Medicine and Health Sciences Commons^™

The Disavowed Curriculum: Understanding Student's Reasoning In Professionally Challenging Situations, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

CONTEXT: Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE: Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN: Qualitative study using 5 videotaped scenarios (each depicting a student placed in a situation which requires action in response to a professional dilemma) and individual interviews, in which students were questioned about what they would do next and why. SETTING: University of Toronto. PARTICIPANTS: Eighteen fourth-year medical students; participation voluntary and anonymous. MAIN OUTCOME MEASURE: A model to explain students' reasoning in the face …

Context, Conflict, And Resolution: A New Conceptual Framework For Evaluating Professionalism, Shiphra Ginsburg, Glenn Regehr, Rose Hatala, Nancy Mcnaughton, Alice Frohna, Brian Hodges, Lorelei Lingard, David Stern

Lorelei Lingard

No abstract provided.

Before The White Coat: Perceptions Of Professional Lapses In The Pre-Clerkship, Shiphra Ginsburg, Natasha Kachan, Lorelei Lingard

Lorelei Lingard

BACKGROUND: It has been shown that the professional development of clinical clerks is influenced by their experiences of unprofessional behaviour, but the perceptions of pre-clerkship students have received relatively little attention. Our purpose was to develop a greater contextual understanding of the situations in which pre-clerkship students encounter professional challenges, and to investigate what pre-clerkship students consider to be professional lapses in these situations.

METHODS: We conducted 4 focus groups (n = 22 students); transcripts were analysed by 3 researchers using grounded theory.

RESULTS: Pre-clerkship students reported lapses in the areas of communicative violation, role resistance, objectification, accountability and harm, …

To Be And Not To Be: The Paradox Of The Emerging Professional Stance, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

PURPOSE: Understanding how students resolve professional conflict is essential to teaching and evaluating professionalism. The purpose of this study was to refine an existing coding structure of rationalizations of student behaviour, and to further our understanding of students' reasoning strategies in the face of perceived professional lapses.

METHODS: Anonymous essays were collected from final year medical students at two universities. Each essay included a description of a specific professional lapse, and a consideration of how the lapse was dealt with. Essays were analysed using grounded theory. The resulting coding structure was applied using NVivo software.

RESULTS: Twenty essays, containing 147 …

Critically Appraising Qualitative Research, Ayelet Kuper, Lorelei Lingard, Wendy Levinson

Lorelei Lingard

No abstract provided.

Ethics Of Surgical Training In Developing Countries, Kevin Ramsey, Charles Weijer

Charles Weijer

The practice of surgical trainees operating in developing countries is gaining interest in the medical community. Although there has been little analysis about the ethical impact of these electives, there has been some concerns raised over the possible exploitation of trainees and their patients. An ethical review of this practice shows that care needs to be taken to prevent harm. Inexperienced surgeons learning surgical skills in developing countries engender greater risk of violating basic ethical principles. Advanced surgical trainees who have already achieved surgical competence are best qualified to satisfy these ethical issues. All training programs need to develop a …

A Death In The Family: Reflections On The Terri Schiavo Case, Charles Weijer

Charles Weijer

No abstract provided.

Will The Real Charles Fried Please Stand Up?, Paul Miller, Charles Weijer

Charles Weijer

In response to the preceding commentary by Jerry Menikoff in this issue of the Journal, the authors argue that Fried's central concern is not that randomized clinical trials (RCTs) are conducted without consent, but rather that various aspects of the design and conduct of RCTs are in tension with physicians' duties of personal care to their patients. Although Fried does argue that the existence of equipoise cannot justify failure to obtain consent from research subjects, informed consent by itself does not supplant ill subjects' rights to personalized judgment and care embodied in Fried's equipoise.

The Ethics Of Placebo-Controlled Trials, Charles Weijer, Kathleen Glass

Charles Weijer

No abstract provided.

Minimal Risk And Its Implications, Charles Weijer

Charles Weijer

No abstract provided.

Misrepresenting Research: Commentary, Charles Weijer

Charles Weijer

No abstract provided.

Benefit-Sharing And Other Protections For Communities In Genetic Research, Charles Weijer

Charles Weijer

No abstract provided.

Clinical Equipoise And Not The Uncertainty Principle Is The Moral Underpinning Of The Randomised Controlled Trial, Charles Weijer, Stanley Shapiro, Kathleen Glass

Charles Weijer

No abstract provided.

Reporting The Study Populations Of Clinical Trials. Clear Transmission Or Static On The Line?, Stanley Shapiro, Charles Weijer, Benjamin Freedman

Charles Weijer

In contrast to attempts that have been made to measure the clarity of reporting of the methods of clinical trials in journal articles, we report here an attempt to measure the accuracy of methods reporting. We focus in this article on eligibility criteria as a test case for the reporting of clinical trial methods. We examined the reporting of eligibility criteria in the protocol, methods paper (if applicable), journal article, and Clinical Alert for articles appearing in print between January 1988 and September 1994 for which a Clinical Alert had been issued. Eligibility criteria were further classified into five categories …

What's The Price Of A Research Subject?, Charles Weijer

Charles Weijer

No abstract provided.

