Funding is an important mechanism for exercising influence over ever more parts of academic systems. In order to do so, funding agencies attempt to export their functional and normative prerequisites for financing to new fields. One essential requirement for fundees is then to construct research processes in the form of a project beforehand, one that is limited in time, scope and content. This article demonstrates how the public funding of doctoral programs expands this model of project research from experienced (...) academics to the socialization process for the new academic generation. This process of “projectification” underlies funding-driven institutional changes in doctoral training. A multi-level comparative study of German policies, funding mechanisms and organizational frameworks for doctoral training demonstrates the emergence of a specific model of predefined PhD projects. The investigation of doctoral training practices reveals that socio-epistemic preconditions regulate whether research fields adopted or rejected this demanding model. This result contradicts widespread claims about a radical change in doctoral training and suggests focusing on the actual practices of field-specific doctoral research. (shrink)

Over the last decade, a plethora of international policies and guidelines on research integrity have been produced, and many countries have developed national codes of conduct. Recently, as a way of implementing these codes, institutions have begun offering mandatory training in research integrity for PhD fellows. This paper is based on a case study of a mandatory course in research integrity for PhD fellows at a faculty of medicine in Denmark. The study comprised a small survey, participatory fieldwork, and (...) interviews with six course participants, the course leader and a teacher. Based on this study, the paper shows that the PhD fellows perceived the integrity course as if it, to some extent, contributed to normalising the questionable research practice and grey zone behaviour that the course was conceived to prevent. The interviews, however, also show that this latent normalisation must be seen in the context of the PhD fellows’ position within a strongly competitive culture, which sometimes rewards questionable behaviour. For this reason, creating a culture of research integrity cannot be accomplished by integrity training alone, it demands a wider structural change in the incentives for career advancement that sustain the current asymmetries of power. (shrink)

Changes in knowledge production, increasing interaction between government, universities and industry, and changes in labor markets for doctoral degree holders are forces that have spurred a debate about the organization of doctoral education and the competencies graduates need to master to work as scientists and researchers in a triple helix research context. Recent policy also has supported a redefinition of researcher training with increasing focus on broader skills and relevance for careers outside the university sector. Consequently, it (...) is pertinent to investigate current changes in doctoral education and researcher training. Particularly further knowledge about university–industry collaboration as a context for researcher training is required. With this in mind, this study provides empirical illustrations of how research training carried out in collaborative research contexts is experienced by doctoral students, and offers some insight into antecedent and process factors that are central in shaping PhD students’ research and training experience in collaborative research contexts. Based on the empirical data and a review of existing literature, suggestions for further research are made. (shrink)

The existing literature in medical ethics does not serve the practical needs of medical students and trainees very well. Medical students or junior doctors often have their own set of ethical concerns and the dilemmas that arise are generally beyond their direct control. The editors have addressed the gap in the literature by compiling a series of case studies from around the world and inviting an international team of leading ethicists and clinicians to comment on them. This volume includes over (...) 80 actual cases that cover the range of possible problems a medical trainee may encounter on the ward. (shrink)

Little is known about the mechanisms by which psychology graduate programs transmit responsible conduct of research (RCR) values. A national sample of 968 current students and recent graduates of mission-diverse doctoral psychology programs completed a Web-based survey on their research ethics challenges, perceptions of RCR mentoring and department climate, whether they were prepared to conduct research responsibly, and whether they believed psychology as a discipline promotes scientific integrity. Research experience, mentor RCR instruction and modeling, and department RCR policies predicted (...) student RCR preparedness. Mentor RCR instruction, department RCR policies, and faculty modeling of RCR behaviors predicted confidence in the RCR integrity of the discipline. Implications for training are discussed. (shrink)

Why would a successful physician who has undergone seven years of rigorous medical training take the trouble to seek out and learn to practice alternative methods of healing such as homeopathy and Chinese medicine? From Doctor to Healer answers this question as it traces the transformational journeys of physicians who move across the philosophical spectrum of American medicine from doctor to healer. Robbie Davis-Floyd and Gloria St. John conducted extensive interviews to discover how and why physicians make the move (...) to alternative medicine, what sparks this shift, and what beliefs they abandon or embrace in the process. After outlining the basic models of American health care-the technocratic, humanistic, and holistic-the authors follow the thoughts and experiences of forty physicians as they expand their horizons in order to offer effective patient care. The book focuses on the radical shift from one end of the spectrum to the other-from the technocratic approach to holism-made by most of the interviewees. Because many American physicians find such a drastic change too threatening, the authors also address the less radical transition to humanism-a movement toward compassionate care arising from within the medical system. (shrink)

This book deals with solving a pressing organizational challenge of bringing employees up to speed faster. In the fast-paced business world, organizations need faster readiness of employees to handle the complex responsibilities of their jobs. The author conducted an extensive doctoral research study with 85 global experts across 66 project cases to explore the practices and strategies that were proven to reduce time to proficiency of employees in a range of organizations worldwide. This book provides the readers with a (...) first-hand account of findings exclusively related to training and learning strategies, instructional methods, and curriculum design. This book delivers over 21 training and learning strategies across online learning, classroom instructions, and on-the-job learning. These strategies will allow training designers and learning specialists to design workplace training programs that hold the potential to shorten time to proficiency of employees. The book not only describes findings of the study and theoretical underpinnings, but it also provides practical guidance for implementation to equip corporate learning specialists, HR professionals, training leaders, performance consultants, and direct managers. (shrink)

