Conflicting Curriculums: Ethics education for residents inconsistent across programs

“Our quest is really to teach the body of knowledge which previously was only dealt with by PhD philosophers who have never had the experience of dealing with patients,” Dr. Kodner said. “But it isn’t a seat-of-the-pants thing. That’s a misunderstanding. There really is a body of knowledge that needs to be learned. The goal is just to be able to recognize there’s a challenge. We see it all the time in surgery.”

Mark Weissler, MD, FACS, professor of otolaryngology-head and neck surgery at the University of North Carolina, chief of the division of head and neck oncology and a member of the ethics committee of the American College of Surgeons’ (ACS) Board of Regents, said that other than requiring the teaching of professionalism as an Accreditation Council for Graduate Medical Education core competency, which may or may not include ethics training, there is no requirement for the teaching of ethics.

“There isn’t, at present, a standardized approach to ethics training… in any specialty, whether otolaryngology or the others,” he said. Everyone would agree that ethics training is important, he said, but added that “it’s harder and harder to teach people in their four to five years of residency what they need to know technically for surgery, given the shrinking duty hours. So there’s a tension there between increasing the amount that you’re going to teach people at the time that you’re decreasing the amount of time that you have to teach them…. There’s so much else that people are worrying about right now.”

In his department, ethics is taught using a program developed by the ACS and based mainly on a set of ethical dilemmas. That program is available to any department wanting to use it, but no program is required to use it.

There have not been many studies on ethics training in surgical residency programs. A review (J Surg Educ. 66:35-42) by Dr. Helft and his team, published in 2009, found just 14 studies that were on point, covering topics such as the framework for and influence of such training, as well as a 1997 survey of the 80 general surgery residency programs.

The survey (Am J Surg. 1997;174:364-369) found that despite the fact that 85 percent of the program directors who responded supported the inclusion of ethics training in residency, 28 percent nonetheless offered no training and 48 percent held just one teaching event in ethics. While there may have been some expansion since that survey, ethics professors say the training of ethics is still scattershot.