Challenges of Teaching Surgery: Ethical Framework

Abstract

Surgeons, trainees, and patients may be uncomfortable with the secrecy that surrounds the process of teaching and learning surgical procedures. Well structured training programs use a system of graded responsibility, supervision, and evaluation to ensure skill development and patient safety. Patient outcomes are generally excellent in training institutions. Disclosure of the role of trainees and their contribution to care enhances trust.

The Therapeutic Misconception at 25: Treatment, Research, and Confusion

“…Clinical practitioners, too, can harbor interests that legitimately compete with their therapeutic obligations. In medical training, for example, a clinician's responsibilities as an educator can compete with optimizing the care of individual patients 14 . Similarly, competing interests are introduced when a practitioner transplants an organ donated by a healthy person, thereby exposing that person to significant risks for the benefit of somebody else, and when a practitioner withholds antibiotics in elderly, terminal patients because of concerns about the spread of antibiotic resistance 15 .…”

Caring for the Incarcerated: An Orthopedic Perspective

“…The amount of intraoperative resident involvement is largely unappreciated by the general public, and although few patients object to the idea of medical education, many hesitate at the idea of a junior resident performing the procedure. 14,15 The extent to which this matter should be included on the informed consent and in the preoperative discussion has been the subject of some debate. It has been noted previously that prisoners' drug use, lower social status, older age, and unconsciousness have contributed to supervisors' willingness to shift responsibility to trainees during surgery.…”

Harmonizing cataract surgery training and patient‐centred care in 2020: Disclosure, consent, supervision and patient altruism

“…Therefore, in the era of patient‐centred care (PCC), that is, “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions,” disclosure of trainee involvement during informed consent may impact core aims of teaching hospitals to train surgeons. Indeed, practitioners may be concerned that detailed disclosure of trainee participation, by uncovering patient fears, may reduce the number of possible learning opportunities …”

“…Indeed, practitioners may be concerned that detailed disclosure of trainee participation, by uncovering patient fears, may reduce the number of possible learning opportunities. [8][9][10][11][12][13] In essence, informed consent is the communication between patients and surgeons in which the patient is provided with all the information required to provide voluntary consent to undergo a surgical procedure. This interactive process requires both full disclosure by the surgeon and comprehension of this information by the patient to allow shared decision-making.…”