As psychiatrists we can touch parts of people’s minds and lives that we have no right to. The suffering experienced by our patients loosens the usual boundaries of what is ordinarily shared between people, and we are given the privilege—though not the right—to help our patients understand and bear their suffering. We do this by learning about the inner experiences of our patients; about their relationships, thoughts, feelings, and fears; about symptoms and deficits; about their decisions, their circumstances; about their losses; and about their adaptations to a life they often did not expect, hope for, or “deserve.” We witness the progression of disease and stand with our patients as they shoulder their burdens and endure misunderstanding and stigma. Although we seldom cure illness or injury in the exact same manner that some physicians in other fields can, we do go about the work of healing through all of these human tasks. This is our privilege.
We have this privilege as psychiatrists because of our membership in the medical profession. Along with other professionals in our society, physicians are entrusted with learning and advancing knowledge, using our expertise to benefit others, serving others’ needs above our own, and ensuring that our colleagues fulfill these responsibilities as well as we do (2). The values of excellence, self-sacrifice, and accountability are at the heart of every profession. These responsibilities and these values serve as the foundation of public trust in medicine (3) and form the basis of our privilege to enter into the lives of our patients in such a deeply personal and distinctly important way.
Affirming this ideal of the healer as good, as nobly motivated, and as engaged in the ethical use of power is not difficult. We like to see ourselves in this way, and we want to believe that our teachers, our colleagues, and our students share this perspective. It is harder, however, to see how these exquisite ideals about the roles and obligations of physicians translate in real life—with its uncertainties, unexpected complexities, and unjust cruelties—into clear prescriptions for honorable conduct and ethically sound decision making. It is even harder, in my mind, to see how we as educators and mentors can best nurture the sensitivities, insights, and skills of our trainees so that they are able to address the ethical aspects of their work each day. Moreover, how do we support our early career colleagues’ ability to have healthy lives so that they are not exhausted of both sleep and compassion by the time they complete their training? How do we help hearten our students as they face the hard ways of living and of dying that they inevitably encounter in our field? Finally, how do we support the appreciative stance of early-career psychiatrists as they learn the true nature of being a professional and endeavor to sustain this ideal over the decades of their careers?
In this issue of Academic Psychiatry, we have assembled several papers that examine professionalism and ethics considerations in medical training. The papers are diverse in the questions they address, but, to the delight of the editors, most are empirical reports. Their content touches upon student perspectives on educational experiences that engender empathy, on professionalism and ethics training methods, on personal illness of physicians-in-training and stigma, on preparation for caring for patients at the end-of-life, and on educational experiences that engender compassion (4–10). Our authors explore issues as neglected as helping psychiatric residents approach existential and spiritual concerns of patients (9), as critical as recognizing that physicians-in-training are fearful of being stigmatized and graded harshly if they themselves become ill (8), and as innovative as using simulated auditory hallucinations to inculcate empathy in medical students (10).
Through this very creative and interesting collection, we see that our students believe in the importance of mentoring, supervision, didactic teaching, and unique learning experiences in supporting ethics and professionalism in medicine. The data gathered here suggest that efforts to improve organizational policies related to ethically important considerations ranging from confidentiality to conflicts of interest are important to our early career colleagues. This set of manuscripts, taken together, also demonstrates that our learners wish for more—more curricular attention, more individual teaching, and more creativity—in the ethics education they receive. They are concerned that professional ideals of medicine translate into the real experience of becoming a physician. Finally, what is perhaps most exciting about this collection is that it provides answers. These studies indicate not only that students will express what are, frankly, socially desirable attitudes toward ethics issues; the papers give us meaningful approaches to supporting and sustaining professionalism in our early-career colleagues.
Disclosures of Academic Psychiatry editors are published in each January issue.