Appendix 2b - Team Player

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

Looking Good

A survey in Academic Medicine found that 89% of trainees personally observed unethical conduct by residents or attending physicians. "Unreasonable demands beget unreasonable actions," one commentator writes. "A system that works people 100 hours a week and more propagates a vicious circle of ethical compromises."[37]

In a 1998 sampling of 1700 American second year residents, 46% saw others falsifying patient records; 70% saw others mistreating patients.[38] Over one fourth of the residents (28.6%) stated that they had been required to do something that they believed was, "immoral, unethical or personally unacceptable."[39] They, "Did something unethical 'to fit in with the team.'"[40]

From the Academic Medicine article:

Pressures to be efficient, look good, and to fit into the environment invited ethical corner-cutting. An underlying tension is whether to 'rock the boat' or be a 'team player' (for instance, even though she may harm a patient, a student performs a procedure when the attending tells her to because she fears offending him). Seeing that their learning often comes at the expense of patients is emotionally difficult, and pressures to fit in usually guarantee that such worries go unexpressed.[41]

Wild Inhibitions

Quoting from an article in Medical Education, "Recent studies have found that the increase in moral reasoning and moral development normally expected for the age and education level of medical students are not occurring over their four years of undergraduate medical education...."[42] Evidence is beginning to appear that demonstrates that the structure of medical education may actually inhibit moral reasoning ability rather than facilitate it.[43] Ethical sensitivity increases between the 1st and 2nd year but then decreases throughout the rest of medical school, such that the 4th-year students are less ethically sensitive than those entering medical school.[44]

Interestingly, the same thing happens in dental school.

Our original expectation [in studying three dental school classes in California] was that, as the students progressed through dental school, they would learn more about professional ethics and display a higher level of ethical responses. The exact opposite occurred.... In the first year 67 percent had a high ethics score... in the final year it had plummeted to 18 percent.... Approaching the end of their professional education, the students were at the nadir of ethicality.


[37] Hundert, EM. "Characteristics of the Informal Curriculum and Trainees' Ethical Choices." Academic Medicine 71(1996):624-640.

[38] Daugherty, SR, DC Baldwin and BD Rowley. "Learning, Satisfaction, and Mistreatment During Medical Internship." Journal of the American Medical Association 279(1998):1194-1199.

[39] Baldwin, DC, SR Daugherty and BD Rowley. "Unethical and Unprofessional Conduct Observed by Residents during Their First Year of Training." Academic Medicine 73(1998):1195-1200.

[40] Satterwhite, WM, RC Satterwhite and CE Enarson. "Medical Students' Perceptions of Unethical Conduct at One Medical School." Academic Medicine 73(1998):529-531.

[41] Hundert, EM. "Characteristics of the Informal Curriculum and Trainees' Ethical Choices." Academic Medicine 71(1996):624-640.

[42] Self, DJ, et al. "The Moral Development of Medical Students." Medical Education 27(1993):26-34.

[43] Self, DJ and DC Baldwin. "Does Medical Education Inhibit the Development of Moral Reasoning in Medical Students?" Academic Medicine 73(1998):S91-S93.

[44] Hebert, PC, EM Meslin and EV Dunn. "Measuring the Ethical Sensitivity of Medical Students." Journal of Medical Ethics 18(1992):142-147.

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