This article reports the results of a survey, by mailed questionnaire, of the attitudes, values and practices of doctors in Singapore with respect to the doctor-patient relationship. Questionnaires were sent to a random sample of 475 doctors (261 general practitioners and 214 medical specialists), out of which 249 (52.4%) valid responses were completed and returned. The survey is the first of its kind in Singapore. Questions were framed around issues of medical paternalism, consent and patient autonomy. As the doctors were (...) exposed to Western ethical concepts in their training, we were not surprised to find that they would mostly allow patients some say in decision-making and keep patients reasonably informed. In respecting patient autonomy, they would usually seek to influence patient choice by persuasion. However, the residual "Asian-ness" of doctors in Singapore gives rise to some inconsistencies between values and practices. Many doctors still believe that a number of their patients are incapable of rational choice. There is some lack of openness in telling patients the whole truth. When patients choose to refuse treatment, many doctors are prepared to involve family members in making a consensus decision. Doctors were also asked how they made ethical judgements in the face of dilemmas, and how they would like disputes with patients to be resolved. By and large, the doctors prefer to make their own judgements rather than to rely on rules. They also wish to keep the law courts out of disputes with patients, preferring less public ways of settling disputes. (shrink)

This study explores the doctoral cultivation system and mechanism of university think tank in China. A policy narrative analysis of doctoral cultivation mechanism aims to unpack how to cultivate university think tank talents. It is suggested that we need to promote the construction of interdisciplinary disciplines and clarify the attribution of disciplines for personnel training; build an interdisciplinary interaction mechanism and form a collaborative training system and give priority to the construction of policy disciplines as basic (...) disciplines for personnel training. Along with the policy suggestions above, the cultivation pathways of cultivating doctoral students in university think tanks is provided systematically in the last section. (shrink)

Background: Ethics consultation is used regularly by some doctors, whereas others are reluctant to use these services.Aim: To determine factors that may influence doctors to request or not request ethics consultation.Methods: A survey questionnaire was distributed to doctors on staff at the University Community Hospital in Tampa, Florida, USA. The responses to the questions on the survey were arranged in a Likert Scale, from strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree to strongly agree. Data were analysed with (...) the Wilcoxon test for group comparisons, the χ2 test to compare proportions and a logistic regression analysis.Results: Of the 186 surveys distributed, 121 were returned, giving a 65% response rate. Demographic data were similar between the groups saying yes and no . No statistically significant differences were observed between the user and non-user groups in terms of opinions about ethics consultants having extensive training in ethics or participating in ethics educational opportunities. On the issue “Ethics committee members or consultants cannot grasp the full picture from the outside”, the non-users were neutral, whereas the users somewhat disagreed . Even more significant was the difference between surgeons and non-surgeons, where, by logistic regression analysis, surgeons who believed that ethics consultants could not grasp the full picture from the outside were highly likely to not use . Non-users of ethics consultations thought that it was their responsibility to resolve issues with the patient or family . Users of ethics consultation believed in shared decision making or the importance of alternate points of view .Implications: Ethics consultations are used by doctors who believe in shared decision making. Doctors who did not use ethics consultation tended to think that it was their responsibility to resolve issues with patients and families and that they were already proficient in ethics. (shrink)

Many senior doctors have had little in the way of formal ethics training, but express considerable interest in extending their education in this area. This paper is the report of an initiative in continuing medical education in which doctors were introduced to narrative ethics. We review the theoretical basis of narrative ethics, and the structure of and response to the two-day workshop.

Doctors in Denial examines the relationship between the Canadian medical profession and the pharmaceutical industry, and explains how doctors have become dependents of the drug companies instead of champions of patients' health. Big Pharma plays a role in every aspect of doctors' work. These giant, wealthy multinationals influence how medical students are trained and receive information, how research is done in hospitals and universities, what is published in leading medical journals, what drugs are approved, and what patients expect when they (...) go into their doctors' offices. But almost all doctors deny the influence and control the drug companies exert. In this book Dr. Lexchin urges the medical profession to make the changes needed to give priority to protecting and promoting patients' health and benefitting society, rather than enabling Big Pharma to dominate health care while raking in billions in profits from citizens and governments. (shrink)

Doctors are increasingly enjoined by their professional organisations to involve themselves in supraclinical advocacy, which embraces activities focused on changing practice and the system in order to address the social determinants of health. The moral basis for doctors’ decisions on whether or not to do so has been the subject of little empirical research. This opportunistic qualitative study of the values of medical graduates associated with the Sydney Medical School explores the processes that contribute to doctors’ decisions about taking up (...) the advocate role. Our findings show that personal ideals were more important than professional commitments in shaping doctors’ decisions on engagement in advocacy. Experiences in early life and during training, including exposure to power and powerlessness, significantly influenced their role choices. Doctors included supraclinical advocacy in their mature practices if it satisfied their desire to achieve excellence. These findings suggest that common approaches to promoting and facilitating advocacy as an individual professional obligation are not fully congruent with the experiences and values of doctors that are significant in creating the advocate. It would seem important to understand better the moral commitments inherent in advocacy to inform future developments in codes of medical ethics and medical education programs. (shrink)

