ObjectivesThis study sought to understand whether UK Foundation doctors perceived the phenomena of ethical erosion and empathy decline during their initial period of clinical practice, and if so, why this occurred. MethodsThis qualitative study used semi-structured interviews with nine doctors in their first year of clinical practice at Royal Bolton Hospital, UK. Participants were invited to discuss the definition of empathy, how individuals acquire and maintain empathic ability, perceptions of ethical erosion in the self and others, and how clinical experiences have influenced their empathic ability. The interviews were transcribed, and analysed to identify emergent themes. ResultsEach participant reported a conscious acknowledgement of empathy decline in their own and their colleagues’ early clinical experiences as doctors. Stressful working environments, the prioritisation of patients’ physical rather than psychological well-being, and the attitudes of senior colleagues were all suggested as possible causes. Some doctors believed that specialties with reduced patient contact had a culture which precluded empathy, and influenced their own practice. In addition, some described how their value judgements of patients had affected their ability to empathise. However, all doctors perceived that empathy skills were desirable in senior clinicians, and some believed that educational interventions may be useful in arresting ethical erosion.   ConclusionsNewly qualified doctors are aware of ethical erosion in themselves and their colleagues as they begin clinical practice. This has serious implications for patient care. Improving working conditions may reverse this trend. Empathy skills training within undergraduate and postgraduate curricula may be a useful intervention.

Bullying, undermining behaviour and harassment are highly prevalent within surgery, and extremely damaging to victims. There is little high-quality research into counterstrategies, although professionalism training using simulated scenarios may be useful.

No abstract

Adult male circumcision (AMC) reduces HIV transmission but uptake is limited in part by current surgical methods. We randomized HIV-uninfected men (n=138) to receive Shang ring (SR) or forceps-guided (FG) AMC from a locally-trained surgeon. In as-treated analyses, more SR procedures were completed within 10 minutes (79% vs 0%, p<0.01) and more subjects reported high satisfaction (77% vs 58%, p=0.03). Healing time and pain scores were similar, though minor complication rates were higher in SR subjects (56% vs 24%, p<0.01). SR circumcision is a rapid and acceptable method of AMC and should be further evaluated to increase uptake of AMC.