS) codes of professionalism require surgeons to disclose the specific roles and responsibilities of trainees to patients during the informed consent process. The objective of this study is to analyze how these requirements are met by urology training programs. An anonymous electronic survey was distributed to the program directors (PDs) of the 143 Accreditation Council for Graduate Medical Education urology residency programs in the United States in 2021. (...) Information was collected regarding program demographics, aspects of the program’s consent process, and the disclosure to patients of the role and participation of residents in their surgery. There were 49 responses to the survey (34.3% response rate). Nearly 70 percent of PDs reported that attending physicians lead the consent process. The topics covered during consent discussion include possible complications (25%), expected recovery time (23%), length of the surgery (22%), the people involved (18%), and their specific roles (7%). Many PDs do not explicitly discuss trainee involvement (48.8%) or when a resident is to perform the majority of the case (87.8%). The majority of PDs (78.8%) communicate medical student involvement, but 73.2 percent reported having a patient decline participation of a trainee after describing their role. Despite the AUA and ACS codes of professionalism, many urologists do not disclose resident involvement in surgery to patients. Further discussions are needed to explore how to better balance resident education and patient autonomy. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% (...) of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine residency clinics (...) in the United States are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives. (shrink)

BackgroundBurnout is being experienced by medical students, residents, and practicing physicians at significant rates. Higher levels of Hardiness and Emotional Intelligence may protect individuals against burnout symptoms. Previous studies have shown both Hardiness and Emotional IntelIigence protect against detrimental effects of stress and can be adapted through training; however, there is limited research on how training programs affect both simultaneously. Therefore, the objective of this study was to define the association of Hardiness and Emotional Intelligence and their potential (...) improvement through hyper realistic immersion simulation training in military medical students.MethodsParticipants in this study consisted of 68 second year medical students representing five medical schools who were concurrently enrolled in the United States military scholarship program. During a six day hyper-realistic surgical simulation training course, students rotated through different roles of a medical team and responded to several mass-casualty scenarios. Hardiness and Emotional Intelligence were assessed using the Hardiness Resilience Gauge (HRG) and the Emotional Quotient Inventory (EQ-I 2.0) respectively, at two time points: on arrival (pre-event) and after completion of the course (post-event).ResultsHardiness and Emotional Intelligence scores and sub scores consistently improved from pre-event to post-event assessments. No difference in training benefit was observed between genders but differences were observed by age where age was more often associated with Emotional Intelligence. In addition, factor analysis indicated that the HRG and EQ-I 2.0 assessment tools measured predominately different traits although they share some commonalities in some components.ConclusionThis study indicates that Hardiness and Emotional Intelligence scores can be improved through immersion training in military medical students. Results from this study support the use of training course interventions and prompt the need for long term evaluation of improvement strategies on mitigating burnout symptoms. (shrink)

