Ethical Issues Confronting Medical Students During a Clerkship in Emergency Medicine

Check out this interesting article for our upcoming Fall 2022 issue!

https://msrj.chm.msu.edu/wp-content/uploads/2022/11/219-ePub-final.pdf

Abstract

Background: Little is known about the ethical issues confronting medical students during their first exposure to emergency medicine (EM). The aim of this study was to review student narratives to determine the type and frequency of ethical issues that beginning students confront in the ED.

Methods: This was a prospective, qualitative observational study of consecutive first- and second-year medical students electing to do a pre-clinical clerkship in Emergency Medicine (EM) at five university- affiliated hospitals. Students were asked to write a short description of three cases that had the greatest impact on them during the month-long clerkship. Each essay was independently analyzed by five members of the research team. Descriptive and kappa statistics were used to summarize the data.

Results: During the four-year study period, 292 consecutive student essays were evaluated from 103 medical students. A total of 194 specific incidents were coded across 15 categories of ethical standards. Overall, 71.1% (138/194) were depictions of exemplary instances of ethical issues, 13.9% (27/194) were considered normal interactions, and 14.9% (29/194) were categorized as unethical behavior. While generally impressed by the admirable behavior of faculty and staff, students were quick to describe instances of improper treatment of patients, such as poor communication, discrimination, improper pain management, or a perceived lack of empathy.

Conclusions: Narrative essays describe a wide variety of interesting ethical situations that beginning medical students confront during their clerkships. Many of these ethical interactions seem to be connected to the student’s role as an observer of the health care team and how that role can lead to ethical tension. As educators, we need to shine a light on the subtle ethical issues that clerkship students struggle with daily and give them practical tools to deal with moral decisions required of them in medical practice.

Quadricuspid Aortic Valve by Transesophageal Echocardiography

Check out this early release of the latest article for our Fall 2022 issue!

http://msrj.chm.msu.edu/wp-content/uploads/2022/11/222-epub-final.pdf

Abstract

Quadricuspid aortic valves (QAVs) are a rare congenital anomaly associated with increased risk of aortic insufficiency. This case presents the incidental finding of a quadricuspid aortic valve on intraoperative transesophageal echocardiography after going undetected on transthoracic echocardiography multiple times, suggesting that transesophageal echocardiography may be a superior imaging modality for the identification of this defect. This patient with a history of coronary artery disease presented with sudden onset moderate to severe aortic insufficiency and required subsequent aortic valve replacement (AVR).

A case of Petit’s hernia presenting as bilateral lipomata of the back

Another new and interesting article! Click the link below to view the full case study.

https://msrj.chm.msu.edu/wp-content/uploads/2022/11/228-ePub-final.pdf

Abstract

We aim to add to the literature regarding Petit (inferior lumbar) hernias. The presence and location of lower back masses may have a deeper origin than initially apparent. We urge the surgical community to keep in mind the differential diagnosis of lumbar hernia, although rare, when evaluating subcutaneous masses and lipomata in this region. Simple excision may address the mass but not the cause and will lead to early recurrence of the presenting problem.

Idiopathic Acute Four-Compartment Syndrome of the Lower Leg

Check out the link below to view the full article.

http://msrj.chm.msu.edu/wp-content/uploads/2022/11/223-epub-final.pdf

Abstract

Case: We present a case of acute idiopathic four-compartment syndrome of the leg, treated by four-compartment fasciotomy, and wounds left to heal by secondary intention due to persistent edema following surgery.

Conclusion: This case highlights the importance of maintaining a high level of clinical suspicion for idiopathic spontaneous compartment syndrome presentation. This case also illustrates the variability of compartment syndrome treatment and recovery. The standard treatment for compartment syndrome is fasciotomy with delayed primary wound closure, but the patient elected to heal by secondary intention. The patient’s long term follow-up results showed positive outcomes.

The Hidden Curriculum of Medicine Portrayed in Popular Television Medical Shows

Check out the link below to view the full article!

https://msrj.chm.msu.edu/wp-content/uploads/2022/11/226-ePub-final.pdf

Background: In addition to the purposeful teaching of knowledge and skills to medical students, the “hidden curriculum” refers to the inadvertent – and often unrecognized – transmission of implicit ideas, attitudes, and behaviors. One way to raise student and teacher understanding of the hidden curriculum (HC) is to provide them concrete examples of how and when it occurs during medical school. The goal of this study was to investigate how the HC is depicted popular medical television (TV) shows.

