Conflicts in Learning to Care for Critically Ill Newborns: “It Makes Me Question My Own Morals”
- 612 Downloads
Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit (NICU) is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their “experience in the NICU.” Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects.
KeywordsPhysician trainee Neonatal intensive care Ethical conflicts Narrative writing United States
- Cohn, F.G., J. Shapiro, D.A. Lie, J. Boker, F. Stephens, and L.A. Leung. 2009. Interpreting values conflicts experienced by obstetrics-gynecology clerkship students using reflective writing. Academic Medicine 84(5): 587–596. doi: 10.1097/ACM.0b013e31819f6ecc00001888-200905000-00015.CrossRefPubMedGoogle Scholar
- Krasner, M.S., R.M. Epstein, H. Beckman, et al. 2009. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. The Journal of the American Medical Association 302(12): 1284–1293. doi: 10.1001/jama.2009.1384.CrossRefPubMedGoogle Scholar
- Novack, D.H., A.L. Suchman, W. Clark, R.M. Epstein, E. Najberg, and C. Kaplan. 1997. Calibrating the physician: Personal awareness and effective patient care: Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. The Journal of the American Medical Association 278(6): 502–509.CrossRefPubMedGoogle Scholar