Developing the Good Physician: The Influence of Role Models in the Development of Virtues and Flourishing in Medical Students.

Objectives: A virtues-based model of character development for training future physicians may lead to increased flourishing in medical students through the influence of exemplary role models. This study aimed to analyze the association between caring virtues and measures of flourishing and to identify facilitators of physician flourishing.

Methods: The authors used data from a 2011 nationally representative sample of 605 US medical students in which caring virtues (mindfulness, empathic compassion, and generosity) were measured using scales at two time points during the students' clinical years.

The Power of Proximity: Toward an Ethic of Accompaniment in Surgical Care.

Although the field of surgical ethics focuses primarily on informed consent, surgical decision-making, and research ethics, some surgeons have started to consider ethical questions regarding justice and solidarity with poor and minoritized populations. To date, those calling for social justice in surgical care have emphasized increased diversity within the ranks of the surgical profession. This article, in contrast, foregrounds the agency of those most affected by injustice by bringing to bear an ethic of accompaniment.

Should Pediatric Patients Be Prioritized When Rationing Life-Saving Treatments During COVID-19 Pandemic.

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation.

Conscience and the Way of Medicine.

Disputes about conscientious refusals reflect, at root, two rival accounts of what medicine is for and what physicians reasonably profess. On what we call the "provider of services model," a practitioner of medicine is professionally obligated to provide interventions that patients request so long as the interventions are legal, feasible, and are consistent with well-being as the patient perceives it. On what we call the "Way of Medicine," by contrast, a practitioner of medicine is professionally obligated to seek the patient's health, objectively construed, and to refuse requests for interventions that contradict that profession.

How Should Physicians Respond to Patient Requests for Religious Concordance?

In which ways and in which circumstances should institutions and individual physicians facilitate patient-physician religious concordance when requested by a patient? This question suggests not only uncertainty about the relevance of particular traits to physicians' professional roles but also that medical practice can be construed as primarily bureaucratic and technological. This construal is misleading. Using the metaphor of shared language, this article contends that patient-physician concordance is always a question of degree and that greater concordance can, in certain circumstances, help to obtain important goals of medicine.

Intensive Care Clinicians' Views on the Role of Chaplains.

There is evidence that addressing the religious and spiritual needs of patients has positive effects on patient satisfaction and health care utilization. However, in the intensive care unit (ICU), chaplains are often consulted only at the very end of life, thereby leaving patients' spiritual needs unmet. This study looked at the views of 219 ICU clinicians on the role of chaplains.

"Just do your job": technology, bureaucracy, and the eclipse of conscience in contemporary medicine.

Market metaphors have come to dominate discourse on medical practice. In this essay, we revisit Peter Berger and colleagues' analysis of modernization in their book The Homeless Mind and place that analysis in conversation with Max Weber's 1917 lecture "Science as a Vocation" to argue that the rise of market metaphors betokens the carry-over to medical practice of various features from the institutions of technological production and bureaucratic administration. We refer to this carry-over as the product presumption.

Taking societal cost into clinical consideration: U.S. physicians' views.

Background: Recent campaigns (e.g., the American Board of Internal Medicine Foundation's Choosing Wisely) reflect the increasing role that physicians are expected to have in stewarding health care resources.

Palliative sedation: clinical context and ethical questions.

Practitioners of palliative medicine frequently encounter patients suffering distress caused by uncontrolled pain or other symptoms. To relieve such distress, palliative medicine clinicians often use measures that result in sedation of the patient. Often such sedation is experienced as a loss by patients and their family members, but sometimes such sedation is sought as the desired outcome.

Addressing religion and spirituality in the intensive care unit: A survey of clinicians.

Objective: Studies have shown that when religious and spiritual concerns are addressed by the medical team, patients are more satisfied with their care and have lower healthcare costs. However, little is known about how intensive care unit (ICU) clinicians address these concerns. The objective of this study was to determine how ICU clinicians address the religious and spiritual needs of patients and families.

Role Models' Influence on Specialty Choice for Residency Training: A National Longitudinal Study.

Background: Role models in medical school may influence students' residency specialty choice.

Objective: We examined whether medical students who reported clinical exposure to a role model during medical school would have an increased likelihood of selecting the role model's specialty for their residencies.

Methods: We conducted a 5-year prospective, national longitudinal study (2011-2016) of medical students from 24 US allopathic medical schools, starting from the middle of their third year.

Project on the Good Physician: Further Evidence for the Validity of a Moral Intuitionist Model of Virtuous Caring.

Theory: In the Project on the Good Physician, the authors propose a moral intuitionist model of virtuous caring that places the virtues of Mindfulness, Empathic Compassion, and Generosity at the heart of medical character education.

Hypotheses: Hypothesis 1a: The virtues of Mindfulness, Empathic Compassion, and Generosity will be positively associated with one another (convergent validity). Hypothesis 1b: The virtues of Mindfulness and Empathic Compassion will explain variance in the action-related virtue of Generosity beyond that predicted by Big Five personality traits alone (discriminant validity).

Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness.

Context: Little is known about patient and physician factors that affect decisions to pursue more or less aggressive treatment courses for patients with advanced illness.

Objectives: This study sought to determine how patient age, patient disposition, and physician religiousness affect physician recommendations in the context of advanced illness.

Methods: A survey was mailed to a stratified random sample of U.

Weighing the Social and Ethical Considerations of Maternal-Fetal Surgery.

Objectives: The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery.

Methods: This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings.

Physicians' Opinions on Engaging Patients' Religious and Spiritual Concerns: A National Survey.

Context: There has been a sustained debate in the medical literature over whether physicians should engage with patients' religious and spiritual concerns.

Objectives: This study explores what physicians believe about the relative importance and appropriateness of engaging with patients' spiritual concerns and physicians' choices of interventions.

Methods: In 2010, a questionnaire was mailed to 2016 U.

Physician Perspectives on Long-Term Relationships and Friendships with Patients: A National Assessment.

Objectives: Shifts in the healthcare environment have introduced challenges to the long-term continuity of the doctor-patient relationship. This study examines whether certain demographic or religious characteristics of physicians are associated with maintaining long-term relationships (LTRs) and/or friendships with their patients and describes physicians' opinions regarding the influence of such patient relationships on health outcomes.

Methods: In 2011, survey responses were obtained from 1289 US physicians from various specialties.

Attitudes of paediatric and obstetric specialists towards prenatal surgery for lethal and non-lethal conditions.

Background: While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes.

Methods: Survey of 1200 paediatric surgeons, neonatologists and maternal-fetal medicine specialists (MFMs).

Personality Traits Are Associated with Academic Achievement in Medical School: A Nationally Representative Study.

Objective: This nationally representative study sought to identify personality traits that are associated with academic achievement in medical school.

Methods: Third-year medical students, who completed an initial questionnaire in January 2011, were mailed a second questionnaire several months later during their fourth year. Controlling for sociodemographic characteristics and burnout, the authors used multivariate logistic regressions to determine whether Big Five personality traits were associated with receiving honors/highest grade in clinical clerkships, failing a course or rotation, and being selected for the Alpha Omega Alpha or Gold Humanism Honor Society.