In December 2014, Physicians for Human Rights released their analysis of the summary of the Committee Report of the Central Intelligence Agency’s Detention and Interrogation Program. PHR focused on the involvement of health care professionals in the CIA torture program, concluding that the health professionals’ commissions and omissions violated the prescriptions of many fundamental bioethical documents, including international declarations of bioethics and medical research ethics. The medical doctors’ involvement evokes some thoughts concerning bioethical education. It seems that instead of developing (...) virtues through practicing morally good habits, the experience of clinical training undermines the moral ideals that medical students identified themselves with at the commencement of their medical education. The hostile response they sometimes get from their mentors when trying to question morally troubling situations may shape the habit of ‘turning a blind eye’ to unethical behaviour, since the students do not want to jeopardize their grades and future medical career. Maybe it was the development of this habit and the failure to develop the habit of moral courage instead that prevented the medical doctors participating in torture programs from defending moral ideals of their profession more effectively. (shrink)

Research in science, technology, engineering, and mathematics fields has become much more complex in the twenty-first century. As a result, the students of our Graduate School, who are all Ph.D. candidates, need to be trained in essential skills and processes that are crucial for success in academia and beyond. Some research problems are inherently complex in that they raise deep moral dilemmas, such as antimicrobial resistance, sustainability, dual-use research of concern, and human cloning. Dealing with moral dilemmas is one of (...) several core competencies that twenty-first-century Ph.D. students must acquire. However, this might prove difficult for STEM Ph.D. students who have had limited exposure to moral philosophy. Since the task of dealing with moral dilemmas in STEM research requires input from both scientific and philosophical disciplines, it is argued with the help of the 4 examples above that this task be explicitly modelled as an interdisciplinary process. Furthermore, it is argued that a particular model from the interdisciplinary education literature could serve as a learning tool to support ethical decision-making in research ethics and integrity courses for doctoral students. (shrink)

In this essay, the author describes how he faced institutionalized homophobia during his psychiatric training, and how he later wrote a play inspired by the life of a gay psychiatrist. Despite Freud’s supportive stance, homosexuality aroused the antipathy of American organized psychiatry and psychoanalysis and came to be listed as an illness in the Diagnostic and Statistical Manual. Dr. John E. Fryer outed himself as “Dr. H Anonymous” at a 1972 meeting of the American Psychiatric Association, and the next (...) year homosexuality was removed from the DSM. The 2014 play Doctor Anonymous offers a fictionalized account of this watershed moment in the history of the gay rights movement. The author discusses his own psychotherapeutic work with gay male patients, including those who had previously been treated with conversion therapy, and explores how the play mirrors his own life experience and the experience of his patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Holding Doctors Responsible at Guantánamo*Nancy Sherman (bio)I recently visited the Guantánamo Bay Detention Center with a small group of civilian psychiatrists, psychologists, top military doctors, and Department of Defense health affairs officials to discuss detainee medical and mental health care. The unspoken reason for the invitation to go on this unusual day trip was the bruising criticism the Bush administration has received for its use of psychiatrists and psychologists (...) in the interrogation of suspected terrorist detainees.1We disembarked from our Navy jet to find an island lush and green from recent storms. A small boat took us from the airfield to the naval hospital. From the boat there was no sign of Camp Delta, where the detainees are actually held. Nor was there a sign of prisons or barbed wire or the detention facility's 505 inmates.Our host was the commanding officer of Gitmo, Major General Jay W. Hood (an artillery officer by training), who had replaced Major General Geoffrey Miller, implicated in the "migration" of torture methods from Gitmo to Abu Ghraib. Dressed in fatigues, General Hood briefed us using PowerPoint. His intelligence director told us that interrogators have not used harsh "fear up" tactics—the ones designed to terrify—since 2003.We went by bus from the naval hospital to the 30-bed detainee hospital for quick briefings from a psychiatrist and a physician. Still, we were not permitted to see any detainees or hunger strikers, despite our requests. During our six hours on the ground, we had only a fleeting glimpse of a few detainees outside their cellblocks behind barbed wire and screened fences.Indeed, when I got home and saw the play "Guantánamo: Honor Bound to Defend Freedom," by Victoria Brittain and Gillian Slovo, I had the disquieting feeling that I had absorbed more about detainee life at the theater than I had from actually being at Gitmo. This only amplified my anxiety that what I had heard and seen during my VIP visit sidestepped the central moral issue of whether abuse is still occurring at Gitmo and whether health professionals are, or have been, a party to coercive interrogation. [End Page 199]The question that the Pentagon leadership has been focusing on, and which was a key subject of discussion during our day at Gitmo, is whether there is an ethical difference between using psychologists or psychiatrists on interrogation teams—what the Pentagon calls, "behavioral consultation teams," or BSCTs, pronounced "biscuit." Some in the Pentagon would like to have doctors and psychiatrists, who are bound by the Hippocratic teaching to "do no harm," be the clinicians treating detainees. Psychologists, who are not as bound by Hippocratic dicta, would consult with and advise interrogators. But this is a red herring. It is hair-splitting that detracts from the real issue of whether health professionals of any stripe can ethically be involved in interrogations that may involve coercive techniques or torture. The answer is clearly no. They should not be involved, directly or indirectly, in situations that may lead to the breach of confidential medical records; to torture or to cruel, inhumane, and degrading treatment; or to exploitation of fears or phobias. Mental health professionals simply should not be collaborating with interrogators in inflicting psychological torture.Hood said that "rapport building" was the preferred and an effective interrogation technique, but that is no guarantee that rougher tactics will not be used. The fact is that there is enormous pressure on the people at Guantánamo Bay to get good intelligence for the war on terror, and it is as easy for behavioral scientists as it is for interrogators to compromise their moral standards. Cunning and deception to extract information may be acceptable in some cases. But many people have been outraged to learn from media reports that methods developed by military psychologists to train our own troops to resist torture—the so-called "survival, evasion, resistance, and escape" methods taught at Ft. Bragg—have been "reverse engineered" at Guantánamo Bay to create coercive, psychologically manipulative interrogation techniques for use against detainees.Plato warned long ago that a doctor's skill, abstracted from good character and wisdom, is a neutral... (shrink)

