Conflicting Curriculums: Ethics education for residents inconsistent across programs

“If you ask program directors in the abstract whether they think it’s important, they would say yes,” Dr. Helft said. “But you spend your time doing what you think is important, and there are increasing pressures that have been created by work-hour restrictions. This is a great example of the law of unintended consequences. When you begin to squeeze surgical residents and their work hours, like all residents, you force people to make choices about what they’re going to prioritize.”

New Approaches

Still, there are innovative ways that ethics is taught in some medical residency programs, from special seminars on ethical communications tools at Indiana University to “pizza grand rounds” on ethics at Washington University to leadership training and mentoring at Duke to simulated ethical dilemmas at Johns Hopkins.

Washington University’s grant program, to be showcased in December, is paid for in part by a man who’d been told by a doctor that his rectal cancer would kill him and that he should go home and write his will. Later, under the care of other doctors, he recovered. He was so astounded by the first doctor’s actions that he funded lectureships and grants on medical ethics.

In Washington University’s general surgery residency program, residents take real-life cases and mull them over during monthly “pizza grand rounds,” which involve free-wheeling discussions on some gut-wrenching situations. The medical school has an elective for fourth-year medical students in which they can take one of these dilemmas and write a manuscript in the journal Surgery, which has an arrangement with the school to provide such a forum.

“These are very interesting sessions,” Dr. Kodner said.

An online training program for residents is also being developed, Dr. Kodner said.

One otolaryngology residency program that deeply incorporates ethics training is at Duke University. There, ethics is a key part of training “tomorrow’s leaders,” said Walter Lee, MD, assistant professor in Duke’s division of otolaryngology-head and neck surgery (OHNS). The program began incorporating new ethics training recently as part of a vision developed over the last year and half, he said.

“It’s not so much what you do,” Dr. Lee said. “It’s more important who you are, because if you’re the right person, then you will make the right decision for the right reason, and you will do the right thing. Teaching them how to do the right thing, if you haven’t addressed the core person, isn’t adequate. That’s going to be lacking.”