Ethics in Practice   |    
Decisions Regarding Resident Advancement and Dismissal
James D. Capozzi, MD1; Rosamond Rhodes, PhD2
1 Department of Orthopaedics, Mount Sinai Medical Center, 1065 Park Avenue, New York, NY 10128. E-mail address for J.D. Capozzi: capoz5@aol.com
2 Department of Bioethics, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029-6574
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An orthopaedic resident had been counseled repeatedly regarding his unprofessional behavior. He had indicated, on multiple occasions, that patient-care tasks had been completed when, in fact, they had not. He had shifted his responsibilities to other residents both with and without their knowledge. Despite acceptable technical skills, he had often been poorly prepared for surgical cases. After repeated guidance sessions, warnings, and admonishments, he was dismissed from his training program.
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Oct 01;87(10):2353-2355. doi: 10.2106/JBJS.8710.eth
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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 safety?
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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