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J Bioeth Inq. 2015 Sep;12(3):437-48. doi: 10.1007/s11673-015-9609-9. Epub 2015 Feb 6.

Conflicts in Learning to Care for Critically Ill Newborns: "It Makes Me Question My Own Morals".

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Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine and Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.
Johns Hopkins University School of Medicine, Berman Institute of Bioethics, Baltimore, MD, 21205, USA.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.


Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit (NICU) is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their "experience in the NICU." Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects.


Ethical conflicts; Narrative writing; Neonatal intensive care; Physician trainee; United States

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