Revisiting Moral Courage as an Educational Objective

In a 2005 paper about the variety of ethical conflicts third-year medical students observed, and their responses to those conflicts, a reluctance to speak up for fear of reprisal emerged as a salient finding. Based on that finding, the authors proposed that moral courage falls within the realm of professional expectations for medical students and that its cultivation is an appropriate formal objective for medical education. Since then, one of those authors has engaged in remediating trainees and practicing clinicians who have committed professional misdeeds, including failures in professionalism, ethics, and maintaining professional boundaries. The perspective gained from working with these individuals and hearing their stories, as well as concepts from behavioral science, have broadened that author's understanding of how poor professional judgments are made and misdeeds committed and expanded her appreciation for the role of moral courage. Most individuals arrive at their remedial course knowing on some level that what they did was wrong, but are incredulous at how they became capable of acting so improperly. They must learn that every student and practitioner, without exception, is at risk for committing a professional misdeed. Moral courage is required to participate in the kind of reflection and self-assessment necessary to examine one's own professional wrongdoing and practice safely and competently at all times, just as it is required to speak truth to power and risk negative consequences. The author concludes that medical educators can and should assist trainees to mitigate their risks through regularly-and courageously-assessing themselves and their circumstances with honesty and clarity to develop a mature professional identity, safeguard patients, and ultimately cherish the privilege of licensure.