Surgical Residents' Perspective on Informed Consent-How Does It Compare With Attending Surgeons?

BACKGROUND: The informed consent discussion (ICD) is a compulsory element of clinical practice. Surgical residents are often tasked with obtaining informed consent, but formal instruction is not included in standard curricula. This study aims to examine attitudes of surgeons and residents concerning ICD. MATERIALS AND METHODS: A survey regarding ICD was administered to residents and attending surgeons at an academic medical center with an Accreditation Council for Graduate Medical Education-accredited general surgery residency. RESULTS: In total, 44 of 64 (68.75%) residents and 37 of 50 (72%) attending surgeons participated. Most residents felt comfortable consenting for elective (93%) and emergent (82%) cases, but attending surgeons were less comfortable with resident-led ICD (51% elective, 73% emergent). Resident comfort increased with postgraduate year (PGY) (PGY1 = 39%, PGY5 = 85%). A majority of participants (80% attending surgeons, 73% residents) believed resident ICD skills should be formally evaluated, and most residents in PGY1 (61%) requested formal instruction. High percentages of residents (86%) and attendings (100%) believed that ICD skills were best learned from direct observation of attending surgeons. CONCLUSIONS: Resident comfort with ICD increases as residents advance through training. Residents acknowledge the importance of their participation in this process, and in particular, junior residents believe formal instruction is important. Attending surgeons are not universally comfortable with resident-led ICDs, particularly for elective surgeries. Efforts for improving ICD education including direct observation between attending surgeons and residents and formal evaluation may benefit the residency curriculum.

Moral medical decision-making: Colliding sacred values in response to COVID-19 pandemic.

In responding to the 2019 novel coronavirus (COVID-19), health-care workers have been exposed to a range of traumatic experiences, including the management of ventilators; provision of treatment; and issues with access to and the use of personal protective equipment. In this commentary, we use recent research on military decision-making to outline the damaging psychological effects of experiences that violate deeply held values. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The effects of nonconventional palliative and end-of-life care during COVID-19 pandemic on mental health-Junior doctors' perspective.

The COVID-19 pandemic has changed the way doctors approach palliative and end-of-life care, which has undoubtedly affected the mental health of patients, families, and health care professionals. Given these circumstances, doctors working on the front line are vulnerable to moral injury and compassion fatigue. This is a reflection of 2 junior doctors experiencing firsthand demands of caring for patients during the outbreak. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Exploring junior doctor morale in a UK hospital.

BACKGROUND: The importance of junior doctor morale is increasingly being recognised. We aimed to identify and explore the factors affecting junior doctor morale in a UK teaching hospital. METHODS: We carried out an online survey asking junior doctors to rate their morale, rank the top five factors that positively affected morale and offer free-text comments. RESULTS: Nine hundred and forty three junior doctors were approached, 402 (42.6%) responded. Overall morale was rated 6 [interquartile range (IQR): 5-8], and how valued 6 (IQR: 4-8), supported 7 (IQR: 6-9) and autonomous 7 (IQR: 6-8) they felt [median ratings using a scale of 0 (low)-10 (high)]. When comparing the four domains of feeling supported, feeling valued, having autonomy and overall morale, respondents felt most supported overall (n = 402, χ2 = 85.6, p < 0.0001). Key themes were identified: team working and relationships, feedback, training and education, resources, wellbeing and pastoral support, staffing and workload, senior clinician support, and autonomy. The most common factors positively affecting morale were 'feeling part of a team' (66.4%) and 'being recognised for good practice' (56.7%). CONCLUSION: We identified a number of diverse themes affecting junior doctor morale. Doctors felt more supported than valued or autonomous, with complex relationships between these domains.

Does It Matter if This Baby Is 22 or 23 Weeks?

A 530-g girl born at 22 weeks and 6 days' gestation (determined by an ultrasound at 11 weeks) was admitted to the NICU. Her mother had received prenatal steroids. At 12 hours of age, she was stable on low ventilator settings. Her blood pressure was fine. Her urine output was good. After counseling, her parents voiced understanding of the risks and wanted all available life-supporting measures. Many nurses were distressed that doctors were trying to save a "22-weeker." In the past, 4 infants born at 22 weeks' gestation had been admitted to that NICU, and all had died. The attending physician on call had to deal with many sick infants and the nurses' moral distress.

Beliefs and challenges held by medical staff about providing emergency care to migrants: an international systematic review and translation of findings to the UK context.