Research documents that many chronic non-malignant pain patients experience existential, spiritual and religious needs; however, research knowledge is missing on if and how physicians approach these needs. We conducted a systematic review to explore the extent to which physicians address these needs in their communication with chronic non-malignant pain patients and to explore the facilitators and challenges of this communication. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searching Embase, Medline, Scopus and PsycINFO. The quality of (...) the included articles was assessed based on design-specific screening tools. We included four of 2337 screened articles and found the quality to be good. Physicians’ communication about existential, spiritual and religious needs was given low priority and depended on the patients’ own initiative, except when clinicians were interested in holistic care. Patient dissatisfaction with the physician’s attention to these needs was related to higher pain and depression. Physicians’ challenges for addressing these needs were their tendency to prioritize physiological aspects and close further elaboration of existential needs when addressed by the patients. The main facilitator was the individual physician’s willingness to listen with openness and empathy to the patients’ existential concerns. A tentative conclusion is that physicians rarely meet the existential, spiritual and religious needs of their chronic non-malignant pain patients. This might be due to higher priority of physical aspects, lack of time and a lack of knowledge about the importance of and training in the ability to address these needs. Further research is needed on physicians’ communication about existential, spiritual and religious needs and on their training in here. (shrink)

According to the brain drain argument, there are good reasons for states to limit the exit of their skilled workers (more specifically, healthcare workers), because of the negative impacts this type of migration has for other members of the community from which they migrate. Some theorists criticise this argument as illiberal, while others support it and ground a duty to stay of the skilled workers on rather vague concepts like patriotic virtue, or the legitimate expectations of their state and co-citizens. (...) In this article, on the contrary, we suggest that the liberal conception of states’ legitimate political authority demands, and not just permits, that developing states from which migration of skilled workers occurs set up contractual mechanisms. These mechanisms will ensure that state-funded training in the health sector is provided against a commitment on the part of future professionals to reciprocate with their services for the benefits obtained. If one of the conditions for the state to maintain legitimate political authority is to provide basic services such as healthcare to its subjects (while respecting at the same time their autonomy and freedom), then this is what developing states affected by the brain drain ought to do. What we call the authority-based approach to the brain drain also helps to clarify the obligations that other states have not to interfere with these contractual mechanisms when they exist, and not to profit from their absence. Inspired by FIFA’s legal instruments of training compensation and solidarity mechanism for the transfer of players, we conclude by suggesting a plausible global policy to complement this authority-based approach. (shrink)

Most commentators have focused on ethical dilemmas and the idea that they were core to the actions of and decisions by Jewish doctors in SS concentration camps and ghettos during the Holocaust. While I recognize Jewish doctors did face ethical dilemmas, in this article, I shift my attention to include two other significant factors: choiceless choices, defined by the eminent Holocaust historian Lawrence Langer as “crucial decisions [that] did not reflect options between life and death, but between one form of (...) abnormal response and another, both imposed by a situation that was in no way of the victim’s own choosing,” and the human condition, whereby decisions and actions were triggered by personal traits and past experiences in response to particular situations and circumstances. Inherent in all three factors is the tenaciousness of reality and how the abhorrent conditions, immorality, inhumanity and evilness cast a shadow over every moment of the Jewish doctor’s life. My thesis is that decision-making was not one-dimensional but multi-dimensional. For the Jewish doctor every incident became a source of dread and tragedy. They were often not trained to treat some diseases or perform surgery and lacked experience to work in such conditions and cope emotionally and psychologically. I will attempt to show that how a person responds to an ethical dilemma is based on his or her own experiences and reasoning, and how they reacted to sudden and inexplicable incidents that threatened life or impacted survival induced abnormal actions and decisions. As Jewish doctors they were driven to be healers, to be normal, but they were forced by circumstances to kill or become perpetrators, acting abnormally. Tragically the abnormal became the norm. The Jewish doctors were professionally trained and culturally socialized to continue their roles as doctors. Nevertheless, they were human and were driven by the innate will to live. (shrink)

