Improving Physician Skills in Managing Morally Problematic Cases.

The skills of physicians in treating patient cases that involve medical-moral problems were studied with a total sample of 19 fourth-year medical students and residents. The focus was the manner in which residents become aware of the patient's moral concerns, talk about them, and communicate with the patient in order to reach some mutually acceptable solutions to the problem. Routine moral problems regularly seen and experienced by doctors in their practice were of concern. An assessment instrument, the Moral Behavior Analysis (MBA), was developed to assess medical student/resident's performance, and specifically the following attributes/skills: elicitation, moral reasoning, formulating and executing plans, and mutuality. After a pretest with a simulated patient, the medical students and residents provided information about their attitudes and intentions. Students/residents were later provided feedback on desirable skills and viewed a videotape of their performance. Role-playing allowed students and residents to take the views of doctor, patient, and observer. Finally, a post-test allowed the student to encounter a second simulated patient. The two clinical cases used in the research are briefly described, and study results are discussed. (SW)