Academic Psychiatry

, Volume 28, Issue 3, pp 183–189

Hidden Ethical Dilemmas in Psychiatric Residency Training: The Psychiatry Resident as Dual Agent

Special Feature Article Special Feature

DOI: 10.1176/appi.ap.28.3.183

Cite this article as:
Hoop, J.G. Acad Psychiatry (2004) 28: 183. doi:10.1176/appi.ap.28.3.183


In addition to learning about confidentiality, civil commitment, informed consent, and other ethical issues, psychiatry residents must deal with less visible ethical dilemmas that arise from the training process itself. Residents grapple with three inherent conflicting duties between their dual roles as physician and learner, as physician and supervisee, and as physician and employee of a training institution. These conflicts must be negotiated at a time of high stress, when residents are plagued with self-doubt, fear, fatigue, and other vulnerabilities that can lead good doctors to make ethically dubious decisions. While such conflicts and stressors are common to residency training in most specialties, they may be heightened in psychiatric residency. This paper proposes a model for understanding covert elements of ethical decision making during psychiatric residency and recommends strategies training programs can use to help residents navigate an ethical minefield.

Copyright information

© Academic Psychiatry 2004

Authors and Affiliations

  1. 1.Department of Psychiatry and the MacLean Center for Clinical EthicsUniversity of ChicagoChicagoUSA
  2. 2.Department of PsychiatryUniversity of ChicagoChicagoUSA