Teaching Procedures in the Neonatal Intensive Care Unit

Abstract

The longstanding tradition of hands-on procedural training is an integral part of clinical education in all fields of medicine. Allowing inexperienced physicians-in-training to perform clinical procedures has been justified based on the needs of future patients, potentially at some cost or burden to the patient involved in the training. This practice may appear, at times, to conflict with the physician's obligation to act in the best interests of the patient at hand. However, an ethical analysis centered on an example of an extremely low-birthweight newborn requiring intubation and other procedures lends support to this practice, provided several qualifications are met. The qualifications include adequate preparation, appropriate supervision, minimization of risks, honesty with families, the avoidance of exploitation, and justice in patient selection. Also, the obligation to the patient at hand is such that, in certain situations, the needs of that patient should outweigh any educational considerations. The analysis and arguments put forth should have relevance to clinical training in all branches of medicine and surgery.