Daring to Taste: A Review of Living as a Bird by Vinciane Despret.

There is a certain sigh of relief-a sense of coming home-when encountering a concept that deeply reinforces a scholarly path that you have been on for over a decade, especially when that concept is better articulated than anything you have ever produced yourself. It was that home that I found in Vinciane Despret's Living as a Bird. My mind perked up when I read, "if we are to sound like economists, there is also a price to be paid,"1 and then really connected with a sentence where she explains that in addition to being particularly punishing to read, studies of bird territories and territorialization, which are rooted in a clean, quantitative economics approach, have certain things that fail to be said, due to an "element of negligence."2 Finally, she turns to a quotation by Bruno Latour that rang wonderfully true with a sense of where I have lived over the last several years.

Grateful Patient Fundraising: Stories from Physicians.

This symposium includes 12 personal narratives from physicians who have been encouraged by their institutions to solicit donations from patients. This issue also includes three commentaries on these narratives by Stacey A. Tovino, Ceciel Rooker & Alyssa Sutton, and Richard Culbertson. This symposium presents a range of real life examples of how physicians and institutions navigate the ethical issues around fundraising from grateful patients paying particular attention to attempting to establish best practices to minimize any ethical conflicts. Some potential problem areas are also explored around transparency, real or perceived coercion and respect for boundaries.

From "What" to "How": Experiential Learning in a Graduate Medicine for Ethicists Course.

Teaching healthcare ethics at the doctoral level presents a particular challenge. Ethics is often taught to medical students, but rarely is medicine taught to graduate students in health care ethics. In this paper, Medicine for Ethicists [MfE] - a course taught both didactically and experientially - is described. Eight former MfE students were independently interviewed in a semi-structured, open-ended format regarding their experience in the experiential component of the course. Themes included concrete elements about the course, elements related to the broader PhD student learning experience, and themes related to the students' past and future career experiences. Findings are related to the educational philosophy of John Dewey and David Kolb's experiential learning theory. Broader implications of this work are explored.

Exploring perceptions of healthcare technologies enabled by artificial intelligence: an online, scenario-based survey.

BACKGROUND: Healthcare is expected to increasingly integrate technologies enabled by artificial intelligence (AI) into patient care. Understanding perceptions of these tools is essential to successful development and adoption. This exploratory study gauged participants' level of openness, concern, and perceived benefit associated with AI-driven healthcare technologies. We also explored socio-demographic, health-related, and psychosocial correlates of these perceptions. METHODS: We developed a measure depicting six AI-driven technologies that either diagnose, predict, or suggest treatment. We administered the measure via an online survey to adults (N = 936) in the United States using MTurk, a crowdsourcing platform. Participants indicated their level of openness to using the AI technology in the healthcare scenario. Items reflecting potential concerns and benefits associated with each technology accompanied the scenarios. Participants rated the extent that the statements of concerns and benefits influenced their perception of favorability toward the technology. Participants completed measures of socio-demographics, health variables, and psychosocial variables such as trust in the healthcare system and trust in technology. Exploratory and confirmatory factor analyses of the concern and benefit items identified two factors representing overall level of concern and perceived benefit. Descriptive analyses examined levels of openness, concern, and perceived benefit. Correlational analyses explored associations of socio-demographic, health, and psychosocial variables with openness, concern, and benefit scores while multivariable regression models examined these relationships concurrently. RESULTS: Participants were moderately open to AI-driven healthcare technologies (M = 3.1/5.0 ± 0.9), but there was variation depending on the type of application, and the statements of concerns and benefits swayed views. Trust in the healthcare system and trust in technology were the strongest, most consistent correlates of openness, concern, and perceived benefit. Most other socio-demographic, health-related, and psychosocial variables were less strongly, or not, associated, but multivariable models indicated some personality characteristics (e.g., conscientiousness and agreeableness) and socio-demographics (e.g., full-time employment, age, sex, and race) were modestly related to perceptions. CONCLUSIONS: Participants' openness appears tenuous, suggesting early promotion strategies and experiences with novel AI technologies may strongly influence views, especially if implementation of AI technologies increases or undermines trust. The exploratory nature of these findings warrants additional research.

Professional decision-making in medicine: Development of a new measure and preliminary evidence of validity.

INTRODUCTION: This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment. METHODS: Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs. RESULTS: Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions. CONCLUSIONS: These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies.

Transplant in a patient with comorbid psychiatric illness: an ethical dilemma.

This article addresses a difficult ethical dilemma that transplant surgeons may potentially encounter: whether a patient with a psychiatric illness is a good candidate for a liver transplant. This case study illustrates the challenges involved when considering the ethical principles of patient self-determination, distributive justice of scarce medical resources, "social worth," and protection of vulnerable patient populations. Are patients with psychiatric illness able to provide consent for transplantation? Is it possible to avoid misallocating valuable donor organs and, at the same time, fairly allocate these resources? This article seeks to answer these questions and provide insight into this ethical dilemma.

The importance of an ethics curriculum in surgical education.

The nature of surgical work provides fertile ground in which ethical problems can grow. The concept of what it means to be a "good surgeon" includes the ability to reason and deliberate about how the surgeon's unique technical capabilities integrate with larger society. Ethics education at the resident level is important for several reasons. It can ensure that care is delivered in a socially and ethically responsible manner through global and emergent effects on institutions and traditions. It will prepare residents for leadership positions. It can allow residents to confront issues, such as the scientific underdetermination of surgical practice, the application of new technologies to trusting patients that have been developed by for-profit companies, and a surgical environment that is becoming increasingly institutionalized. Resident ethics education provides the opportunity for a model of collective deliberation to be developed that can be used to make sense of ethical problems as they arise.

The ethics of conducting graduate medical education research on residents.

The field of graduate medical education (GME) research is attracting increased attention and broader participation. The authors review the special ethical and methodological considerations pertaining to medical education research. Because residents are at once a convenient and captive study population, a risk of coercion exists, making the provision of consent important. The role of the institutional review board (IRB) is often difficult to discern because GME activities can have multiple simultaneous purposes, educational activities may go forward with or without a research component, and the subjects of educational research studies are not patients. The authors provide a road map for researchers with regard to research oversight by the IRB and also address issues related to research quality. The matters of whether educational research studies should have educational value for the study subject and whether to use individual information obtained when residents participate as research subjects are explored.