When teaching morally or spiritually complex issues during medical training, physicians should create a supportive environment with respectful discourse, suggest the authors of an article published in the AMA Journal of Ethics.

During medical education, physician-educators may come up against students who have conscientious objections to participating in certain procedures. Often, this happens when discussing abortion. Although abortion tends to be the most commonly discussed complex topic, these approaches can extend to any topic that generates divergent views among students.

The first recommendation that the researchers make is simple: listen. By listening, physician-educators are demonstrating respect for students deeply held beliefs. However, listening alone is not enough. Students must have a safe, open environment in which to share their views. The researchers discourage having tough discussions during rounds or in other open spaces; instead, offer students the opportunity to discuss the issue in a neutral space.

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To respect all students’ views, physician-educators should give every student an equal opportunity to share his or her point of view. The physician-educator should also offer his or her views on the topic, talking about how they are informed by the physician’s experience in practice.

The researchers stress that physician-educators should not focus on changing students’ minds — instead, they should ask students to continue to remain open to new perspectives. Forcibly trying to change a student’s beliefs is disrespectful because of the power dynamic of teacher and student.

In response to abortion in particular, the researchers recommend supporting students who choose not to participate, as it is inappropriate to ask anyone to participate in something that they believe strongly is wrong.

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If a student chooses not to participate in a particular procedure, it is critical for the physician-educator to talk about what this means for patients. Physician-educators should consider each student’s medical specialty and practice setting and discuss how the student’s choice will affect the broader community and other physicians.

“Given that we are engaged in a discussion, we do not tell our students what they must or must not do. That is not our purpose,” the researchers wrote. “We engage in advocacy in other arenas. Instead, we discuss with our students how all our patients, even those with whom we disagree, deserve our respect and care.”


King LP, Penzias A. Fostering discussion when teaching abortion and other morally and spiritually charged topics. AMA J Ethics. 2018;20(7):E637-642.