Letters to the Editor
To the Editor: We applaud the recent article by Jochemsen-van der Leeuw et al1 identifying positive and negative attributes of clinical trainers as role models for interns and residents. Although the authors recommend that medical trainees consider these attributes prior to imitating specific behaviors, they stop short of exploring how medical trainees learn to manage novel professional and ethical dilemmas that role models have not had opportunity to demonstrate. Indeed, simple role modeling is necessary but not sufficient to prepare medical trainees for the professional and ethical decisions they will confront throughout their careers.
In our experience trainees from across the health sciences approach professional and ethical decisions by two means.2 First, trainees rely on personal values that, for instance, they have learned from loved ones. Second, as the authors of the article imply, more sophisticated trainees rely on behaviors learned from role models to make professional and ethical decisions. When trainees confront novel professional or ethical dilemmas, however, both approaches overlook the critical thinking process that transcends personal values and routine role modeling and that nurtures the professional and ethical principles inherent to medical care. It is this critical thinking process that clinical trainers must demonstrate so that trainees have the essential tools to manage the range of professional and ethical quandaries they will encounter upon entering medical practice.
Clinical trainers commonly use the SOAP (Subjective, Objective, Assessment, and Plan) method to teach trainees a critical thinking process for solving clinical problems. As we have argued elsewhere, “professional and ethical decisions require precisely the same evaluation and analytic skills afforded to clinical cases.”2 Thus we contend that the SOAP method is equally applicable to decisions about novel professional and ethical dilemmas: identify the Subjective and Objective elements of the professional or ethical dilemma to make an Assessment about potential courses of action in order to reach and execute a Plan that satisfies professional and ethical responsibilities.2
Role modeling is a necessary part of clinical education. However, medical trainees also need reliable tools that will help them develop a familiar and lasting critical thinking process for decisions about novel professional and ethical dilemmas throughout their careers.
Christopher R. Freed, PhD
Assistant professor of sociology, Department of
Sociology, Anthropology and Social Work, University
of South Alabama, Mobile, Alabama; firstname.lastname@example.org.
Ronald D. Franks, MD
Vice president for health sciences and professor of
psychiatry, University of South Alabama, Mobile,
1. Jochemsen-van der Leeuw HG, van Dijk N, van Etten-Jamaludin FS, Wieringa-de Waard M. The attributes of the clinical trainer as a role model: A systematic review. Acad Med. 2013;88:26–34
2. Freed CR, Bonnici DM, Craddock LN, Franks RD. Professional and ethical decision-making among health science students: A call to action about critical thinking. Med Sci Educ. 2012;22:33–36