Writing an academic text within institutions of higher education and research generally responds to two concerns. First, the immediate motivation to publish and possibly been recognized by their respective academic peers. Second, satisfying a training requirement widely recognized by the academic community and by society. In both cases, the epistemic and cognitive value of the text content varies in function on the referring ones from which its object of study were conceived, and on which it rests the design, the (...) structure and the organization of its writing. This paper deals with the epistemological problems that goes with the development of the doctoral dissertation in social sciences, and proposes a methodological strategy to be applied to an ongoing research, whose objective is to examine the contribution of doctoral dissertation to the development of the field of social and educational research. Escribir un texto académico en el marco de establecimientos de educación superior e investigación responde generalmente a dos inquietudes: a la motivación inmediata de publicarlo y, en la medida de lo posible, ser acreedor del reconocimiento de los respectivos pares académicos, o bien, cumplir con un requisito de formación como lo es el presentar una tesis y obtener un título o un grado universitario ampliamente reconocido por la comunidad de académicos y por la sociedad. En ambos casos, el valor epistémico y cognitivo del contenido del texto varía en función de los referentes a partir de los cuales fue concebido su objeto de estudio, y sobre los cuales descansa el diseño, la estructura y la organización de su escritura. En este artículo se aborda la problemática epistemológica que acompaña a la elaboración de la tesis doctoral en ciencias sociales y se propone una estrategia metodológica para ser aplicada a una investigación en proceso, donde el objetivo es analizar la contribución de las tesis doctorales al desarrollo del campo de la investigación social y educativa. (shrink)

The physician’s duty of confidentiality is based on the observance of the patient’s privacy and intimacy and on the importance of respecting both of these rights, thus creating a relationship of confidence and collaboration between doctor and patient. The main objective of this work consists of analyzing the aspects that are related to the confidentiality of patients’ data with respect to the training, conduct and opinions of doctors from different Clinical Management Units of a third-level hospital via a questionnaire. (...) The present study aimed to define the problem and determine whether the opinions of these professionals correspond to those observed in a previous work conducted at the same center. Of the 200 questionnaires that were collected, 62.5% were from consultants and the rest were from residents with an average of 14.4 ± 12.5 years in professional practice. The respondents noted habitual situations in which confidentiality was breached in the reference hospital. The section on their attitudes and behaviors towards situations related to confidentiality showed a slightly lower average score than that of their medical knowledge; significant differences in these scores were observed between the consultants and residents as well as between the extreme age groups and years of professional practice, thus more inadequate attitudes were consistently noted in younger doctors who had fewer years of experience. Finally, the respondents answered that the training of doctors in the aspects of healthcare law and ethics was the most important measure that the hospital could adopt regarding confidentiality practices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Training and Other Important Needs for Nursing AssistantsNanci RobinsonTraining of Nursing AssistantsI think the nursing assistant (NA) training programs should be longer. My original course for Long Term Care was four weeks long after that I took an additional two months at a hospital to work on a Med/ Surg floor. So, I have a combined three months of schooling.Personally, I'd like to see certified nursing assistants (...) (CNAs) given more responsibilities. I'd like to see a six-month program to include CPR and capillary blood glucose (CBG) training as well as more in depth anatomy training. I think six months would keep some, who are just looking for money, out of the field and help keep those of us who really want a career in nursing in the field. It would be a better stepping stone for those who plan to go on to a LPN or RN program.I currently have CBG training but my employer will not let me use it. It's disappointing because it's a skill I have that I can't use and it could really help out the nurses. I think if courses were a bit longer, CNAs might be taken a bit more seriously by their employers and respected by their colleagues in the medical field.I was trained in CBG while working for the hospital and received a card like a CPR card to show I was trained. I live and work and was trained in Arkansas. I'm not allowed to do CBGs in the long-term care and rehab facility where I work now, though. However, unless the resident is diabetic we do have to clip and file nails. It took many years for nurses to gain respect and be allowed to do some things that now CNAs do. For example, for many years doctors didn't feel nurses were qualified to even take vital signs. I suppose CNAs will have the same struggle. [End Page 147]"I'm wondering if extending the initial training time would not keep many out of the field, because they need a job with income ASAP." The same could be said for LPN training, could it not? Or even an RN. I don't understand why there is a train of thought that "anyone" should be allowed to be a CNA and as quickly as possible. I can tell when I'm working alongside a Certified Nursing Assistant who is in it because they want to be versus someone who wants the paycheck (not sure why, though, because to be honest Arkansas doesn't pay CNAs all that great, though I suppose for some it might be better than McDonalds). I took a $5 an hour paycut go get back into nursing because it's my passion, and while we all need a paycheck, that should not be the only reason for doing this work."If extending the initial training time would keep many out of the field because they need a job with income ASAP, maybe employer facility-specific follow-up training would seem to be much more feasible for all. A CNA-in-training could be responsible for a lighter than 'normal' shift assignment while under the guidance of a qualified proctor CNA. It could improve efficiency and quality of care in the long run and probably improve retention rate of CNAs, for those administrators that are astute enough to consider the long-term effects of their policies." This might be good—the only problem is that most facilities aren't going to want to absorb any cost this might create by having additional staff for this purpose. Also, on the job training is not appreciated by employers as much as what might be considered actual "education" hours. Most CNAs want to do as much patient care as they can for the nurse—learning to assist with dressing changes, CBGs and other things that would be beneficial for both CNAs and the Nurse.Ensuring there is enough staff and that those staff members are there for the right reasons would do much more to improve the retention rate of NAs or CNAs. (I'm a... (shrink)

For the past 3 years, since acquiring formal training in healthcare ethics and philosophy, I have been one of those physicians who “does” ethics. I teach medical students and residents, write articles, speak at conferences, chair an ethics committee, and informally consult with colleagues on cases where they request advice related to ethical issues in the care of patients. These activities have been a rewarding and challenging part of my practice. There has also been a fair amount of frustration. (...) Unfortunately, both in teaching and patient care, it has been a frequent experience to finish a discussion with physicians only to be told that what I said was nice but had no bearing in the real world. In the words of a medical resident: 'You know, this ethics stuff is really a lot of crap, isn't it?'. (shrink)

McCabe & Healey argue that in patient‐psychiatrist interaction, the more the participants engage in repair, i.e., trying to fix potential misunderstandings, the better the outcomes of the interaction, as measured by treatment adherence and the quality of the Dr – patient relationship. This holds both for self‐repair, when psychiatrists fix their own utterances, as well as other‐repair, where patients try to fix the understanding displayed by the psychiatrist.

