Ethics Consultations as a Novel Approach to Needs Assessments in Surgical Ethics Curriculum Development

IF 2.1 3区医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES

Journal of Surgical Education Pub Date : 2025-08-21 DOI:10.1016/j.jsurg.2025.103654

Sharmi C. Amin BA , Daniel C. Jenkins BS , Christian J. Vercler MD, MA , Janice I. Firn PhD, MSW, HEC-C

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引用次数: 0

Abstract

OBJECTIVE

Previous studies suggest that nationally standardized surgical ethics curricula may not fully prepare surgical teams for complex ethical dilemmas encountered in clinical practice. Local needs assessments can bridge this gap by identifying areas for targeted training. Studies assessing institutional surgical ethics needs have utilized literature review, surveys, and interviews with staff, but not review of ethics consultation documentation. This study analyzes the ethical issues and contextual features underlying ethics consultations involving surgical specialties to assess their utility as a needs assessment tool and to inform formal ethics curriculum development.

DESIGN

A retrospective review of ethics consultations involving surgical teams between January 2014 and June 2024 was conducted using deductive conceptual content analysis to identify primary ethical themes and contextual features. Descriptive statistics were used to analyze data.

SETTING

Ethics consultation documentation at Michigan Medicine, a tertiary academic medical center in Ann Arbor, Michigan.

PARTICIPANTS

The review included 51 pediatric consultations and 119 adult consultations.

RESULTS

Pediatric consultations involved 8 surgical subspecialties; adult consultations involved 11. Most consultations (58.8%) occurred during the preoperative period. In the pediatric cohort, the most common ethical themes were disagreements regarding goals of care (23.5%), treatment over objection or refusal (15.7%), and surrogate decision-making (13.7%). In the adult cohort, decision-making capacity (23.5%), surrogate decision-making (22.7%), and disagreements regarding goals of care (18.5%) were most prevalent. The most frequent contextual features were staff-family conflict (29.4%) in pediatric cases and communication issues (37.8%) in adult cases.

CONCLUSIONS

Review of ethics consultations is an effective method for identifying scenarios where surgical teams need additional support and could benefit from targeted ethics training. This work supports ongoing curricular development aimed at providing trainees with broad ethical foundations and adaptable, subspecialty-specific components. These enhancements ensure that education remains relevant to the complex, specialty-specific challenges faced during formative years of training.

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伦理咨询作为外科伦理学课程开发中需求评估的新途径

目的以往的研究表明，国家标准化的外科伦理课程可能无法为外科团队在临床实践中遇到的复杂伦理困境做好充分准备。当地需求评估可以通过确定有针对性的培训领域来弥补这一差距。评估机构外科伦理需求的研究使用了文献综述、调查和对工作人员的访谈，但没有审查伦理咨询文件。本研究分析了涉及外科专业的伦理咨询的伦理问题和背景特征，以评估其作为需求评估工具的效用，并为正式的伦理课程开发提供信息。DESIGNA回顾性审查了2014年1月至2024年6月期间涉及外科团队的伦理咨询，使用演绎概念内容分析来确定主要的伦理主题和上下文特征。采用描述性统计对数据进行分析。密歇根医学伦理咨询文件，密歇根安娜堡的一个三级学术医疗中心。本综述包括51例儿科咨询和119例成人咨询。结果儿科会诊涉及8个外科亚专科；成人咨询涉及11人。大多数咨询（58.8%）发生在术前。在儿科队列中，最常见的伦理主题是关于护理目标的分歧（23.5%），反对或拒绝治疗（15.7%）和替代决策（13.7%）。在成人队列中，决策能力（23.5%）、替代决策（22.7%）和对护理目标的分歧（18.5%）最为普遍。儿童病例中最常见的情境特征是员工与家庭冲突（29.4%），成人病例中最常见的情境特征是沟通问题（37.8%）。结论伦理咨询审查是确定外科团队需要额外支持的有效方法，可以从有针对性的伦理培训中受益。这项工作支持正在进行的课程发展，目的是为受训者提供广泛的道德基础和适应性强的、分专业的组成部分。这些改进确保了教育与培训形成阶段所面临的复杂的、特定专业的挑战保持相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Education EDUCATION, SCIENTIFIC DISCIPLINES-SURGERY

CiteScore

5.60

自引率

10.30%

发文量

261

审稿时长

48 days

期刊介绍： The Journal of Surgical Education (JSE) is dedicated to advancing the field of surgical education through original research. The journal publishes research articles in all surgical disciplines on topics relative to the education of surgical students, residents, and fellows, as well as practicing surgeons. Our readers look to JSE for timely, innovative research findings from the international surgical education community. As the official journal of the Association of Program Directors in Surgery (APDS), JSE publishes the proceedings of the annual APDS meeting held during Surgery Education Week.