Results From A Novel Surgical Ethics Curriculum for General Surgery Residents

Objective

To identify the surgical ethics topics that general surgery residents find most challenging and design a longitudinal, resident-led curriculum to address these deficits.

Design, setting, participants

We conducted a needs assessment to characterize baseline confidence with 17 key ethics topics among general surgery residents at Mount Sinai Hospital, a quaternary care center. Confidence was measured on a 5-point Likert scale. We then designed 6 modules to address the identified deficits. Modules consisted of a twenty-minute didactic on an ethics concept led by a surgical resident in conjunction with a faculty ethicist, followed by a small-group discussion of a case pertaining to that principle. We then distributed a postcurriculum survey to re-assess resident confidence across the 17 topics. Changes in confidence were assessed using Wilcoxon rank sum test.

Results

50 participants (68.5% of eligible residents) completed the needs-assessment, and 46 participants subsequently completed the postcurriculum survey. Prior to implementation of the curriculum, only 29.2% of participants felt they could systematically evaluate and resolve a novel ethical dilemma. Participants reported lowest confidence in their ability to resolve dilemmas pertaining to treatment over objection (2.90 ± 1.03), disagreements with senior colleagues (2.80 ± 0.98), and concerns with a colleague’s competence (2.79 ± 0.98). There were significant increases in participant confidence in 10/10 of the topics directly addressed by the curriculum (p < 0.05). There was no post curriculum change in confidence in the topics that participants initially reported greatest baseline confidence. There was strong agreement that the curriculum was valuable (90.0%) and relevant (96.0%).

Conclusions

We identified the ethical challenges that residents found most vexing and designed a longitudinal, resident-led curriculum utilizing a combination of existing ethics resources produced by the American College of Surgeons and small group discussions of real cases. This educational intervention increased confidence in 10 key domains of surgical ethics.