Learning gestures and ethical issues in oncology and nuclear medicine

Purpose: The purpose of this study is to show the importance of learning gestures in three medical procedures (chemotherapy, brachytherapy, and bone scan). It allows us to assess complications, lack of benefit, and ethical questions to which resident physicians are confronted in their training. Materials and Methods: The study is based on a questionnaire divided into two parts distributed to 70 resident physicians and 90 patients: 60 physicians radiation oncologists and 10 nuclear physicians completed the first part of 24 items. It concerned the learning of medical practices. The second part of 18 items was completed by 90 patients (30 patients in the chemotherapy unit, 30 patients in the brachytherapy unit, and 30 patients in the nuclear medicine department; it was related to patients′ information prior to the completion (performance) of the gesture. Results: The training of medical residents physicians took place mainly during the first year on conscious and well-informed patients, with the exception of brachytherapy taught later in the second year. It was preceded by a theoretical education in 56.7%, 43.3%, and 100%, respectively, in case of chemotherapy, brachytherapy, and bone scan unit, but the previous observation by a senior had failed in 16.7% in case of chemotherapy and in 36.7% in case of brachytherapy unit. Despite the almost constant presence of a senior, four incidents were associated with the first acts of chemotherapy and brachytherapy unit and one incident with the bone scan unit. These incidents had been generated, respectively, from 23.4%, 26.7%, and 20% of resident physicians surveyed (in chemotherapy, in brachytherapy, and in bone scan) and had a consequence of a loss of opportunity for patient, in 20%, 13.3%, and 40%, respectively. Most patients were informed before the completion of the medical procedure, and cause ethical problems. Alternative ways of learning were known by most of the resident physicians in training. Conclusion: Despite a relatively low rate of incidents associated with a loss of opportunity for the patient, our study has highlighted a high rate of observation and supervision prior to the first medical procedure, and the importance of ethics for the resident physician throughout his medical training.