M. P. Kuncewitch1, J. M. Nicastro1, G. F. Coppa1, W. Doscher1 1North Shore University And Long Island Jewish Medical Center,Surgery,Manhasset, NY, USA
Introduction: Throughout surgical training residents may find themselves in situations in which they disagree with the clinical decision-making of the attending surgeon. We sought to survey the experiences and opinions of surgical residents of all PGY levels at our large surgical residency program with regard to moral and ethical controversy. Our purpose was to understand the frequency of such situations, what role residents believe they play in confronting them, and what recourse residents believe they have to address ethically controversial situations in
Methods: A survey was distributed to the 60 residents in our general surgery residency program. The survey asked our residents to anonymously respond to a questionnaire with 12 multiple-choice questions covering the incidence of ethically controversial situations as well as resident feelings towards these situations and any subsequent action taken by the resident. An additional question asked residents for their PGY year. At the close of the survey residents were given the opportunity to anonymously comment and extrapolate their experience.
Results:Forty-seven out of our 60 residents (78.3% responder rate) completed the survey. Sixty-six percent of residents reported at least one instance in which they faced a moral objection to an attending’s decision to operate (or refuse to operate) on a patient, while 48% reported taking part in intra-operative decision making that they felt clearly deviated from appropriate care. Sixty-one percent of residents said they felt comfortable raising concerns with an attending decision on moral or ethical grounds, however only 27% of residents felt assured that this would not result in any form of retaliation. Sixty-one percent of residents felt that at least half of their attending would be receptive to a resident voicing their patient-care decisions or moral or ethical grounds. A majority of residents (71%) felt that a senior resident was the most appropriate person to consult when they didn’t feel comfortable voicing their concerns with a particular attending.
Conclusion:Surgical residency training can challenge residents with difficult decision-making regarding patient care on both moral and ethical grounds. A majority of residents in our general surgery residency reported facing situations in which they disagreed with an attending on such grounds. Variability exists in how residents chose to respond and the comfort level with which they do so.