110 Pediatric Postgraduate Residents' Perceptions of Ethical Dilemmas during their Training

Pediatric residents face numerous ethical dilemmas. Some of the ethical issues they face are experienced by all pediatricians, and other issues are specifically related to resident training. It has been found that medical students often feel they are placed in positions which compromise their own ethical principles or feel that have been harassed or abused in their training. A US study showed that residents frequently face examples of unethical and/or unprofessional conduct amongst staff and further, the residents did not know how to respond to these issues. There is, however, little description of the ethical dilemmas facing Canadian postgraduate trainees. The purpose of this study is to identify and describe in more detail the ethical dilemmas perceived by pediatric residents in their training program. Qualitative research methods were used to study the lived experience of pediatric residents. Data collection consisted of four focus groups organized according to the four separate years of residency training. Focus groups consisted of 4–10 participants, and were led by a research assistant from the University of Toronto Joint Centre for Bioethics. The focus groups were audio taped and transcribed verbatim eliminating all data that would identify any of the participants or staff mentioned. Data analysis involved a modified thematic analysis in two steps: first in open coding and then by identifying chunks of data that relate to a concept or idea. For example, power relationships, communication issue, lack of training were three of the codes used to identify data. While residents occasionally face the traditional pediatric ethical issues such as “do not resuscitate” and “demands for futile treatment”, more often they face dilemmas due to the hierarchy of the medical care team, and these often on a daily basis. Their ability to deal and cope with these issues change as they go through their training. Many residents in the first part of their training were more frustrated and confused with ethical issues, how to address them with others or how to deal with them on their own. In these cases, residents found their best support from their peers and other senior residents. Residents in the later years of training seem more accustomed to ethical issues and did not view them quite as significant as their juniors. Common to all residents was the disconnection with senior physicians and fellows. Many felt that both staff physicians and fellows were unapproachable, over directive and in some cases accusatory. Residents at all levels of training have felt that their own moral principles have been compromised, but were unsure how to deal with this, and most dealt with it inwardly. Further, almost all residents felt that other members of their health care team have acted in an unethical or unprofessional way, and that there was no way to manage with this. Pediatric residents face serious ethical dilemmas. Understanding these ethical dilemmas will help those responsible for postgraduate medical education (a) to review or revise the ethics curriculum in keeping with the current ethical dilemmas faced by residents and (b) to mentor and guide trainees.

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