Perhaps the most looming obstacle for trainees trying to act morally is the perception of medical hierarchy and struggling to find their place in that hierarchy. Challenging the decisions and actions of someone higher in authority can be the most threatening and unsettling of dilemmas. Inevitably moments arise when trainees question the decisions of their superiors. This raises tremendous conflicts. Should they press to question authority, or stifle their objections in respectful silence? To what extent should they perhaps put their career in jeopardy by challenging the system? What should the response be, for example, if the student is asked to do a procedure a superior does not want to do, on for example an AIDS patient? At the same time, positioning oneself for a more favorable place in the hierarchy, even to the detriment of peers, becomes difficult to resist. This problem of accepting the status quo is amplified when influence is peddled by drug companies and other outside forces.