Ethics of Resident Involvement in Surgical Training

Abstract

INTRODUCTION: An attending surgeon must maintain a balance between allowing appropriate resident independence while ensuring safe medical management of the patient. This pilot investigation aims to characterize these conflicts within an ethical framework by qualitative analysis of opinions of active teaching physicians and residents in the field. We hypothesize that the ethical principles of patient autonomy, physician beneficence, and justice/equal opportunity can be applied to organizing the themes and opinions that will be provided by study participants. METHODS: After IRB approval, attending physicians and residents from 3 Accreditation Council for Graduate Medical Education–approved institutions were invited to participate in our pilot study. Participation involves completion of an anonymous, peer-revised online survey, structured to characterize the ethical foundations of surgical teaching from the perspective of both teachers and trainees. The survey answers and general demographics are transcribed and coded for quantitative and qualitative analysis. RESULTS: This study is currently ongoing. In preliminary findings, we have identified particular reluctance in providing autonomy to residents when caring for vulnerable populations (ie children, oncology). The importance of disclosure and informed consent has also been a recurring theme. CONCLUSION: Although surgical residents may measure the success of their training on their level of intraoperative independence, we have identified that intraoperative autonomy afforded to the resident does not only depend on their objective skill or experience. There are complex ethical considerations that the attending surgeon must navigate as they decide on appropriate, effective teaching and safe surgical management, which is especially relevant when vulnerable patient populations are involved.