Are doctors who have been ill more compassionate? Attitudes of resident physicians regarding personal health issues and the expression of compassion in clinical care.

Background: Compassion is an attribute central to professionalism and modern clinical care, yet little is known about how compassion is acquired and preserved in medical training. We sought to understand whether personal illness experiences are thought by residents to foster compassion.

Methods: The authors surveyed 155 (71% response rate) second- and third-year residents at the University of New Mexico School of Medicine regarding their views of the relationship of personal life experience with illness to compassion and empathy for patients.

Medical students' affirmation of ethics education.

Objective: Despite the acknowledged importance of ethics education in medical school, little empirical work has been done to assess the needs and preferences of medical students regarding ethics curricula.

Methods: Eighty-three medical students at the University of New Mexico participated in a self-administered written survey including 41 scaled questions regarding attitudes, needs, and preferences toward medical ethics and ethics education.

Results: Students reported strong personal interest in learning more about ethics in clinical medicine and research.

Professionalism and ethics education on relationships and boundaries: psychiatric residents' training preferences.

Objective: Awareness of the privileges and limits of one's role as physician, as well as recognition and respect for the patient as a human being, are central to ethical medical practice. The authors were particularly interested in examining the attitudes and perceived needs of psychiatric residents toward education on professional boundaries and relationships given the heightened current focus on professionalism and ethics.

Methods: Residents from six psychiatric residencies provided views on professionalism and ethics education on a survey encompassing 10 domains of professionalism.

When residents need health care: stigma of the patient role.

Objective: Whether and under what circumstances medical residents seek personal health care is a growing concern that has important implications for medical education and patient welfare, but has not been thoroughly investigated. Barriers to obtaining care have been previously documented, but very little empirical work has focused on trainees who seek health care at their home institution.

Methods: A self-report survey on special issues in personal health care of residents was created and distributed at the University of New Mexico School of Medicine in 2001.

Delaying care, avoiding stigma: residents' attitudes toward obtaining personal health care.

Purpose: The authors sought to understand the health issues and care-seeking practices reported by residents and explored the extent to which fear of academic jeopardy, stigma, and being the subject of discussion by colleagues may affect residents' care-seeking.

Method: Residents at the University of New Mexico Health Sciences Center were surveyed in 2000-2001 regarding avoidance or postponement of obtaining necessary health care, responses of others to absences, and perceptions of jeopardy to training status if a supervisor learned of a specific condition. Responses were analyzed via repeated-measures MANOVA.

Psychiatrists' attitudes regarding genetic testing and patient safeguards: a preliminary study.

Aims: A probability sample of U.S. psychiatrists (n = 93) was invited to complete a mail survey regarding the likely impact of genetic testing on psychiatry; the clinical utility of pharmacogenetic, diagnostic, and susceptibility genetic testing; and 14 proposed ethical and legal safeguards for clinical genetic testing.

Personal health care of residents: preferences for care outside of the training institution.

Objective: The personal health care issues of residents are important but have received minimal study. Available evidence suggests that residents experience difficulties obtaining care, partly related to both the demands of medical training and concerns about confidentiality and privacy.

Methods: A self-report survey was distributed in 2000-2001 to advanced residents at the University of New Mexico Health Sciences Center.

Assessments by patients with schizophrenia and psychiatrists of relative risk of research procedures.

Objective: Schizophrenia studies involve diverse procedures with varying levels of risk. Federal regulations indicate that oversight of these protocols entails assessment of risk in relation to the risks encountered in everyday life. No data exist on comparing assessments of people with schizophrenia with those of psychiatrists regarding research procedure risks in relation to the usual risks of living with schizophrenia.

An inverse relationship between perceived harm and participation willingness in schizophrenia research protocols.

Objective: This study attempted to clarify how people with schizophrenia evaluate the potential harm associated with various research-related procedures and how these assessments relate to participation willingness.

Method: The authors conducted a semistructured interview among participants with schizophrenia.

Results: Sixty participants with schizophrenia rated four procedures as harmful (e.

Views of people with schizophrenia regarding aspects of research: study size and funding sources.

Serious mental illness research poses many ethical questions, including important considerations pertaining to how large a study is and its source of funding. Little is known about how people with schizophrenia understand these ethical considerations and whether these factors may influence their decisions to participate in research. Structured interviews were conducted with 60 people with schizophrenia.

Perspectives on medical research involving men in schizophrenia and HIV-related protocols.

Ethical issues in research on serious physical and mental illnesses have received great attention, and yet little is known about how the perspectives of clinical research participants with different diagnoses may compare. We conducted a preliminary study to examine the attitudes of men enrolled in schizophrenia-related protocols and in HIV-related protocols regarding the importance of medical research, key aspects of research participation, and the acceptability of research involvement by various groups. A total of 33 men enrolled in schizophrenia protocols and 15 men enrolled in HIV-related protocols volunteered for our study.

Teaching medical students to discern ethical problems in human clinical research studies.

Purpose: Investigators and institutional review boards are entrusted with ensuring the conduct of ethically sound human studies. Assessing ethical aspects of research protocols is a key skill in fulfilling this duty, yet no empirically validated method exists for preparing professionals to attain this skill.

Method: The authors performed a randomized controlled educational intervention, comparing a criteria-based learning method, a clinical-research- and experience-based learning method, and a control group.

Do research procedures pose relatively greater risk for healthy persons than for persons with schizophrenia?

Federal regulations governing human research suggest that potential harms and discomforts of research be considered in relation to the risks normally encountered in daily life or in routine examinations. No data regarding relative risks of research exist for persons with schizophrenia. We surveyed psychiatrists (N = 68) to assess their perceptions of the risk associated with 12 research procedures in 2 categories, that is, evaluation- and intervention-type procedures.

Bioethics principles, informed consent, and ethical care for special populations: curricular needs expressed by men and women physicians-in-training.

Objective: Physicians-in-training today are learning in an ethical environment that is unprecedented in its complexity. There is a call for new approaches in preparing medical students and residents for the ethical and professional issues they will encounter. The perspectives of physicians-in-training at different levels regarding the level of curricular attention needed for emerging bioethics concepts, practical informed consent considerations, and the care of special populations are unknown.

Employees' perspectives on ethically important aspects of genetic research participation: a pilot study.

Purpose: Insights from genetic research may greatly improve our understanding of physical and mental illnesses and assist in the prevention of disease. Early experience with genetic information suggests that it may lead to stigma, discrimination, and other psychosocial harms, however, and this may be particularly salient in some settings, such as the workplace. Despite the importance of these issues, little is known about how healthy adults, including workers, perceive and understand ethically important issues in genetic research pertaining to physical and mental illness.

Perspectives on use and protection of genetic information in work settings: results of a preliminary study.

The societal use of genetic information raises ethical concerns, and the views of working persons regarding genetic information have received little attention. We performed an empirical project to characterize perspectives of 63 employees at two sites who expressed strong interest in learning about and protecting their personal genetic information. Genetic data were seen as more sensitive than other health data, and disclosure of genetic susceptibility was perceived as having negative consequences.

The positive role of professionalism and ethics training in medical education: a comparison of medical student and resident perspectives.

Objective: To assess the perspectives and preferences of medical students and residents regarding professionalism and ethics education.

Methods: A new written survey with 124 items (scale: "strongly disagree" = 1, "strongly agree" = 9) was sent to all medical students (n=308) and PGY 1-3 residents (n=233) at one academic center.

Results: Of the 336 participants (200 students, 65% response; 136 residents 58% response), only 18% found current professionalism and ethics preparation sufficient.