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Radiology and Ethics Education: Aline Camargo Li Liu David M. Yousem
Radiology and Ethics Education: Aline Camargo Li Liu David M. Yousem
Camargo et al.
Ethics Education and Radiology
n the past 3 decades, the teaching cal Society of North America. The link re-
Male 256 (73.6) History, diagnosis, prognosis, and the like acquired during the 268 (63.2) 424
Female 92 (26.4) physician-patient relationship may be disclosed to an insurance
company representative. (False)
Years after completing residency, 14 (0–28)
median (IQR) (n = 308) The AMA Code of Medical Ethics directly addresses disclosure of 254 (61.5) 413
records to data collection companies. (True)
Status (n = 308)
Payment by or to a physician solely for the referral of a patient is fee 362 (85.8) 422
Practicing radiologist 220 (71.4) splitting. The Code of Medical Ethics of the AMA and the Code of
Trainee 88 (28.6) Ethics of the ACR allow this practice, as long as the skills of the
physician to whom the patient has been referred are guaranteed.
Work setting (n = 342) (False)
Academic 231 (67.5) Concerning the retention of medical records, the records of any 349 (83.3) 419
Private practice 57 (16.7) patient covered by Medicare or Medicaid must be kept at least 5
years. (True)
Hybrida 38 (11.1)
The Code of Medical Ethics prohibits the physician from 134 (31.9) 420
Government 8 (2.3) accepting any in-kind gift from pharmaceutical, biotechnology, and
Other 8 (2.3) medical device companies. (False)
Country of practice (n = 350) Physicians should not recommend that a patient obtain a second 415 (98.1) 423
opinion because this may harm the patient-physician r elationship.
United States 334 (95.4) (False)
Other 16 (4.6) A physician is not allowed to charge a patient for a missed appoint- 293 (69.4) 422
Country where medical school was ment. (False)
attended (n = 276) Unethical conduct that violates state licensing provisions should be 408 (97.6) 418
United States 226 (81.9) reported to the state licensing board. (True)
European countries and Canada 32 (11.6) The AMA Code of Medical Ethics does not address sex d iscrimination 302 (72.6) 416
in the medical profession. (False)
Other 18 (6.5)
Note—AMA = American Medical Association, ACR = American College of Radiology.
Country where residency was
completed (n = 276)
had never read the nation-based code of medi- ported in the present study. Another possible ex-
United States 253 (91.7) cal ethics [8]. Similarly, we found that only 79 planation may be that respondents did not have
European countries and Canada 12 (4.4) of the respondents (22.8%) had ever read the an interest in the subject because they think that
Other 11 (4.0) AMA Code of Medical Ethics, and only 113 such educational material will not change their
(32.6%) had ever read the ACR Code of Eth- already established conduct and opinions.
Note—Except where otherwise indicated, data are
number (%) of survey respondents. IQR = ics. On the basis of data from the ACR, the to- Our survey touched upon only a few issues
interquartile range. tal number of Internet downloads of the Code associated with medical ethics knowledge.
a Academic and private practice.
of Ethics (including the Bylaws section) was We chose the AMA Code of Medical Ethics
only 723 in the 1-year period between June as a focus for assessing the ethics knowledge
Previously published research studies 1, 2015, and May 31, 2016, after the most re- base among our survey respondents because it
showed that knowledge of ethics among resi- cent update of the Code of Ethics occurred is widely applied and available. However, ev-
dents and the confidence to deal with ethical (Farmerie S, personal communication, January ery code of ethics has limitations in shaping
situations increased when ethics education 26, 2017). Given that the ACR has more than appropriate responses to ethical dilemmas.
