Thankfully, the above scenario is an uncommon occurrence. The Accreditation
Council for Graduate Medical Education (ACGME) reported that four orthopaedic
residents were dismissed from their programs during the 2003-2004 academic
year1. This case
does, however, illustrate a myriad of ethical issues: professionalism,
communication, physician trust, learning curves, and informed patient consent.
However, the ethical issues that we would like to explore relate to the
conflict between a training program's responsibility to its young
physicians-in-training and its responsibility to protect the patients
entrusted to its care. How often should a program allow a resident to falter
before terminating the relationship? What steps should be taken to correct
inappropriate behavior? Does tolerance or charity justify risks to patients?
In short, where do we draw the line between residency training and patient