This paper supports the need for health professionals to be trained in argumentation theory, by illustrating the challenges that they face in interacting with patients and according to the different models of consultation that patients prefer. While there is no ideal model of consultation that can be promoted universally, the ability to construct arguments in support of health professionals’ points of view, as well as the ability to engage in critical discussion with patients, translate in essential skills for reaching patients’ (...) agreement when communication develops through the interpretative model or the informed decision model or, eventually, shared decision-making. Keywords: models of consultation, argumentation skills, medical training, patient-centeredness, informed consent. (shrink)

This study explores the institutional logics and socialization experiences of STEM doctoral students in the context of the current American economic narrative that is specific to science and technology. Data from qualitative interviews with 36 students at three research universities first reveals a disconnect between a well-established national science and technology policy narrative that is market-oriented and the training, experiences, and perspectives of science and engineering doctoral students. Findings also indicate science and engineering doctoral students mostly (...) understand entrepreneurship and innovation in the contexts of funding research activities and creating social impact, which parallel rather than oppose dominant academic values and norms. Based on the findings, we contend that it is both possible and prudent for universities and graduate programs to pursue strategies that align science and engineering doctoral education with the current national economic agenda and support the personal, professional values and perspectives of students without coming in conflict with the scientific core of the academy. (shrink)

IntroductionDespite the need for trained physician ethicists, fellowships in clinical ethics are limited and primarily offered to thosewho have completed a graduate degree. The standardization of credentialing for clinical ethics consultants (CECs) and the restructuring of undergraduate medical education allow innovative models to train CECs that can provide an expanded opportunity for formal ethics training at an earlier stage.MethodsAt the University of Michigan Medical School we developed, implemented, and evaluated a pre-doctoral clinical ethics fellowship program from 2017 to (...) 2019 for senior medical students, designed to meet established competencies for CECs. Consultation notes from the beginning and end of the fellowship program were randomly selected for each fellow and independently rated by two faculty ethicists who used the validated Ethics Consultation Quality Assessment Tool (ECQAT).1 Inter rater reliability and trends in scores over time were calculated.ResultsThree students successfully completed the fellowship at the University of Michigan Medical School, conducted at least 50 formal ethics consultations, and spent approximately 40 hours a week on service for a minimum of six months. All students finished the fellowship with teaching and policy development experience, first-authored peer-reviewed manuscripts, and national presentations. The fellows demonstrated improvement in their ECQAT overall holistic rating score; all ended their fellowship with a holistic score of adequate or above. There was 92 percent agreement between raters withrespect to the acceptability of the fellows’ ethics consult notes. Two fellows have taken and passed the Healthcare Ethics Consultant-Certification (HEC-C) exam offered by the American Society for Bioethics and Humanities (ASBH).ConclusionsIntegration of a pre-doctoral fellowship model that meets professional certification standards for clinical ethics consultation creates an opportunity for medical students to become trained CECs early in their career. (shrink)

In the United States, the field of bioethics has expanded over the last two decades. Several institutions offer graduate-level training at both the masters and doctoral level. However, a lack of published literature on the outcomes of doctoral training in bioethics from the perspective of graduates exists. Researchers conducted an online survey of doctoral students who had finished all doctoral requirements but their dissertation, as well as doctoral graduates, of four US-based institutions to (...) ascertain their perspectives on a number of items regarding their doctoral training and their perception of how that training prepared them for their current role in the workforce. Responses from 34 participants were assessed. Respondents had positive overall views on the utility of a bioethics doctorate and the educational training they received in their respective programs. A number of areas for improvement were identified, including better structured clinical ethics training, greater opportunities for research and publishing, and having the ability to teach during their doctoral program, as well as formal pedagogy training. Greater exposure to clinical ethics consultation during the doctoral program was associated with feeling fully prepared as a clinical ethics consultant. This is the first study to assess the perspectives of bioethics doctoral graduates and ABD students regarding the utility of a bioethics doctorate. Per the perspectives of graduates and ABD students, bioethics doctorates are important and effective to train professional bioethicists. We recommend that a few key changes to these programs’ curricula can further bolster their effectiveness. (shrink)

ABSTRACT This cross-sectional study compared the moral reasoning of first-year and third-year doctoral students in clinical psychology. Nineteen first-year and 20 third-year students were recruited from 17 doctoral training programs in the UK. Most adopted a sophisticated approach to moral judgments, as assessed by the Defining Issues Test, although, surprisingly, more experienced students had significantly less sophisticated schemata. In their moral judgments, less experienced students relied more heavily on their personal, and more experienced students on their professional, (...) constructs, as assessed by repertory grid technique. Integration between personal and professional constructs was higher in more experienced students. (shrink)

