Abstract
Background
For medical students, the emergency department (ED) often presents ethical problems
not encountered in other settings. In many medical schools there is little ethics
training during the clinical years. The benefits of reflective essay writing in ethics
and professionalism education are well established.
Objectives
The purpose of this study was to determine and categorize the types of ethical dilemmas
and scenarios encountered by medical students in the ED through reflective essays.
Methods
During a 4th-year emergency medicine rotation, all medical students wrote brief essays on an ethical
situation encountered in the ED, and participated in an hour debriefing session about
these essays. Qualitative analysis was performed to determine common themes from the
essays. The frequency of themes was calculated.
Results
The research team coded 173 essays. The most common ethical themes were autonomy (41%),
social justice (32.4%), nonmaleficence (31.8%), beneficence (26.6%), fidelity (12%),
and respect (8.7%). Many of the essays contained multiple ethical principles that
were often in conflict with each other. In one essay, a student grappled with the
decision to intubate a patient despite a preexisting do-not-resuscitate order. This
patient encounter was coded with autonomy, beneficence, and nonmaleficence. Common
scenarios included ethical concerns when caring for critical patients, treatment of
pain, homeless or alcoholic patients, access to care, resource utilization, and appropriateness
of care.
Conclusion
Medical students encounter patients with numerous ethically based issues. Frequently,
they note conflicts between ethical principles. Such essays constitute an important
resource for faculty, resident, and student ethics training.
Keywords
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Article info
Publication history
Published online: December 03, 2014
Accepted:
September 30,
2014
Received in revised form:
August 19,
2014
Received:
March 17,
2014
Footnotes
Prior Presentations: Council of Emergency Medicine Residency Directors (CORD) Academic Assembly, Denver CO, March 2013; Association of American Medical Colleges Central Group on Educational Affairs, Cincinnati, OH March 2013.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
