For Residents

Training and ethics for treating critically ill children

It's an ethical question that has been discussed in medical circles for years: How do we train new doctors to perform life-saving procedures while maintaining high-quality patient care?

An article in this month's Virtual Mentor—the AMA's online ethics journal—grapples with finding the optimum balance between the educational needs of trainees and safe, efficient patient care when dealing with critically ill children. While it's clear that trainees need practice to develop the skills to become tomorrow's high-quality clinicians, the risk of complications is higher when trainees perform procedures.

The authors argue that this dilemma has been compounded by the fact training programs generally perceive that residents are performing fewer procedures since the Accreditation Council for Graduate Medical Education established new duty-hour limitations. Accrediting organizations don't often require that residents perform a certain number of life-saving procedures, but even if they have completed the minimum recommended, residents don't always feel comfortable in their abilities.

The authors conclude that "in the era of specialization, while all pediatric trainees should learn a minimum set of effective life-saving procedures, training in advanced skills … should be reserved for those who are specializing in emergency medicine, neonatology, anesthesia, and critical care."

The traditional "see one, do one, teach one" approach is no longer acceptable, they say, and programs need to determine which "procedures pediatric trainees need to learn and which clinicians need to develop competency in additional skills to care for the critically ill child." They also advocate for the use of simulation training and closely supervised experiences before residents are allowed to actually perform these delicate procedures in clinical situations.

Interview initiative captures minority doctors' inspiration

Did you know that only about 9 percent of all U.S. physicians are African-American, Hispanic, American Indian, Native Hawaiian or Alaskan Native? Meanwhile, almost 30 percent of the patient population are from these racial and ethnic groups.

Trends such as this demonstrate the need to increase the amount of underrepresented minorities in the field of medicine. The AMA has attempted to analyze these trends through its Physician Interview Project, an effort to learn from minority physicians what helped guide them in their career paths. The initiative aims to ascertain specific determinants that have proven successful in helping minority students pursue medicine as a career.

View an edited video of interviews with several minority physicians and see how these doctors are making a difference. You also can view the entire interview of each participating physician on the Physician Interview Project Web page.