To the Editor.
—Sulmasy et al1 are to be applauded for attempting to demonstrate the usefulness of clinical ethics instruction. Unfortunately, while their intent is commendable, their findings do not meet the proposed objective or support the conclusion drawn. Their study has two main problems.First, the authors state that the study is a "1-year randomized, controlled trial." Calling the study "controlled," however, presumes that the connection between the content of the instruction and the increase in "concurrent care concerns" (CCCs) is both causal and primary. The authors provide no justification for this presumption.Furthermore, other connections are possible. Attending regular meetings with fellow house officers and discussing (traditionally) nonmedical issues may create a comradeship that promotes open discussion of a wide range of issues. If so, it would be the kind of dialogue between house officers that leads to the increase in CCCs addressed; the clinical ethics instruction