Table 4. ethical considerations for the use of learning curves.

Ethical considerations	Sample questions to consider
Learners	What decisions can be made with a learning curve? When is it considered ethical to dismiss a student who does not meet a competency threshold on the learning curve? Can the learning curve be used for formative and customized feedback that is not punitive?
Patients	When a simulator or coach is used to accelerate the learning curve, when can learners start practicing clinical skills directly with patients?
Policy	What guidelines have been implemented prior to incorporating direct patient care into learning curve practice? Have enough resources been allocated to implement effective teaching using learning curves?
Vulnerable populations	If you know a learner is not meeting competency on their learning curve, should they participate in the care of vulnerable populations? Is it possible to provide protection, respect, and dignity to vulnerable populations within an educational environment that still necessitates practice? Are we erring on the side of paternalism with these considerations?