Proficiency of surgical faculty and residents with ethical dilemmas : Is modeling enough?

1. Proficiency of surgical faculty and residents with ethical dilemmas:Is modeling enough? Kamela K. Scott, PhD David J. Chesire, PhD J. Bracken Burns, Jr, DO Michael S. Nussbaum, MD Department of Surgery University of Florida College of Medicine -Jacksonville

2. Background • Surgeons practice an “intense form of applied ethics.” Kodner IJ. Surgery 2008; 143:460 • Most incoming residents received training in ethics during medical school • Surgery does not specify ethics training in its essential curriculum for surgical training Downing MT, et al. Am J Surg. 1997; 174:364

3. Background • The majority of PDs in surgery support teaching ethics, but most residencies do not currently include ethics in core curriculum • Surgery still embraces the “see one, do one, teach one” philosophy Downing MT, et al. Am J Surg. 1997; 174:364 • Lack of faculty expertise in ethics frequently cited as the major reason for its lack of inclusion • The literature questions “mentoring” as an effective teaching method for ethics Helft PR, et al. J Surg Ed. 2009; 66: 35

4. Concern • Faculty frequently self-designate or are designated as the appropriate models for ethical comportment in the clinical setting

5. Purpose • To evaluate the need for ethics education at all levels of surgical training and practice • Investigate the differences between faculty and residents in dealing with ethical scenarios • Levels of knowledge about the scenarios • Levels of comfort in dealing with the scenarios

6. Hypothesis • There are no significant differences in levels of knowledge in ethics between surgical residents and surgical faculty, but faculty will be more confident in their ability to handle ethical problems

7. Questions • Is there a definitive need for training in medical ethics among surgery residents and faculty? • Is the degree of acumen in ethics among surgical faculty such that they function effectively as models of appropriate ethical comportment?

8. Experimental Design: The Pre-test • Pre-curriculum questionnaire developed to assess knowledge about ethical principles and confidence in dealing with ethical issues (IRB approved) • 13 MCQ and true/false knowledge questions • 8 questions evaluating confidence rated on a Likert scale 1-5 • Knowledge and confidence scores compared between residents and faculty using Student’s t-test with p<0.05 set as significant

9. Subjects

10. Results * p< 0.05 compared to residents # p<0.0.05 compared to male faculty

11. Conclusions • While surgical faculty are more confident in their ethical decision-making, their fundamental knowledge base in ethics is not different than that of the residents • Female faculty may have greater confidence in ethical principles over male faculty • Supports the need for BOTH residents and faculty to engage in an integrated education program in ethics to promote on-going, effective dialogue in this complex topic within the clinical arena

12. Study Limitations • Results are based on a subset of the surgical faculty that may have a greater investment in ethics training • Results may not accurately reflect the faculty at large (~ 50% of faculty participated in survey) • Findings regarding female confidence are based upon only 3 female faculty members

13. Future Directions • Findings support the definitive need for formal ethics curricula in surgery both in residency and throughout the surgical career • We must promote the value of ethics curricula throughout “progressive stages of surgical life” Kodner IJ. World J Surg. 2003; 27: 1143

14. Future Directions • Engage faculty in recognition that “see one, do one, teach one” mentality does not effectively work for complex ethical dilemmas • Further methodological studies on teaching outcomes are needed

15. Thank You! Kamangar Surgery Residents Training Program in Medical Ethics American College of Surgeons