Article

Perspective: Creating an Ethical Workplace: Reverberations of Resident Work Hours Reform

Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 04/2009; 84(3):315-9. DOI: 10.1097/ACM.0b013e3181971ee1
Source: PubMed

ABSTRACT

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The development of ethical physicians is highly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The consequence of long duty hours on the moral development of physicians is less understood. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. The dynamic relationship between individual character traits and the situational dependence of their expression suggests that a systems approach will help promote and nurture moral development. Ethical behavior can be supported by systems that make it more difficult to veer from the ideal. Work hours limits are a structural change that will help preserve public safety by preventing physicians from taking the moral shortcuts that can occur with increasing work and time pressures. Work hours rules are beneficial but insufficient to optimize an ethical work and training environment. Additional measures need to be put in place to ensure that ethical tensions are not created between the patient's well-being and the resident's adherence to work hours rules. The ethical ideals of physician autonomy, selflessness, and accountability to the patient must be protected through the judicious and flexible use of work hours limits, physician extenders, census caps, nonteaching services, and high-quality handoffs.

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    • "Fourth, and due to emergent concerns about quality of care and patient safety issues (ABIM Foundation, ACP-ASIM Foundation & European Foundation of Medicine, 2002; Lopez & Katz, 2009), the demands of pedagogy are beginning to take a back seat to the demands of work, whether that be in the clinic, classroom, or confessional. Thus, while it is well established that learning must take place alongside , or even within, the responsibilities for delivering services, it also is held to be true that the need to train future practitioners must not unduly disrupt the essential nature of that work. "
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    ABSTRACT: If the ultimate goal of workplace learning is to be successful teaching students who have been placed in the workplace setting to learn, then strategies that will help the instructors learn how to support the students are the goal of faculty development (also called staff development or educational development in different countries and disciplines) and its practitioners. To use the more familiar workplace learning denotation, faculty developers are the trainers who train the trainers. The focus of that training, and this chapter, is the workplace instructor and the goal of that training is to make the workplace instructors more effective when helping students. This chapter will identify evidence-based practices that can help instructors be more effective, while maintaining the integrity of the workplace activities.
    Full-text · Chapter · Dec 2010
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    • "Fourth, and due to emergent concerns about quality of care and patient safety issues (ABIM Foundation, ACP-ASIM Foundation & European Foundation of Medicine, 2002; Lopez & Katz, 2009), the demands of pedagogy are beginning to take a back seat to the demands of work, whether that be in the clinic, classroom, or confessional. Thus, while it is well established that learning must take place alongside , or even within, the responsibilities for delivering services, it also is held to be true that the need to train future practitioners must not unduly disrupt the essential nature of that work. "
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    ABSTRACT: This chapter on conceptions and theories of learning is intended to inform the work of educators about those components of professional education that occur in the practice settings of the workplace, the signature pedagogy in education for the professions. In those milieus, novices experience professional socialization as they enter into a community of practice; develop clinical and professional skills through observation, coaching, mentoring, and supervision; and develop specialized knowledge as the situations of practice provide meaning and motivation for abstract learning. The role of this chapter within this book as a whole is to characterize conceptions and theories of learning that are particularly applicable to learning in the workplace, providing a context for the synthesis of research on pedagogy and best teaching practices in workplace settings and recommendations on assessment and faculty development. The focus of this chapter is on learning in the context of practice situations in the early stages of professional education.
    Preview · Chapter · Dec 2010
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    • "Fourth, and due to emergent concerns about quality of care and patient safety issues (ABIM Foundation, ACP-ASIM Foundation & European Foundation of Medicine, 2002; Lopez & Katz, 2009), the demands of pedagogy are beginning to take a back seat to the demands of work, whether that be in the clinic, classroom, or confessional. Thus, while it is well established that learning must take place alongside , or even within, the responsibilities for delivering services, it also is held to be true that the need to train future practitioners must not unduly disrupt the essential nature of that work. "
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    ABSTRACT: This chapter is intended to inform the work of educators for the professions and focuses on the formal curriculum and conceptual perspectives, particularly as they relate to those components of professional education that occur in the practice settings of the workplace. The author presents a definition of the concept of curriculum; discusses the rationale for the pervasive attention to learning in the practice settings of the workplace within professions education curricula, typically very early in the preservice curriculum; and discusses the implications for learning in the workplace of three predominant traditions of scholarship and practice in curriculum studies – the systems, deliberative curriculum inquiry, and “reconceptualist” approaches.
    Preview · Chapter · Dec 2010
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