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ABSTRACT BACKGROUND The use of online social networks (OSNs) among physicians and physicians-in-training, the extent of patient–doctor interactions within OSNs, and attitudes among these groups toward use of OSNs is not well described. OBJECTIVE To quantify the use of OSNs, patient interactions within OSNs, and attitudes toward OSNs among medical students (MS), resident physicians (RP), and practicing physicians (PP) in the United States. DESIGN/SETTING A random, stratified mail survey was sent to 1004 MS, 1004 RP, and 1004 PP between February and May 2010. MEASUREMENTS Percentage of respondents reporting OSN use, the nature and frequency of use; percentage of respondents reporting friend requests by patients or patients’ family members, frequency of these requests, and whether or not they were accepted; attitudes toward physician use of OSNs and online patient interactions. RESULTS The overall response rate was 16.0% (19.8% MS, 14.3% RP, 14.1% PP). 93.5% of MS, 79.4% of RP, and 41.6% of PP reported usage of OSNs. PP were more likely to report having visited the profile of a patient or patient’s family member (MS 2.3%, RP 3.9%, PP 15.5%), and were more likely to have received friend requests from patients or their family members (MS 1.2%, RP 7.8%, PP 34.5%). A majority did not think it ethically acceptable to interact with patients within OSNs for either social (68.3%) or patient-care (68.0%) reasons. Almost half of respondents (48.7%) were pessimistic about the potential for OSNs to improve patient–doctor communication, and a majority (79%) expressed concerns about maintaining patient confidentiality. CONCLUSION Personal OSN use among physicians and physicians-in-training mirrors that of the general population. Patient–doctor interactions take place within OSNs, and are more typically initiated by patients than by physicians or physicians-in-training. A majority of respondents view these online interactions as ethically problematic.

Purpose To assess the extent and types of publication misrepresentation among medical students applying to the urology residency program at the University of Washington. Research experience and publications are the selection criteria used to judge and rank urology residency applicants. Methods Electronic Residency Application Service (ERAS) applications submitted for the incoming class of 2011 for urology residency at the University of Washington were reviewed. All listed publications were verified against PubMed and Google search engines. Misrepresentation was defined as non-authorship of an existing article, authorship claimed of a nonexistent article, or first-authorship listed incorrectly. Results Of the 198 total applications, 124 (63 %) applicants reported 541 publications, including 112 abstracts and 429 journal articles. 347 (65 %) articles and abstracts were verifiable. Misrepresentation of 12 (3.5 %) published articles was found in 9 applicants (7 %), which included self-promotion to first-authorship (6), followed by non-existent articles (5), and a repeated publication listing (1). On univariate analysis, higher age ( p  = 0.008), higher number of total publications reported ( p  < 0.001), additional graduate degree ( p  < 0.001), and foreign medical graduate (FMG) status ( p  < 0.001) were associated with misrepresentation. Due to the low incidence, the study was not adequately powered to perform a multivariate analysis. Conclusions Misrepresentation of publications listed in ERAS among urology applicants remains significant. Residency program directors should require applicants to submit copies of all of their publications, whether in print, in-press, or submitted to be placed as part of their application file.

The development and deployment of matching procedures that incentivize truthful preference reporting is considered one of the major successes of market design research. In this study, we test the degree to which these procedures succeed in eliminating preference misrepresentation. We administered an online experiment to 1,714 medical students immediately after their participation in the medical residency match—a leading field application of strategy-proof market design. When placed in an analogous, incentivized matching task, we find that 23% of participants misrepresent their preferences. We explore the factors that predict preference misrepresentation, including cognitive ability, strategic positioning, overconfidence, expectations, advice, and trust. We discuss the implications of this behavior for the design of allocation mechanisms and the social welfare in markets that use them.

ABSTRACT Moral distress is the experience of cognitive-emotional dissonance that arises when one feels compelled to act contrary to one’s moral requirements. Moral distress is common, but under-recognized in medical education and training, and this relative inattention may undermine educators’ efforts to promote empathy, ethical practice, and professionalism. Moral distress should be recognized as a feature of the clinical landscape, and addressed in conjunction with the related concerns of negative role modeling and the goals and efficacy of medical ethics curricula.

