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Teaching Residents the Attitudes and Empathy Required for Autonomous Practice :

November 5, 2020

Complex cases can raise multiple ethical issues.

Complex cases can raise multiple ethical issues. This month’s Ethics Rounds in Pediatrics(10.1542/peds.2020-011007) recounts a pediatric resident performing a bladder catherization on a 5-year-old girl with pyelonephritis under the supervision of a nurse. The resident attempted the procedure with difficulty serval times before succeeding, traumatizing the patient. Neither the supervising nurse nor the patient’s father interrupted the procedure, however, the father later requested the attending physician exclude all residents from future procedures. The case would be substantially different had the patient’s father refused to let the resident try to catheterize his daughter to begin with.

This more complex case permits the commentators to discuss issues in addition to how to appropriately balance trainees’ educational needs with the profession’s duty to protect patients, and how to adequately obtain informed consent for trainees’ participation in procedures. While not characterizing the procedure as a medical error, commentators nonetheless note the importance of apologizing. One also notes the power differential between physicians, nurses, and parents that may have contributed to the nurse and father’s hesitancy to interrupt the procedure. These considerations potentially contribute to the resident not only learning procedural skills, but also the attitudes and empathy required for autonomous practice.

This article raises the issues of not only how to respond to requests to exclude residents from patient care but also how to address medical errors and to empower nurses and family members. Please read it and consider how you would have acted if you were the attending.

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