The current study tries to verify the effectiveness of a training program in increasing Crowdfunding awareness. The sample was (50) students in CIS, who were purposively selected and distributed equally into a treatment and control group. The researchers designed the study tools (a training program to increase Crowdfunding awareness). The study findings revealed the existence of statistically significant differences between the treatment and control groups in favor of the former. Furthermore, there were statistically significant differences between (...) the pre and the post measures of the treatment group in favor of the post measures. Furthermore the current study is unique by the virtue of its nature, scope and way of implied investigation, as it is the first study for Crowdfunding training program in Arabic world. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Threat to Selfhood: Moral Distress and the Psychiatric Training CultureEsther NathansonWhile many medical specialties offer to heal, or even cure, psychiatry—uniquely—places the doctor–patient relationship at the center of the therapeutic effort. Psychiatrists must possess a complex and challenging combination of broad medical knowledge, finely honed interpersonal and analytic skills and confidence in their abilities, despite limited understanding of the workings of the brain. Inpatient psychiatry in particular (...) demands a degree of strength to withstand emotional, and sometimes physical, assault from patients who may be suicidal, desperate, paranoid, aggressive or delusional. Beyond these abilities, a good psychiatrist must have robust but ‘therapeutically porous’ emotional boundaries that allow genuine empathy for the patient but, at the same time, limit internalization of the patient’s anguish as the practitioner’s own: the exquisite balance of ‘self–versus–other’ in the therapeutic encounter.Unfortunately, during my psychiatry residency in the UK, development of these intangible but essential boundaries was entirely absent from the curriculum. Early in training I struggled with my tendency to become an emotional chameleon with feelings and energies buffeted around by the prevailing emotions of each patient that walked through the door. I felt that patients expected me to offer tidy explanations for their suffering and provide answers to profound questions of meaning; to make the world a safe and understandable place. Given the complexity of mental illness and its interplay with social circumstances this was naïve and, I now realize, often unnecessary, but the weight of responsibility was unbearable. I was also completely unprepared for the intensity of human suffering I saw, and wholly unready to provide the level of interpersonal engagement required for genuine healing. My own emotional integrity felt threatened by the depth of patients’ needs, and my response—both physical and emotional—was intense and frightening.Much of my distress resulted from the profound and inevitable tension between the empathy necessary to comprehend patients’ experiences, which were often extreme and bewildering, and the need for resilience and self–protection at a time when my grasp of psychological theories and treatment practices was still rudimentary. I felt guilty that patients bore the brunt of my inexperience, and duplicitous purporting to help while burdening them with intolerable drug side–effects and stigmatizing, albeit effective, treatments such as electroconvulsive therapy (ECT). Time constraints and guidance from senior faculty encouraged expediency over treatment efficacy or durability; psychopharmacology was prioritized over the psychotherapeutic techniques and psychosocial interventions I found more effective for many patients. During the phase of our training that took place in a rambling, now defunct, asylum in the U.K, visits to the locked ward, which was reserved for patients considered a danger to others, were usually prompted by nurses’ requests for chemical restraint, the ‘pharmaceutical strait–jacket’. I was deeply uncomfortable with the role of ‘restrainer’ but had insufficient experience or seniority to propose other methods. It was only when, years later, I investigated re–training in the U.S that the senior psychiatry resident at a well–known program told me gently, ‘Oh, we assume that students will have a breakdown in their first year, so we have systems in place to help’. I’ll never forget those words; they are, to this day, the only validation of the emotional toll of my early training years.Adding to my discomfort were various ethically dubious administrative practices, the most troubling being the clinic’s unwillingness to disclose to patients that we were trainees, with little clinical experience. Senior faculty were dismissive when I asked whether my first psychotherapy patient had been told I was a trainee, indeed that I had never conducted psychotherapy before. My question was greeted with amusement and an assurance that, although she had not been told, I (not the patient, interestingly) would do fine.Due to the large number of no–shows in psychiatric outpatient clinics it was also standard practice to triple–book appointment times on the [End Page 115] assumption that one or more patients would fail to attend. Not uncommonly, more than one patient would arrive for the same appointment, leaving others to suffer agonizing waits that were often intensified by the deep discomfort... (shrink)

Ethics rounds in clinical ethics have already taken hold in multiple venues. There are “sit-down rounds,” which usually consist of a bioethicist setting a specific, prescheduled time aside for residents and/or others to bring a case or two for discussion with the bioethicist. Another kind of rounds that occurs on an ad hoc or infrequent basis is to have either a staff or outside bioethicist give hospital-wide and/or departmental “grand rounds.” Grand rounds is a traditional educational format in medicine and (...) adding bioethics to the topics covered in grand rounds is an important means of elevating ethical awareness within a department or throughout a healthcare organization. Newer is the rounding practice of adding a bioethicist to other established rounding processes, such as case management and utilization review rounds. All of these kinds of ethics rounds are important opportunities to elevate the level of moral discourse within a healthcare setting and are becoming part and parcel of any full-service hospital bioethics program. (shrink)

The authors analyze results of a survey of members of the Columbia University Graduate School of Business classes of 1953–1987 in order to assess the potential effectiveness of firms' ethics training programs. Results suggest that such training has a positive effect, but that relatively few firms provide such programs (about one-third of the respondents worked for firms with such programs). Although the sample is not representative of American employees and managers generally, the results suggest that it may be (...) worthwhile for firms to provide formal ethics training to their employees. (shrink)