OBJECTIVE: Migration has increased globally. Emergency departments (EDs) may be the first and only contact some migrants have with healthcare. Emergency care providers' (ECPs) views concerning migrant patients were examined to identify potential health disparities and enable recommendations for ED policy and practice. DESIGN: Systematic review and meta-synthesis of published findings from qualitative studies. DATA SOURCES: Electronic databases (Ovid Medline, Embase (via Ovid), PsycINFO (via OVID), CINAHL, Web of Science and PubMed), specialist websites and journals were searched. ELIGIBILITY CRITERIA: Studies employing qualitative methods published in English. SETTINGS: EDs in high-income countries. PARTICIPANTS: ECPs included doctors, nurses and paramedics. TOPIC OF ENQUIRY: Staff views on migrant care in ED settings. DATA EXTRACTION AND SYNTHESIS: Data that fit the overarching themes of 'beliefs' and 'challenges' were extracted and coded into an evolving framework. Lines of argument were drawn from the main themes identified in order to infer implications for UK policy and practice. RESULTS: Eleven qualitative studies from Europe and the USA were included. Three analytical themes were found: challenges in cultural competence; weak system organisation that did not sufficiently support emergency care delivery; and ethical dilemmas over decisions on the rationing of healthcare and reporting of undocumented migrants. CONCLUSION: ECPs made cultural and organisational adjustments for migrant patients, however, willingness was dependent on the individual's clinical autonomy. ECPs did not allow legal status to obstruct delivery of emergency care to migrant patients. Reported decisions to inform the authorities were mixed; potentially leading to uncertainty of outcome for undocumented migrants and deterring those in need of healthcare from seeking treatment. If a charging policy for emergency care in the UK was introduced, it is possible that ECPs would resist this through fears of widening healthcare disparities. Further recommendations for service delivery involve training and organisational support.

Junior doctors and moral exploitation.

In this paper I argue that junior doctors are morally exploited. Moral exploitation occurs where an individual's vulnerability is used to compel them to take on additional moral burdens. These might include additional moral responsibility, making weighty moral decisions and shouldering the consequent emotions. Key to the concept of exploitation is vulnerability and here I build on Rosalind McDougall's work on the key roles of junior doctors to show how these leave them open to moral exploitation by restricting their reasonable options. I argue that there are a number of ways junior doctors are morally exploited. First, their seniors can leverage their position to force a junior to take on some discreet decision. More common is the second type of moral exploitation where rota gaps and staffing issues means junior doctors take on more than their fair share of the moral burdens of practice. Third, I discuss structural moral exploitation where the system offloads moral burdens onto healthcare professionals. Not every instance of exploitation is wrongful and so I conclude by exploring the ways that moral exploitation wrongs junior doctors.

How Should Clinicians and Trainees Respond to Each Other and to Patients Whose Views or Behaviors Are Offensive?

This commentary responds to a case in which a senior resident physician, an attending physician, and a medical student who is a person of color treat a patient expressing racial bias. By applying affect labeling (naming of emotions), this commentary illustrates how to balance patient preferences with a duty to treat and demands of justice in a way that can be healing for all stakeholders.

Should Trauma Physicians Treat a Severely Injured Patient for the Sake of Elucidating Preferences about Organ Donation?

Organ donation potential is not a motivator of care in the trauma bay, and it is ethically problematic to consider organ donor potential during the active resuscitation of a trauma patient. Despite organ donation being a public good, the role of the trauma physician is to maintain focus on the patient as an individual and to respect a patient's right to life and autonomy. This tenet of medicine is the foundation of the trust that a community and individuals must have in order for the health care system to function. Fortunately, there are guidelines and systems in place to allow physicians to care for the patient in front of them while simultaneously making morally sound decisions regarding donation in the setting of the current organ shortage.

Índice C en médicos de dos centros hospitalarios chilenos según el test de competencia moral de Lind / Assessment of moral competence of physicians

Background: Moral competence (MC) in physicians is fundamental, given the increasing complexity of medicine. The "Moral Competence Test" (MCT © Lind) evaluates this feature and its indicator is the C Index (CI). Aim: To explore moral competence and its associated factors among physicians working in Chile. Material and Methods: The MCT was answered by 236 physicians from two medical centers who voluntarily participated in the study. Besides the test, participants completed an encrypted form giving information about gender, years in practice and post-graduate studies. Results: The average CI value of the participants was 20,9. Post-graduate studies had a significant positive influence on CI. There was a significant decrease in CI, between 16 and 20 years of professional exercise. Gender and the area of post-graduate studies did not have a significant influence. Conclusions: The studied physicians showed a wide range of CI which was positively affected by the postgraduate studies performed. The years of professional practice had a negative influence. Expanding training opportunities during professional practice could have a positive effect on CM as measured by CI.