Letters to the Editor
To the Editor:
Myers and Herb1 do a great service to clerkship directors in reminding them of the importance of addressing the problems first identi fied by Christakis and Feudtner2 in this journal 10 years ago. From my experience teaching ethics in clerkships for 20 years, it is clear that clerks often feel moral distress that needs to be addressed if they are to maintain (or reclaim) their idealism and altruism. Reflective exercises like journaling help, but proactive administrative support is equally important. Students ought to be confident that legitimate institutional problems will be addressed. That said, however, it must be emphasized that this is only one part of the ethics that must be taught in the clerkships. It would be a sorry missed opportunity if third-year ethics were reduced to the “ethics of the short white coat,” issues unique to medical students, when the purpose of the clerkships is to help them identify the career goal that best fits their interests and talents.
Each clerkship ought to include a frank introduction to the ethical issues unique to its field, so as to help students make a better career choice. Third-year students would be wise to choose a field where the ethical issues seem important enough that they want to engage them in their practice daily for 30 or 40 years. And they should avoid going into any field whose ethical issues seem trivial or annoying—they will eventually lead to boredom or frustration. To enable students to make an informed career choice, then, it is necessary to introduce them to the ethical issues in each field of medicine.
As an experienced ethicist, the third year is the most important year to teach clinical ethics to future clinicians. This is where students learn that “medical ethics” is not confined to internal medicine, and that any decision that affects a patient has an ethical dimension. This is the right time and place for “just in time” teaching: The clerkships should be where ethical issues in obstetrics are taught, as well as pediatric ethics, and surgical ethics, and neuroethics, and ethical issues in psychiatry. To make the teaching most effective, the same lessons must also be presented to the residents and faculty—for example, in intensive care unit rounds and grand rounds.3
Jeffrey P. Spike, PhD
Samuel Karff Professor, John McGovern Center for Humanities and Ethics, UT-Health, Houston, Texas; firstname.lastname@example.org.
1. Myers MF, Herb A. Ethical dilemmas in clerkship rotations. Acad Med. 2013;88:1609–1611
2. Christakis DA, Feudtner C. Ethics in a short white coat: The ethical dilemmas that medical students confront. Acad Med. 1993;68:249–254
3. Spike JP. Residency education in clinical ethics and professionalism: Not just what, but when, where, and how ought residents be taught? Am J Bioethics. 2006;6:1 July/August