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June 13, 1986

Ethical Dilemmas for House Staff Physicians

Author Affiliations

Rhode Island Hospital Providence
University of Chicago Society for Health and Human Values
American Board of Internal Medicine Portland, Ore

JAMA. 1986;255(22):3113. doi:10.1001/jama.1986.03370220075011

To the Editor.—  Dr Winkenwerder's1 sensitive description of the difficult situations frequently encountered by residents is a valuable contribution to the growing literature on the ethical dimensions of graduate medical training. He correctly emphasizes the curricular inadequacies that leave residents ill-equipped to handle the ethical dimensions of clinical care and decision making. Stressing that because most formal medical ethics teaching takes place during the preclinical years, it is inevitably dominated by theoretical (or at best, hypothetical) discussion only. Even the long-term effectiveness of these preclinical ethics courses is undermined by the near absence of formal ethics training during the later, formative years of residency.Practical problem-solving approaches to the real-life ethical issues of patient care are most effectively taught in residency training. Residents are very receptive to this instruction because their first primary patient responsibilities vividly illustrate its usefulness. Moreover, residents in training have acquired the experience necessary to