Combating junior doctors’ “4am logic”: a challenge for medical ethics education

Abstract

Undergraduate medical ethics education currently focuses on ethical concepts and reasoning. This paper uses an intern's story of an ethically challenging situation to argue that this emphasis is problematic in terms of ensuring students' ethical practice as junior doctors. The story suggests that it is aligning their actions with the values that they reflectively embrace that can present difficulties for junior doctors working in the pressures of the hospital environment, rather than reasoning to an ethically appropriate action. I argue that junior doctors need skills for implementing their ethical decisions and that these ought to form a central component of undergraduate medical ethics education.

What is it to do good medical ethics? Minding the gap(s)

“…Yet, for many, that learning is limited in its impact 21. To do good medical ethics is surely to be empowered to act.…”

A practical approach to teaching medical ethics

“…Furthermore, does it provide us with the skills to implement ethical practices once the issues have been recognised, or do junior doctors sometimes falter under pressure, such as time constraints, demands from the patient or their family, or insistence from a senior colleague to act in an unethical manner? A recent paper suggests that, despite knowing on reflection what is ethically or morally correct, that putting this ethical behaviour into practice offers a far greater challenge and that more needs to be done at an undergraduate level to help combat this 6. Could a practical approach to teaching medical ethics in the critical care setting be applied to the teaching of all medical students to help overcome these apparent deficits in our training?…”

“…Alongside this, it is not until you see patients in real-life situations that you are truly able to explore and reflect on your own personal moral or spiritual beliefs and how they may differ from those of the patients and other medical professionals. McDougall6 suggests that writing first-person narratives about clinical experiences in medical ethics aids reflection and improves self-awareness in these difficult situations. My experience during the SSC week supports this.…”

“…This leads to a dilemma over whether to voice their concerns and communication between junior and senior doctors regarding ethical issues is often poor 6 8. Following their undergraduate training, junior doctors can usually identify what the correct moral outcome in a situation should be but do not always have the convictions to speak up and implement this, which can create a negative experience that the doctor may look back on with regret 6.…”

“…This leads to a dilemma over whether to voice their concerns and communication between junior and senior doctors regarding ethical issues is often poor 6 8. Following their undergraduate training, junior doctors can usually identify what the correct moral outcome in a situation should be but do not always have the convictions to speak up and implement this, which can create a negative experience that the doctor may look back on with regret 6. By writing reflections based on the ethical checklist medical students have a foundation for discussion with the consultant regarding the issues that have arisen, allowing them the opportunity to raise concerns they have about a patient’s care and to challenge the actions of the healthcare team in a non-confrontational and low-pressure environment.…”