Without any warning, in September 1999, David Newman was told he had a rare and life-threatening tumor in the base of his skull. In the compressed space of five weeks, he consulted with leading physicians and surgeons at four major medical centers. The doctors offered drastically differing opinions; several pronounced the tumor inoperable and voiced skepticism about the effectiveness of any nonsurgical treatment. _Talking with Doctors_ is the story of Newman's efforts, at a time of great stress and even impending (...) death, to wend his way through the dense thicket of medical consultations in search of a physician and a treatment that offered the possibility of survival. It is the story, especially, of the harrowing process of assessing conflicting "expert" opinions and, in so doing, of making sense of the priorities, personalities, and vulnerabilities of different doctors. All too often, he found, the leading specialists to whom he was sent were strangers in the consulting room-and strangers who became stranger still, both cognitively and emotionally, when ambiguous findings pushed them to the outer limits of their training and experience. Newman writes poignantly of his sense of powerlessness and desperation, of the painstaking means by which he ascertained what could be known about his tumor, and of the fortuitous events that finally led him to life-saving help. _Talking with Doctors_ is a compelling, absorbing, unsettling story that touches a collective raw nerve about the experience of doctors and medical care when life-threatening illness leads us to subspecialists at major medical centers. Probing the nature of medical authority and the grounds of a trusting doctor-patient relationship, Newman illuminates with grace and power what it now means for a patient to participate in life-and-death medical decisions. (shrink)

La trayectoria profesional son las actividades que requieren capacitación y se realizan con el propósito de que los individuos obtengan conocimientos teóricos y prácticos de una profesión. El objetivo de esta investigación es describir las variables de trayectoria profesional de doctores de una universidad de México. Se diseñó y aplicó un instrumento (cuestionario) con 12 ítems. El estudio contó con una muestra no probabilística de tipo cuantitativo descriptivo, no experimental y transversal, con la participación de 234 doctores. Los hallazgos señalan (...) la necesidad de efectuar diagnósticos para identificar las áreas de oportunidad en relación a la formación en investigación. (shrink)

BackgroundHealthcare ethics is neglected in clinical practice in LMICs such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses in a tertiary teaching hospital in Nepal.MethodsThis was a cross sectional study conducted among resident doctors and ward nurses in the largest tertiary care teaching hospital of Nepal during January- February 2016 with a self-administered questionnaire. A Cramer’s V value was assessed to (...) ascertain the strength of the differences in the variables between doctors and nurses. Association of variables were determined by Chi square and statistical significance was considered if p value was less than 0.05.ResultsOur study demonstrated that a significant proportion of the doctors and nurses were unaware of major documents of healthcare ethics: Hippocratic Oath, Nuremberg code and Helsinki Declaration. A high percentage of respondents said that their major source of information on healthcare ethics were lectures, books, and journals. Attitude of doctors and nurses were significantly different in 9 out of 22 questions pertaining to different aspects of healthcare ethics. More nurses had agreement than doctors on the tested statements pertaining to different aspects of healthcare ethics except for need of integration of medical ethics in ungraduate curricula,paternalistic attitude of doctor was disagreed more by doctors. Notably, only few doctors stood in support of physician-assisted dying.ConclusionsSignificant proportion of doctors and nurses were unaware of three major documents on healthcare ethics which are the core principles in clinical practice. Provided that a high percentage of respondents had motivation for learning medical ethics and asked for inclusion of medical ethics in the curriculum, it is imperative to avail information on medical ethics through subscription of journals and books on ethics in medical libraries in addition to lectures and training at workplace on medical ethics which can significantly improve the current paucity of knowledge on medical ethics. (shrink)

In this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa. The loss of health professionals from the South African public system is a key contributor to the present healthcare crisis. South African medical schools have revised curricula to engage trainee doctors with a broader set of social concerns, but the disjunctures between training, health systems failures, and a high disease burden call into question whether junior doctors are adequately (...) prepared or whether conditions of care extend beyond medical training. A concern with 'resilience' suggests a correct ethical relation to a putative obligation to provide care in a struggling system. By examining the ways in which trainee doctors are expected to 'cope' with the demands of medical practice, to adopt the correct moral posture in relation to the urgency of care, and to enact a desirable ethical relation to the broader social and political context of medical practice, we examine the picture of humanist concern that animates the subjectivities and techniques of the self called for by this training, and advocate for endurance as an alternative framework for understanding the political and ethical relations between doctors, patients and health systems. (shrink)

Clinical ethics can be viewed as a practical discipline that provides a structured approach to assist healthcare practitioners in identifying, analysing and resolving ethical issues that arise in practice. Clinical ethics can therefore promote ethically sound clinical and organisational practices and decision-making, thereby contributing to health organisation and system quality improvement. In order to develop students’ decision-making skills, as well as prepare them for practice, we decided to introduce a clinical ethics strand within an undergraduate medical curriculum. We designed a (...) programme of clinical ethics activities for teaching and assessment purposes that involved using ethical frameworks to analyse hypothetical and real-life cases in uni- and inter- professional groups. In this paper, we draw on medical student feedback collected over 6 years to illustrate the appeal to students of learning clinical ethics. We also outline the range of benefits for students, healthcare organisations, and the field of clinical ethics arising from tomorrow’s doctors experiencing clinical ethics early in their training. We conclude by briefly reflecting on how including clinical ethics within tomorrow’s doctors curricular can secure and continue future engagement in clinical ethics support services in the UK, alongside the dangers of preparing students for organisational cultures that might not exist. We anticipate the findings presented in the paper will contribute to wider debates examining the impact of ethics teaching, and its ability to inform future doctors’ practice. (shrink)

