The practice of medicine is a complex endeavor requiring high levels of knowledge and technical capability, and the capacity to apply the skills and knowledge to do the right thing in the right way, for the right reason, in a particular context. The orchestration of the virtues, managing uncertainty, applying knowledge and technical skills to a particular individual in a particular circumstance, and exercising the virtues in challenging circumstances, are the tasks of practical wisdom. Centuries ago, Aristotle suggested that capacities (...) for wise action are developed through practice, experience, and reflection. Neuroscience and cognitive psychology are now beginning to contribute to our understanding of the complex interplay between emotion, cognition, and behavior that is necessary for wise action, and how this capacity for wise action can be developed. In this paper, I propose that wisdom offers an appropriate true north for medical education. Wisdom shifts the focus beyond the simple acquisition of knowledge and technical skills and integrates essential virtues like compassion, trustworthiness, humility, and the balancing of the virtues, into the professional formation for medical students. Informed by the humanities, the neurosciences, and the social sciences, we must now integrate the skills and practices necessary to the development of practical wisdom into medical education at all levels. (shrink)

Caring for hospitalized patients with COVID-19 raises ethical dilemmas in which clinicians must weigh the unknown value of an intervention against the unknown risk of viral transmission. Current guidelines for delivering high-value care in the time of the COVID-19 pandemic do not directly address ethical dilemmas that arise from the unique concerns of individual patients. We propose an “ethical pause” in which clinicians address ethical dilemmas by taking time to ask three questions that invoke the major bioethical principles of beneficence, (...) nonmaleficence, and distributive justice: will this intervention help my patient? Could this intervention harm my patient? Could this intervention harm or help others? Using two exemplar cases, we demonstrate how the process of deliberately asking and answering structured ethical questions is a mindful problem-solving strategy that facilitates delivery of high-value care. (shrink)