was included as part of the residency curric- 38,000 members, this finding suggests that if Beauchamp and Childress stated, “Theory and
ulum [5, 6]. Such findings highlight the state- each download was intended for review by a principles are only starting points and gener-
ment by Perkins that “medical ethics (educa- single person, only 1.9% of those 38,000 mem- al guides for the development of norms of ap-
tion) provides the conceptual tools necessary bers have viewed the most recent version of the propriate conduct” [9]. Their theory assumed
for residents to develop their own ethical de- ACR Code of Ethics. This finding highlights that deontologic absolute principles (i.e., rules-
cision-making frameworks” [7]. that many physicians do not consider ethics a based ethics) can govern ethical behavior. In
A previous Brazilian study that evaluated critical educational subject but, rather, a per- contrast, a more pragmatic approach, known
medical students revealed that less than one- sonal concept based on their own perceptions. as casuistry, involves looking at each case indi-
half of them considered ethics education in the The perception that ethics might just be an vidually and determining whether precedence
core curriculum of medical school as instru- intrinsic group of values that cannot be learned has been established by similar examples else-
mental in the formulation of their philosophy may justify the lack of interest in the pursuit of where in society to determine what should be
regarding ethics, and 41.4% reported that they ethics knowledge from external sources, as re- done. This approach is similar to the use of
Do you think your medical ethics training in medical school was sufficient? 146 (42.7) 196 (57.3) 342
Did you have medical ethics training in your residency? 122 (35.1) 226 (64.9) 348
Did you think the medical ethics training in your residency was sufficient? 102 (30.0) 238 (70.0) 340
Do you follow discussions on medical ethics as part of your ongoing education or interest? 175 (50.6) 171 (49.4) 346
Note—Except where otherwise indicated, data are number (%) of responses. AMA = American Medical Association, ACR = American College of Radiology.
case law in the courts or case-based learning Second, the ACR should solicit leaders in 1976; 235:1030–1033
in medical education. In The Abuse of Casuist- thought in this arena to provide an updated 3. Wolfe SM, Williams C, Zaslow A. Public Citi-
ry: a History of Moral Reasoning, Jonsen and online program for radiology trainees and zen’s Health Research Group ranking of the rate
Toulmin stated that one should not be wedded practitioners as part of the offerings of their of state medical boards’ serious disciplinary ac-
to absolute principles (e.g., because two good Radiology Leadership Institute, and this pro- tions, 2009–2011. Public Citizen website. www.
principles, such as paternalism and individual gram should be made accessible to all radiol- citizen.org/documents/2034.pdf. Published May
freedom, often may contradict each other) [10]. ogists. Leadership demands ethical behavior. 17, 2012. Accessed November 10, 2016
They recommended assigning a moral issue to Third, ethics education for practicing radi- 4. Silverberg LI. Survey of medical ethics in Ameri-
a taxonomy (i.e., a category of principles) and ologists should also be encouraged through can medical schools: a descriptive study. J Am
then resolving the dilemma on the basis of ex- the creation of specific materials by radiolo- Osteopath Assoc 2000; 100:373–378
amples in that taxonomy that have already been gy subspecialty societies, including seminars 5. Sulmasy DP, Marx ES. Ethics education for med-
adjudicated [10]. at society meetings, with relevant case sce- ical house officers: long-term improvements in
More studies are necessary to understand narios included for discussion. knowledge and confidence. J Med Ethics 1997;
the current state of ethics education in medi- Fourth, radiology journals should add 23:88–92
cal schools and radiology residencies, to im- medical ethics–oriented articles for the edifi- 6. Sulmasy DP, Geller G, Levine DM, Faden RR. A
prove weaknesses and highlight the impor- cation of their readership. randomized trial of ethics education for medical
tance of the teaching of ethics. We believe that these changes in the ap- house officers. J Med Ethics 1993; 19:157–163
On the basis of our survey, we concluded proach toward medical ethics and its teach- 7. Perkins HS. Teaching medical ethics during resi-
that changes in medical ethics training and ed- ing will improve how radiologists deal with dency. Acad Med 1989; 64:262–266
ucation in radiology residencies are required ethical situations and therefore will support 8. Camargo A, de Almeida MAS, Morita I. Ethics
to promote ethical behavior in radiology prac- professional integrity. and bioethics: what sixth year medical students
tice. We recommend the following changes. have to say. Rev Bras Educ Med 2014; 38:182–189
First, just as the Accreditation Council for References 9. Beauchamp TL, Childress JF. Principles of
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