One of the significant roles performed by the higher degree research supervisor is to assist students to prepare their dissertations for examination. At a time when there is increasing interest in how the academy manages the transition of creative arts HDR candidates from apprentice to peer, there is also concern about the processes, practices, and policies associated with this largely under-researched area of research training. In a recent national Office of Learning and Teaching funded project, we investigated the policy (...) expectations, expert and peer beliefs and expectations, and examiners’ practice around HDR examination, and canvassed the creative arts academic community for their recommendations on best practice in the examination of creative arts doctorates. An unexpected finding was the role of the HDR supervisor in relation to these key areas, and the impact of supervisors upon the examination of students’ theses. This article presents our findings with special reference to the role, understandings, and aspirations of HDR supervisors in the context, and process, of preparing their students for creative arts HDR examination. (shrink)

Does responsible conduct of research (RCR) training improve levels of trust between researchers? Using data gathered as part of a survey on the attitudes of master's and doctoral-level students toward RCR, we found that RCR training correlated with a weakened beliefs of students toward their supervisors' ethicality but a stronger belief in the ethicality of their peers. We believe that these findings point to new avenues of research on trust in the academic setting and to needs for (...) curriculum changes in RCR training. (shrink)

As out-of-hospital emergencies become more commonplace, so does the call for a “doctor in the house”. New York City paediatrician Mitchell Rubin has responded to numerous such crises over the past 25 years. He explores reactions on all sides of this peculiar physician–victim relationship, his growing concerns and fears, and possible reasons why many doctors hesitate to act. His thoughts and experiences instigate the discussion about the need for a universal system of Good Samaritan physician respondersWhile flying to Italy last (...) spring, the pilot’s voice came over the loudspeaker: “Is there a doctor on board”? How many times have I heard this request in the last 25 years? A passenger had fainted. As I began caring for her, the pilot asked me, “Should we take the plane down?”. Surprised to be given this responsibility, I took my best guess and answered “no”. After a stressful landing, while I gave oxygen to the prostrate woman, we were met by an ambulance on the tarmac. The woman was appreciative and gracious, the pilot scarcely offered thanks, and I began my vacation exhausted.Having been trained as a paediatrician, I have responded to nearly two dozen “Good Samaritan” scenarios, where a person was injured or became critically sick in a public setting. Perhaps I have had more than my fair share, but I wonder if this is an important and mounting phenomenon. With America growing older and more and more people with serious, chronic illnesses remaining active in the community, we should not be surprised to see increasing numbers of out-of-hospital emergencies. And, as this becomes more commonplace, I become less and less certain of the role I—and other physicians like me—should have.When I was young, cocky and fearless, the call to meet an emergency was exciting. Shortly after training, an …. (shrink)

The aim of this study was to ascertain nurses' and doctors' perspectives on the practice of slow codes, which are cardiopulmonary resuscitative efforts that are intentionally performed too slowly for resuscitation to occur. A Heideggerian phenomenological study was conducted in 2005, during which data were gathered in the Republic of Ireland from three nurses and two doctors (via unstructured interviews) and analysed using Colaizzi's reductive procedure. Slow codes do occur in Ireland and are intended as beneficent acts. However, slow codes (...) were identified as pointless and undignified when intrusive measures were employed. There is a need for discussion on the topic of slow codes in Ireland, and for aids to cardiopulmonary resuscitation decision making to be developed, such as advance directives, communication training, clinical guidelines and an explanatory leaflet for patients and families. (shrink)

Background Medical ethics deals with the ethical obligations of doctors to their patients, colleagues and society. The annual reports of Sri Lanka Medical Council indicate that the number of complaints against doctors has increased over the years. We aimed to assess the level of knowledge, attitude and practice regarding medical ethics among doctors in three teaching hospitals in Sri Lanka. Methods A hospital-based cross-sectional study was conducted among doctors using a pre-tested self-administered, anonymous questionnaire. Chi Squared test, and ANOVA test (...) were used to identify the significance of association between level of knowledge and selected factors. Results Most doctors had a poor level of knowledge on medical ethics, with postgraduate trainees showing significantly higher level of knowledge. The average knowledge on medical ethics among doctors was significantly different between the three hospitals. Over 95% had a favourable attitude towards gaining knowledge and advocated the need for training. The majority indicated awareness of unethical practices. 24.6% of respondents stated that they get a chaperone ‘sometimes’ during patient examination while 3.5% never do. The majority responded that they never accept gifts from pharmaceutical companies in recognition of their prescribing pattern. 12–41% of doctors participated in the study acknowledged that they ‘sometime’ engaged in unethical practices related to prescribing drugs, accepting gifts from pharmaceutical companies and when obtaining leave. Conclusion Most doctors had a poor level of knowledge of medical ethics. Postgraduate trainees had a higher level of knowledge than other doctors. The majority showed a favourable attitude towards gaining knowledge and the need of training. Regular in-service training on medical ethics for doctors would help to improve their knowledge on medical ethics, as well as attitudes and ethical conduct. (shrink)