Mandated Reporters: The Ethical Education of Medical Students on Pediatrics Clerkship

Abstract

Medical students are taught to cherish the ethical mandate to “do no harm.” However,\xa0the competency to actualize this mandate – or at least theorize how – is not always\xa0available to students on pediatrics clerkship when they encounter situations suspicious\xa0for child abuse. Mandated reporter training for medical students is largely perfunctory\xa0and does not prepare students to identify or document instances of suspected child\xa0abuse. Such training approaches students from the threatening angle that they can\xa0face punitive measures if they fail to report suspected abuse. In the absence of more\xa0thorough, ethics-driven training, students learn informally about their responsibilities\xa0as mandated reporters by observing pediatricians communicate about their own\xa0interactions with Child Protective Services (CPS), if the topic arises during clerkship. The theoretical premise of child protection is that all involved parties act in accordance with implicitly understood and shared ethical principles to safeguard the wellbeing\xa0of children [3]. Despite this assumption of accord, very little standardization exists\xa0throughout the process of identifying and reporting suspected child abuse, with the\xa0exception of some specific situations that explicitly require CPS referral. Families of\xa0color, especially Black families, are disproportionately reported to CPS for child abuse,\xa0revealing a major consequence of subjective bias in assessing parental adequacy [2].\xa0A pediatrician may, for example, misattribute a parent’s confusion about a child’s\xa0treatment plan to noncompliance and medical neglect [1]. A CPS referral in such an\xa0instance draws a line between the medical treatment team – in the role of benevolent\xa0advocate of the child’s wellbeing – and the obstructionist, perhaps abusive parent. The\xa0medical student, as part of the treatment team, has proximity to the power-holder in\xa0the situation, the physician. The student is incentivized to neglect an ethical obligation\xa0to explore whether this dynamic is causing harm to the patient. The student does not\xa0learn to interrogate the etiology of challenges faced by the parent, or to consider that\xa0CPS involvement itself may have deleterious effects on the family [4]. A more intentional\xa0and expansive approach to the ethics of mandated reporting throughout medical\xa0school would better prepare students to understand and exercise ethical judgment.