"An Opportunity to Fail": An Examination of Bias in Pediatric Residents' Case Presentations

This article presents an examination of the cases from 2002 to 2015 during the Pediatric Chairman’s Ethics Rounds at East Carolina University’s Brody School of Medicine, with specific attention placed on bias and the day-to-day interactions that were identified by our residents. The themes and ethical issues included: pediatrics at the end of life, neonatal issues ranging from the fetus as a patient to the first few months after birth, maternal-fetal issues, parental decision making, adolescent decision making, determining the appropriate decision maker, abuse/neglect, organizational ethics, and professionalism. Figure 1 summarizes the number of cases and the primary ethical issues that were presented during this 13-year time frame. While most of the themes and ethical issues were discussed in detail when they were presented, it was not until we re-examined these cases that we noticed the undercurrent of themes that may have contributed to the overall moral distress involved in one case. Professionalism was initially indicated as a central theme by residents in 32 cases, and, upon further examination, this number increased to 86. While the professionalism issues varied in scope, one of the subtle components that impacted the residents’ case presentation was the concept of bias.