Ethical challenges of in-the-field training: a surgical perspective

Abstract

The teaching of professions in which technical and manual acts combined with excellent judgment are used to enhance the safety of people, poses challenges to educators. Book learning combined with mock or simulated situations goes a long way, but ultimately ''in-the-field'' instruction and learning is necessary to qualify trainees for many occupations such as doctors, pilots, firefighters, police officers, and many others. The dilemma is how to teach potentially life-altering techniques in a real-life setting without compromising the safety of the recipient of the service being taught. Using the exemplary model of surgical teaching in the technology-heavy and high-tension world of neurosurgery, the authors attempt to explore this ethical and practical dilemma.

Overcoming Ethical Challenges of Bedside Medical Education

“…Risks of procedures performed by trainees can be minimised by attentive supervision especially in the early stages of training. 8 This is supported by data that such supervised procedures can have equivalent outcomes to those performed by qualified staff. 9 Enhancement of benefits to teaching subjects should be linked to their health and not financial inducements or additional unrelated medical benefits.…”

Resident Autonomy

“…Supervising attendings have a responsibility to utilize their best judgment about when a trainee has demonstrated the appropriate trustworthiness, level of awareness of his or her limitations, and adequate competence to be given the autonomy to perform a particular patient care task [45,46]. Attendings should clearly specify their expectations for residents so that they are aware of the goal they are trying to reach [7].…”

“…Attendings should clearly specify their expectations for residents so that they are aware of the goal they are trying to reach [7]. It is also imperative that supervising physicians provide constructive feedback that is specific enough to allow residents to understand how to improve their performance [46]. The provision of specific and timely feedback may be the most important factor in improving resident performance and is a key component of deliberate practice [47,48].…”

“…The provision of specific and timely feedback may be the most important factor in improving resident performance and is a key component of deliberate practice [47,48]. Supervising physicians also have a responsibility to provide appropriate assistance when their trainees reach their limits of ability and/or comfort [46]. Attendings who want to promote resident autonomy should work to provide appropriate scaffolding for novice trainees and to gradually withdraw that scaffolding as the resident develops competence and gains confidence [7,11].…”

Application of Pedagogical Perspectives in the Teaching and Training of New Cataract Surgeons—A Literature-Based Essay

“…However, when an operation is performed by a trainee surgeon or a less experienced independent surgeon, there is a greater risk of surgical complications [2]. Complex ethical issues thus arise when teaching new surgeons, as Bernstein & Knifed point out regarding neurosurgery [3]. These issues are further emphasized by the fact that cataract surgery in almost 100% of cases is carried out nowadays under lo-cal anesthesia with light or no sedation, allowing patients to be aware of surrounding activities and conversations during their operation.…”