Methods: A systematic content analysis of successive episodes of eight prime-time TV shows was completed using a standardized classification scheme. A complete season of each TV program was analyzed to identify and classify depictions of the HC as it pertains to medical students. Our classification scheme used four dominant themes: what students discovered about medicine, what students learned about becoming a physician, what students experienced, and what students realized about themselves. After coding, all incidents were classified as “negative” if a rule or normal procedure was broken, or “positive” if they followed established professional values or provided patient-centered care.

Results: A total of 137 episodes were viewed with 1160 depictions of the HC portrayed. The TV shows with the most depictions were Code Black and Scrubs. Within the four dominant themes, 45 subthemes were identified. Most depictions (66.7%) were described as positive and included conflict resolution, sensitivity, respect, empathy, accountability and role-modeling. However, 33.3% (386/1160) were negative and included unrealistic patient expectations, working in a chaotic environment, haphazard learning interactions, emotional detachment, loss of idealism, complex social situations, and dealing with uncertainty.

Conclusions: Television dramas contain many positive and negative examples of the hidden curriculum during undergraduate medical training. Short snippets from these incidents could be used in an educational setting to teach related issues including professionalism, ethics, role modeling, communication skills, and coping techniques.

Medical School is Killing My Personality

Author: Haleigh Prather, MHS, Oregon Health & Science University

Here’s a reflection from our Fall 2021 journal that most of us could relate to:
https://msrj.chm.msu.edu/wp-content/uploads/2022/10/227-ePub.pdf

Abstract: This piece is a conversation and reflection of my ongoing relationship with toxic professionalism in medical school. Students are often at the whim of their evaluators to give them outstanding feedback in the name of having a strong residency application, but a great deal of the criteria we are evaluated on is subjective. One piece of feedback I’ve gotten more than once that I take issue with is the idea that being extroverted, enthusiastic, and cheery in medicine is seen as “unprofessional” and that I need to change myself. I am pushing back on this idea and advocating for medical students to feel more comfortable being themselves during patient encounters and asking those in evaluative positions of power to consider how feedback such as this contributing to phenomena like physician burn out.

Key Phrases: Medical School, Medical Professionalism, Student Burnout

The Crooked Tree: An Essay and Sculpture

Check out this interesting reflection!

https://msrj.chm.msu.edu/wp-content/uploads/2022/10/212-ePub.pdf

Author: Hettiarachchige  Diluksha  Prasad  Jayawardana, University of Colombo

Abstract: The crooked tree has been adopted as the universal symbol for the field of orthopedics. Each part of this tree has hidden meanings closely related to orthopedic surgery. The purpose of this article is to generate thoughts among medical professionals and stimulate discussion among them on concepts behind the crooked tree and orthopedic surgery.

Generational Giving: Japanese High School Students’ Motivation to Donate Blood

Another new and interesting article from our Fall 2021 Issue!

https://msrj.chm.msu.edu/wp-content/uploads/2022/10/208-ePub.pdf

Authors: Luna Kinoshita¹*, Aya Goto, MD, PhD², Makoto Kashimura, PharmD, PhD3, Norihiko Watanabe, BS4, Kenneth E. Nollet, MD, PhD5

1School of Medicine, Fukushima Medical University, Fukushima, Japan. 2Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan. 3Education Evaluation Division, Fukushima Medical University, Fukushima, Japan. 4Medical Information and Supply Management Division, Fukushima Red Cross Blood Donor Center, Fukushima, Japan. 5Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.

Background: As the number of young people in Japan decreases, the proportion of them who donate blood warrants urgent attention. The aims of this investigation were to test whether students’ motivation of “doing good for others” associated with their blood donation behavior and to explore factors associated with their motivation.

Methods: Fukushima Red Cross Blood Donor Center conducted a questionnaire survey in 2018 at 10 high schools in Fukushima Prefecture (N=4506). From the database, we analyzed the factors associated with motivation as assessed by the perception of “doing good for others” using chi-square tests and binomial logistic regression.

Results: The percentage of those answering “doing good for others” as “important” was 67.2%. Students who donated blood more often tended to cite “doing good for others” as important. The probability of regarding this perception as important was significantly higher among females, those with better subjective health, and those knowing their own blood type and donation eligibility criteria.

Conclusion: Health promotion activities that improve subjective perceptions of one’s health may reinforce students’ awareness of blood donation as “doing good for others” that might promote frequent donation. Our results also support greater outreach to male students and improving students’ knowledge related to blood donation.

Key words: blood donation, blood donors, donation behavior, students, Japan