Given the growing public concern and attention placed on cases of research misconduct, government agencies and research institutions have increased their efforts to develop and improve ethics education programs for scientists. The present study sought to assess the impact of these increased efforts by sampling empirical studies published since the year 2000. Studies published prior to 2000 examined in other meta-analytic work were also included to provide a baseline for assessing gains in ethics training effectiveness over time. In total, (...) this quantitative review consisted of 66 empirical studies, 106 ethics courses, 150 effect sizes, and 10,069 training participants. Overall, the findings indicated that ethics instruction resulted in sizable benefits to participants and has improved considerably within the last decade. A number of specific findings also emerged regarding moderators of instructional effectiveness. Recommendations are discussed for improving the development, delivery, and evaluation of ethics instruction in the sciences. (shrink)

In this article we present a training program based on the empirical research conducted in the project 'argumentational integrity'. After a brief sketch of the problem dimensions concerning unfair argumentation we give an overview of the training concept and the underlying empirical research. Exemplification of the instructional design is given for the second and the fifth training dimension (standards of argumentational integrity and reactions to unfair contributions). Finally we indicate how the training is to be (...) evaluated and present initial results demonstrating that in comparison with an untrained control group participants in the training significantly improve their skills in identifying and naming argumentative rule violations. (shrink)

Anesthesiology training programs are tasked with equipping trainees with the skills to become medically and ethically competent in the practice of anesthesia and to be prepared to obtain board certification, yet there is currently no standardized ethics curriculum within anesthesia training programs in the United States. To bridge this gap, and to provide a validated ethics curriculum to meet the aforementioned needs, in July 2021, a survey was sent to anesthesia scholars in the field of biomedical ethics to (...) identify key areas that should be included in such an ethics curriculum. The responses were rated on a Likert scale and ranked. This paper identifies the top ten topics identified as high priority for inclusion in an anesthesiology training program and consequently deemed most relevant to meet the educational needs of graduates of an anesthesiology residency: (1) capacity to consent; (2) capacity to refuse elective versus lifesaving treatment; (3) application of surrogate decisionmaking; (4) approach to do not resuscitate (DNR) status in the operating room; (5) patient autonomy and advance directives; (6) navigating patient beliefs that may impair care; (7) “futility” in end-of-life care: when to withdraw life support; (8) disclosure of medical errors; (9) clinical criteria for “brain death” and consequences of this definition; and (10) the impaired anesthesiologist. (shrink)

BackgroundThe use of dedicated training programs for improving decision-making (DM) in team sports players has grown in the last several years. Approaches such as imagery training, video-based training, or game-based drills are some of the interventions used in youth players in order to improve DM. However, no systematic reviews or meta-analyses have been conducted to summarize the main evidence regarding the effects of these programs on the players and identify the magnitude of the effects compared to control (...) groups.ObjectiveThis systematic review (with meta-analysis) was conducted to assess the effects of training programs on the DM of youth team sports players.Data SourcesThe data sources utilized were PubMed, PsycINFO, Scopus, SPORTDiscus, and Web of Science.Study eligibility criteriaThe criteria included the following: (i) youth (≤ 18 years old) team sports players with no restriction on sex or competitive level; (ii) players subjected to training programs to develop DM; (iii) control groups; (iv) pre–post outcomes related to tactical behavior, technical execution, reaction, and decision time; and (v) controlled trials.ResultsThe database search initially identified 2497 titles. From these, six articles were eligible for the systematic review and meta-analysis. The results showed a significant beneficial effect of DM interventions on tactical behavior (ES = 1.12;p= 0.035;I2= 80.0%; Egger’s testp= 0.066), whereas no significant effect of DM interventions on technical execution was found (ES = 0.74;p= 0.180;I2= 69.1%; Egger’s testp= 0.873).ConclusionThe DM interventions were significantly effective in improving tactical behavior in youth team sports players independently from the number of sessions to which players were exposed. In addition, DM interventions were significantly effective in improving technical execution. However, the results should be carefully interpreted due to the heterogeneity of the articles’ overall methodological quality. Future DM interventions should consider using combined approaches that allow players to develop both tactical behavior and technical execution. (shrink)

