Book: Ward Ethics: Dilemmas for Medical Students and Doctors in TrainingBMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7313.638a (Published 15 September 2001) Cite this as: BMJ 2001;323:638
Eds Thomasine K Kushner, David C Thomasma
Cambridge University Press, £18.95, pp 265
ISBN 0 521 66452 7
In 1993 the General Medical Council published Tomorrow's Doctors—its radical proposals to shake up medical education in the United Kingdom—which recommended that the teaching of medical ethics and law should become a core part of the undergraduate curriculum. The report advised that students should acquire knowledge and understanding of the ethical and legal issues relevant to medicine so that they could consider such problems appropriately when reaching decisions.
Research published in the BMJ earlier this year showed that 47% of final year students had felt pressurised to act unethically in a clinical situation during their training (BMJ 2001;322:709-10). It is clear that there is a need to tackle such issues and provide students with a means of addressing concerns. However, I know from personal experience that ethics teaching in this country focuses on more traditional dilemmas. End of life issues, consent to treatment, and the Mental Health Act are all valid concerns but of little use to the student who is asked to perform a rectal examination on an unconscious patient or instructed to undertake a new procedure unsupervised. It appears that nothing much is being done to address the things that are of a far more immediate concern to clinical medical students.
Ward Ethics seeks to fill this yawning gap. The editors aim “to break the silence that surrounds the daily dilemmas faced by trainees as they try to balance learning medicine, performing procedures and interacting with patients and colleagues.” The book uses more than 80 real life cases—followed by comments from international experts from varying fields—aiming to empower readers to reach their own conclusions. Although these cases are isolated incidents, the book addresses a huge range of topics that will be familiar to many readers, from performing procedures and the place of humour on the ward round to whistleblowing on colleagues—the list is exhaustive.
However, in many cases simple, textbook solutions aren't necessarily the answer—with the introduction of continuous assessment at the end of every attachment how many students are going to feel able to stand up to their seniors, to report unethical behaviour, or to refuse to carry out a procedure? While Ward Ethics is a step in the right direction, there is still a long way to go.
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