Protecting Communities In Research: Philosophical And Pragmatic Challenges, Charles Weijer

Charles Weijer

The issue of the protection of communities in clinical research first arose 10 years ago in studies conducted in technologically developing countries by scientists from technologically developed nations. The question was, which ethical standards ought to apply, those of the Western investigators or local standards?

Voting Ourselves Rights: A Critique Of The Canadian Medical Association Charter For Physicians, Nuala Kenny, Charles Weijer, Francoise Baylis

Charles Weijer

No abstract provided.

Another Tuskegee?, Charles Weijer

Charles Weijer

No abstract provided.

Placebo-Controlled Studies In Schizophrenia: Ethical And Scientific Perspectives. Panel Discussion, T. Lemmens, P. Appelbaum, W. Carpenter, C. Mccarthy, C. Peterson, D. Streiner, Charles Weijer

Charles Weijer

No abstract provided.

Placebo-Controlled Trials In Schizophrenia: Are They Ethical? Are They Necessary?, Charles Weijer

Charles Weijer

The current controversy as to the proper role of the placebo control in the evaluation of new treatments for schizophrenia requires an analysis that is sensitive to both ethical and scientific issues. Clinical equipoise, widely regarded as the moral foundation of the randomized controlled trial (RCT), requires the use of best available treatment as the control in RCT. Scientific criticisms of the use of an active control are examined and none present an insuperable barrier to the use of an active control. Indeed, scrutiny of the most recent argument for the use of placebo controls, 'assay sensitivity', suggests that the …

Why Should We Include Women And Minorities In Randomized Controlled Trials?, Charles Weijer, R. Crouch

Charles Weijer

No abstract provided.

Bioethics For Clinicians: 16. Dealing With Demands For Inappropriate Treatment, Charles Weijer, Peter Singer, Bernard Dickens, Stephen Workman

Charles Weijer

Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus …

Self Interest Is Not The Sole Legitimate Basis For Making Decisions, Charles Weijer

Charles Weijer

No abstract provided.

Cardiopulmonary Resuscitation For Patients In A Persistent Vegetative State: Futile Or Acceptable?, Charles Weijer

Charles Weijer

No abstract provided.

A Study In Contrasts: Eligibility Criteria In A Twenty-Year Sample Of Nsabp And Pog Clinical Trials, Abraham Fuks, Charles Weijer, Benjamin Freedman, Stanley Shapiro, Myriam Skrutkowska, Amina Riaz

Charles Weijer

We studied changes in eligibility criteria--the largest impediment to patient accrual--in two samples of clinical trials. Trials from the NSABP (National Surgical Adjuvant Breast and Bowel Program) and POG (Pediatric Oncology Group) were analyzed. After eliminating duplications, the criteria in each protocol were enumerated and classified according to a novel schema. NSABP trials contained significantly more criteria than POG trials, and added precision criteria (making study populations homogeneous) at a faster rate than POG studies. The difference between NSABP studies (explanatory trials) and POG studies (pragmatic trials) suggest that large numbers of eligibility criteria are not necessary for quality studies. …

Ccnp Position Paper On The Use Of Placebos In Psychiatry, William Friend, Charles Weijer

Charles Weijer

No abstract provided.

Evolving Ethical Issues In Selection Of Subjects For Clinical Research, Charles Weijer

Charles Weijer

Wittgenstein, in his famous critique of philosophy, noted that the influence of an idea can be such that it alters the way that we see the world. “It is like a pair of glasses on our nose through which we see whatever we look at,” he said. “It never occurs to us to take them off.” This view of the power of an idea suggests that the interpretation of an event, and what response this event calls for, can depend upon the view one has of the world. A person who is naive about medical facts may, for example, interpret …

Placebo Orthodoxy In Clinical Research I: Empirical And Methodological Myths, Benjamin Freedman, Charles Weijer, Kathleen Glass

Charles Weijer

No abstract provided.

Placebo Orthodoxy In Clinical Research Ii: Ethical, Legal, And Regulatory Myths, Benjamin Freedman, Kathleen Glass, Charles Weijer

Charles Weijer

No abstract provided.

The Breast Cancer Research Scandal: Addressing The Issues, Charles Weijer

Charles Weijer

The three claims put forward by Dr. Roger Poisson to rationalize his enrollment of ineligible subjects in clinical trials do not justify research fraud. None the less, certain lessons for the conduct of clinical research can be learned from the affair: experimental therapies should be made available to technically ineligible subjects when no effective therapy exists for their disease; further research must investigate the possible benefits of clinical-trial participation; broadly based, pragmatic trials must be regarded as the ideal model; and each eligibility criterion in a clinical-trial protocol should be justified.