Accountability and pediatric physician-researchers: are theoretical models compatible with Canadian lived experience?

These models frame the expectations placed upon physician-researchers by colleagues, regulators, patients and research participants. This paper examines the extent to which the data from semi-structured interviews with 30 physician-researchers at three major pediatric hospitals in Canada reflect these traditional models. It seeks to determine the extent to which existing models align with the described lived experience of the pediatric physician-researchers interviewed.Ultimately, we find that although some physician-researchers make references to something like the weak version of the similarity position, the pediatric-researchers interviewed in this study did not describe their dual roles in a way that tightly mirrors any of the existing theoretical frameworks. We thus conclude that either physician-researchers are in need of better training regarding the nature of the accountability relationships that flow from their dual roles or that models setting out these roles and relationships must be altered to better reflect what we can reasonably expect of physician-researchers in a real-world environment."I guess for me you know, in the morning I wake up and I say.... Am I more physician or more a researcher? Am I more a clinician or the other one?" [i]Physician-researchers are bound by the ethical norms of both traditional medical practice and clinical research. Unfortunately, these norms can conflict. Traditional medical practice is primarily concerned with the best interests of individual patients, while clinical research is primarily concerned with creating generalizable knowledge. Practices best suited to fulfill one goal may undermine the other. Numerous attempts have been made and debated in the clinical and bioethics literature in order to establish both descriptive and prescriptive models for the relationship of these two roles. The models at the poles of the spectrum have been referred to as the 'similarity position' and the 'difference position' [1]. The sim