"Teaching at the Crossroads" How educators can navigate ethical dilemmas in training : practical tips

<ns5:p>Background When medical trainees enter the clinical setting, they find themselves in a perplexing position where they have to care for patients, acquire medical knowledge, strengthen clinical skills, adhere to the hierarchy of healthcare teams, and obtain positive assessments. Balancing these competing objectives while trying to preserve individual integrity can be a source of ethical dilemmas. Ethical dilemmas are acknowledged as problematic situations in which learners witness or participate in a behavior that they deem improper, wrong, unethical, or against their values. Remarkably, despite the imperative need to address the aforementioned issues, a code of silence has long prevailed among trainees and educators regarding these challenges. Recently, there has been growing recognition among medical educators of the distinct ethical dilemmas inherent to medical trainees’ status in clinical settings, prompting efforts to explore their underlying roots and consequences. Methods The authors acknowledge and respond to the need for clear guidance in understanding the theoretical foundation relevant to these ethical conundrums and how to address them. Findings This paper provides an understanding of the clinical milieu dynamics; explores the concepts of moral agency, moral duty, and medical identity development; and discusses motives and biases leading to unethical behaviors. It further describes different approaches reported in the literature to address these ethical dilemmas. Conclusions The courage of those who unveiled what usually remains silent hardship would be best acknowledged if these ethical issues were well understood and addressed. By providing an overview of the roots and strategies, medical educators, healthcare professionals, and trainees will be able to navigate, with confidence, one of the most complex challenges in clinical training.</ns5:p>