Study in the period of coronavirus disease 2019 lockdown and the effect of different exercise training programs on the quality of life dimension are limited. This randomized control study as a part of which the impact of an 8-week neuromuscular training program on the 90 healthy young individuals’ QoL after COVID-19 lockdown was assessed using a short form of the WHOQOL-BREF questionnaire comprising of four domains. The intervention group took part in a neuromuscular training program (...) consisting of dynamic neuromuscular stabilization and whole-body vibration training. In contrast, the control group did not participate in any programmed physical activity. From pre- to post-intervention test, the NT group significantly and substantially improved [mean change ] all the QoL domains, physical for 12.78 scores, psychological for 13.12 scores, social relationships for 20.57 scores, and environmental for 24.40 scores. These results suggest that the NT program could enhance QoL in young and healthy participants following COVID-19 lockdown. (shrink)

This intervention study examined the effects of a career crafting training on physicians' perceptions of their job crafting behaviors, career self-management, and employability. A total of 154 physicians working in two hospitals in a large Dutch city were randomly assigned to a waitlist control group or an intervention group. Physicians in the intervention group received an accredited training on career crafting, including a mix of theory, self-reflection, and exercises. Participants developed four career crafting goals during the training, (...) to work on in the subsequent weeks, after which a coaching conversation took place over the phone. Physicians in the control group received no intervention. A pre- and post-test 8 weeks later measured changes in job crafting and career self-management and employability of 103 physicians that completed the pre- and post-test. RM ANOVAs showed that the intervention enhanced perceptions of career self-management and job crafting behavior to decrease hindering job demands. No support was found for the effect of the intervention on other types of job crafting and employability. This study offers novel insights into how career crafting can be enhanced through training, as this is the first empirical study to examine a career crafting intervention. HR managers can use the outcomes to develop tailored career policies and career development practices. (shrink)

The article aims to review the program of professional training of teachers for the prevention of adrenaline addiction in adolescents and its effectiveness. The task of the work is to determine the strategy that will ensure the effectiveness of professional training of teachers for the prevention of adrenaline addiction in adolescents in the course of experimental work. In the process of studying the problem, the work of researchers in the selected scientific field is considered. As a result (...) of the work done, the strategy and plan of the teacher's professional training program were determined for the organization of effective professional training for preventive activities aimed at the adrenaline addiction of adolescents. (shrink)

The curriculum design, faculty characteristics, and experience of implementing masters' level international research ethics training programs supported by the Fogarty International Center was investigated. Multiple pedagogical approaches were employed to adapt to the learning needs of the trainees. While no generally agreed set of core competencies exists for advanced research ethics training, more than 75% of the curricula examined included international issues in research ethics, responsible conduct of research, human rights, philosophical foundations of research ethics, and research regulation (...) and ethical review process. Common skills taught included critical thinking, research methodology and statistics, writing, and presentation proficiency. Curricula also addressed the cultural, social, and religious context of the trainees related to research ethics. Programs surveyed noted trainee interest in Western concepts of research ethics and the value of the transnational exchange of ideas. Similar faculty expertise profiles existed in all programs. Approximately 40% of faculty were female. Collaboration between faculty from low- and middleincome countries (LMICs) and high-income countries (HICs) occurred in most programs and at least 50% of HIC faculty had previous LMIC experience. This paper is part of a collection of papers analyzing the Fogarty International Research Ethics Education and Curriculum Development program. (shrink)

The field of spirituality and medicine has seen explosive growth in recent years, due in part to significant private support for the development of curricula in more than half of all U.S. medical schools, and for related residency training programs and research centers. While there is no single definition of " spirituality " in use across these initiatives, this article examines the definitions and learning objectives relevant to spirituality that are addressed in a 1999 report of the Medical (...) School Objectives Project, with special attention to their ethical implications. It concludes with several "diagnostic" case studies of religious consciousness from the medical literature and in literary texts, again with attention to ethical concerns. (shrink)