P. Singh1, M. D. Sur1, B. A. Shakhsheer1, P. Angelos1 1University Of Chicago,Surgery,Chicago, IL, USA
Introduction:
Education in clinical medical ethics has been increasingly recognized as a valuable component of surgical education. The Accreditation Council for Graduate Medical Education (ACGME) includes professionalism, defined as adherence to ethical principles, as one of its six core principles. Although most general surgery residency programs currently include some consideration of ethics in their curricula, the content and format for ethics education varies widely. The objective of this study was to develop and evaluate a surgical ethics curriculum specifically for surgical residents that was integrated into the clinical conference schedule.
Methods:
A year-long, IRB-approved curriculum was developed focusing on eight major topics within surgical ethics: informed consent, transplantation, withdrawing and withholding care, surgical training, error disclosure, surgical innovation, surgical research and global surgery. Each topic was presented as a case-based discussion drawing from selected readings with faculty-led moderation and presentation of pertinent clinical issues. Residents participated in pre- and post-test closed-form surveys assessing their attitudes toward ethics education, confidence in their skills in management of challenging ethical situations, and factual knowledge of key concepts in surgical ethics.
Results:
Forty categorical general surgery residents participated in at least one component of the curriculum. Of these, 31 completed the pre-test and 21 completed the post-test; 16 completed both. Although 75% of residents had received formal ethics training previously, 94% believed ethics education to be ‘important’ or ‘very important.’ Prior to participating in the course, residents felt most comfortable with informed consent and least comfortable with advanced directives and do-not-resuscitate (DNR) orders. Residents scored an average of 68.6% (range 52.6–89.5%, n=31) on 19 multiple choice knowledge-based questions on the pre-test and did not significantly improve with the course. Pre-test scores did not correlate with level of residency as compared between junior (PGY 1-2) and senior (PGY 3-5) residents (P=0.42). There was a trend toward improved confidence in all areas at the completion of the curriculum and a significant improvement in confidence managing advanced directives and DNR orders (P<0.001, n=16). Most participating residents responded with ‘somewhat agree’ or ‘strongly agree’ to statements that the course was useful, made an important contribution to their surgical training and was valuable for future residents.
Conclusion:
A surgical ethics curriculum can be successfully implemented as part of general surgery residency and residents value a curriculum that presents relevant issues to their training. Although residents may have received ethics education in the past, an ethics curriculum can help improve their confidence in dealing with a variety of ethical issues.