1. Ethics Education in Neurosurgery- A Survey of North American Program Directors
N Rajmohamed, A Cheong BSc, J Riva-Cambrin MD, AV Kulkarni MD, PJ McDonald MD
Division of Neurosurgery, BC Children’s Hospital and National Core for Neuroethics, University of British Columbia
INTRODUCTION
RESULTS
CONCLUSION
Over the past several decades, biomedical ethics has played an increasingly important role in both undergraduate and postgraduate medical education. Both the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Accreditation Council for Graduate Medical Education (ACGME) in the United States consider ethics education to be mandatory during residency training. Despite this, little is known about how ethics education is undertaken during residency training. Neurosurgery trainees encounter a wide scope of ethical issues during training, including those related to end-of-life care, resource allocation, informed consent and shared decision-making. The purpose of this study was to assess the current state of ethics education in North American neurosurgery training programs.
Invitations to complete the survey were sent to 119 PDs, of whom 47 (40%) completed at least part of the survey. 13 (28%) of respondents were from Canada with the remaining 34 (72%) from the US. Not all respondents answered all questions in the survey. Most programs (74%) spent less than 10 hours per year on formal ethics education. Informal discussion with faculty (86%), case presentations (67%) and didactic ethics lectures (55%) were the most common pedagogical methods used; with most respondents (85%) feeling real-life experience was the most important method to prepare residents. Ethics teaching was most commonly provided by neurosurgical faculty (86% of programs), followed by other medical faculty (48%) and clinical ethicists (26%). Most (54%) felt residents received the right amount of ethics education with time constraints (42%) and a lack of faculty with ethics expertise (24%) the most common barriers to ethics education. Topics felt to be most important for residents to learn were end of life/withdrawing or withholding care (95%), conflicts of interest/industry relationships (81%), informed consent (81%), futility (66%) and research ethics (66%). The majority of respondents (78%) felt ethics education should be mandatory during residency training and most felt their trainees were prepared to deal with ethically challenging situations by the end of residency (95%).
This study provides a snapshot of ethics education in North American neurosurgery training. Time constraints and a lack of faculty with ethics expertise were seen as barriers to ethics education in neurosurgical residency programs. Despite this, most program directors felt their residents were well prepared to deal with ethical issues in practice. Ethical topics felt to be important were identified and can serve as a template for program directors when designing ethics curricula.
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TAKE HOME POINTS
78% of PDs think ethics education should be mandatory for neurosurgery trainees
Most important topics for neurosurgery resident ethics training are end of life care, conflicts of interest/industry relationships and informed consent
95% of PDs feel graduating residents are prepared to deal with ethically challenging situations
METHODS
A web-based survey was developed based on ethics competencies outlined by the RCPSC and the ACGME and similar surveys of different specialty training programs. The survey was piloted on a sample of Canadian residency program directors (PDs) and then delivered via invitation to neurosurgery residency program directors across North America. Participant responses were analyzed using descriptive statistics. The study was approved by the University of British Columbia Faculty of Medicine Research Ethics Board.
ACKNOWLEDGMENTS AND DISCLOSURES
This work was funded through a Studentship from the Office of Pediatric Surgical Education and Innovation at BC Children’s Hospital. Dr. McDonald is the Alcan Chair in Neurosciences at UBC which also supported this work.