This study aims to understand the perspectives of operative autonomy of surgical residents at various postgraduate levels. Categorical general surgery residents at a single academic residency were invited to participate in focus groups to discuss their opinions and definitions of operative autonomy. Employing constructivist thematic analysis, focus groups were audio recorded, transcribed, and inductively analyzed using a constant comparative technique. Twenty clinical surgical residents participated in 6 focus groups. Overarching themes identified include autonomy as a dynamic, progressive path to operative independence and the complex interaction of resident-as-teacher development and operative autonomy. Four within operative case themes were intrinsic factors, extrinsic factors, autonomy promoting or inhibiting behaviors, and the relationship between residents and attendings. Residents define operative autonomy as a progressive and dynamic pathway to operative independence. Teacher development is viewed as both an extension beyond operative independence and potentially in conflict with their colleagues’ development. [Display omitted] •Residents define autonomy as a dynamic and progressive path to operative independence.•The autonomy granted is influenced by intrinsic factors and behaviors of residents and attendings.•Extrinsic pressures such as time, outcomes, and hospital metrics negatively impact autonomy.•Resident teacher development may come in direct conflict with operative autonomy.

This study characterizes prevalence, frequency, and forms of patient-derived gender-based discrimination (GBD) experienced by resident physicians, as well as their experiences witnessing and reporting patient-derived GBD. A web-based survey was sent to residents from 12 programs at three academic institutions. Response rate was 47.9% (309/645) with 55.0% of respondents identifying as women. Women were more likely than men to experience patient-derived GBD during residency (100% vs 68.8%, p < 0.001), including inappropriate physical contact, receiving less trust from patients, and being mistaken for a nurse (p < 0.001). While 85.9% of residents personally experienced and 95.0% of residents witnessed patient-derived GBD, only 3.4% of residents formally reported patient-derived GBD. Women were more likely to report negative personal and professional consequences of patient-derived GBD. Patient-derived GBD is pervasive and disproportionately affects women residents. Current reporting mechanisms are not adequately capturing nor addressing patient-derived GBD. •Patient-derived GBD is experienced by the majority of resident physicians.•Women physicians are ubiquitously affected by patient-derived GBD.•Women are more likely to experience personal and professional consequences of patient-derived GBD.•Current reporting mechanisms do not adequately capture or address patient-derived GBD.

BackgroundThe COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories.MethodWe used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed.Results11 residents participated across several programmes. Three main themes emerged from the participants’ stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants’ journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together.DiscussionCases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics.ConclusionEfforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems.

While the proliferation of diversity, equity, and inclusion (DEI) initiatives among medical schools and residency training programs has provided important benefits of demographic and experiential diversity among medical trainees, there has not been a similar emphasis upon the importance of moral diversity in medical training. Enhanced attention to the importance of moral diversity and the centrality of conscience to medical practice might allow trainees to better interface with the morally diverse patients they serve, learn important virtues like humility, patience, and tolerance, and deepen their understanding of and appreciation for alternative moral viewpoints among their fellow practitioners.

Background Residents who do not internalize professional values may not be a good fit for their specialty and compromise the quality of their patient care. Research aimed at recognizing residents’ shortcomings in professionalism may help to prevent future shortcomings towards patients. The aim of this study was to increase insight into residents’ shortcomings in medical professionalism in light of professional values relevant within residency training. Methods We analyzed all law cases from the Dutch national conciliation board from 2011 to 2020 on the unprofessional behaviors described. Results During the period investigated, 61 dismissed residents challenged their dismissal. In 39 of 61 cases (64%), the program director named unprofessional behavior(s) as (one of the) reasons for dismissal. The most prevalent deficit of residents deemed unprofessional was poor self-awareness (80%); less prevalent deficits were: shortness of engagement and dishonest and disrespectful behavior (31% or less). Conclusions We describe perceived unprofessional behavior in residency, which was not about exceptional or abominable behaviors. For the most part, these behaviors concerned the accumulation of remediation-resistant day-to-day underperformance, discrediting trust and professional reliability. This finding encourages dedicated longitudinal assessment of professionalism and fuels the ethical debate about required professional values in hospital care.

Critics argue, essentially, that there is no ethical way to study residents' duty-hour rules in a randomized fashion. But in assuming that untested practice is safe, we have compromised trainees' freedom to judge for themselves when their patients need them. In 2014, Facebook users were furious to discover that they’d unwittingly been experimented on. 1 Researchers had randomly assigned users to news feeds with reduced “positive” content or reduced “negative” content and found that happy posts beget happy posts and that grim ones beget grim ones. 2 Although that may now seem obvious, previous evidence had suggested that because we tend to compare ourselves to others, exposure to positive content compromises users’ well-being. There was thus no reason to believe that the status quo — news feeds curated by an algorithm tailored to users’ viewing habits — was any “safer” than the . . .