Nonmaleficence in medical training: Balancing patient care and efficient education

Abstract

The principle of nonmaleficence requires that every medical action be weighed against all benefits, risks, and consequences, occasionally deeming no treatment to be the best treatment. In medical education, it also applies to performing tasks appropriate to an individual’s level of competence and training. Students, residents, and attending physicians alike maintain a beneficence-based responsibility to patients, and attending physicians have a fiduciary responsibility to educate younger generations of doctors. For medical education to progress, medical students and resident physicians must develop new skills throughout their time in training. Yet involving inexperienced students in delivering patient care can place the value of education and training in opposition to the bioethics values of patient-centred care and nonmaleficence by increasing the risk of harm to patients. Having all medical procedures, examinations, and histories performed by seasoned medical professionals would mitigate the risk but would also destroy the institution of medical education and lead to a shortage of trained professionals. For medical education to be successful, students and their supervisors must balance the principles of nonmaleficence with those of education in order to ensure excellence in both patient care and medical training. We present a broad discussion of the ethical dilemmas raised by the interaction of medical education and current patient care and suggest guideposts for training practices that satisfy the dual requirements of medical learning and patient-centred care.