Amendola Michael F, Bosch Gundula, Kaplan Brian
Virginia Commonwealth University Health System, Richmond, Virginia; Virginia Commonwealth University School of Medicine, Richmond, Virginia.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
J Surg Educ. 2019 Nov-Dec;76(6):1562-1568. doi: 10.1016/j.jsurg.2019.06.013. Epub 2019 Jul 12.
Surgical ethics has been suggested as a distinct field of study apart from clinical ethics due to a unique practice type and treatment dynamic. At our institution, most if not all teaching of clinical ethics is undertaken by nonsurgical faculty. We introduced a novel online Surgical Ethics Program (SEO) in a pilot form (SEO-P) for initial presentation to learners in our environment. The overall goal of our educational intervention was to enhance knowledge, understanding and appreciation for surgical ethics in medical students and to evaluate our curriculum.
SEO-P was undertaken over a 4-week period in 2018 with 9 fourth-year medical students enrolled in a surgery elective at our institution. These learners all had career plans in general surgery or a surgical subspecialty. There was 3 weeks of content: (1) background in clinical ethics as it applies to surgical practice, (2) surgical consents and autonomy, and (3) the impaired physician. All pilot learners were evaluated with: (1) postprogram final exam assessment (compared to preprogram knowledge base test), (2) self-reflection essay of ethical practice in surgery, (3) evaluation of 2 case studies, and (4) an assessment of participation in online discussion forums. Postprogram survey of the learners was also undertaken in an anonymous fashion.
Four of 9 or 44.4% of students scored greater than or equal to 80% on the postprogram knowledge assessment test. A preprogram knowledge-based examination of all learners yielded a mean and standard deviation of 57.1 ± 6.0%. Postprogram knowledge-based test with mean and standard deviation was 78.8 ± 15%. This was a statistically significant increase in scores (p = 0.004; t test). All 9 passed the course with a mean final summative course grade of 95.2 ± 3.2%. From the postprogram evaluation survey, all 7 students who responded felt that the SEO-P would help them become an "ethical" practitioner. Surprisingly, only half of the learners (57.1%) thought "technology used to support the SEO Course (i.e., the chosen curriculum management system) was effective in conducting the course."
We set forth to use "web-based" technology to enhance exposure of medical students in our institution to surgical ethics. Hence, we designed our pilot curriculum to be a completely online offering. We feel that the utilization of the surgical voice, that is a surgical ethics curriculum developed by surgeons to explore surgically related clinical ethical issues, is an essential theme and goal of our program. Future challenges will be to present this voice in an effective manner with either an improved curriculum delivery system or by potentially utilizing a blended approach.
由于手术具有独特的实践类型和治疗动态，手术伦理学已被视为一个有别于临床伦理学的独特研究领域。在我们机构，大部分（如果不是全部的话）临床伦理学教学由非外科教员承担。我们以试点形式（SEO-P）推出了一个新颖的在线手术伦理学课程，以便在我们的环境中初次向学习者呈现。我们教育干预的总体目标是增强医学生对手术伦理学的知识、理解和认识，并评估我们的课程。
SEO-P于2018年进行，为期4周，9名四年级医学生参加了我们机构的外科选修课程。这些学习者都有从事普通外科或外科亚专业的职业规划。课程内容为期3周：（1）适用于外科实践的临床伦理学背景，（2）手术同意书与自主权，（3）受损医生。所有试点学习者接受了以下评估：（1）课程结束后的期末考试评估（与课程开始前的知识库测试相比），（2）关于外科伦理实践的自我反思文章，（3）对2个案例研究的评估，以及（4）对在线讨论论坛参与情况的评估。还以匿名方式对学习者进行了课程结束后的调查。
9名学生中有4名（44.4%）在课程结束后的知识评估测试中得分大于或等于80%。对所有学习者进行的课程开始前基于知识的考试，平均分为57.1±6.0%。课程结束后基于知识的测试，平均分和标准差分别为78.8±15%。分数有统计学显著提高（p = 0.004；t检验）。所有9名学生都通过了该课程，课程最终总成绩平均分为95.2±3.2%。从课程结束后的评估调查来看，所有7名回复的学生都认为SEO-P会帮助他们成为一名“有道德的”从业者。令人惊讶的是，只有一半的学习者（57.1%）认为“用于支持SEO课程的技术（即所选的课程管理系统）在开展课程方面是有效的”。
我们着手利用“基于网络的”技术，增强我们机构医学生对手术伦理学的接触。因此，我们将试点课程设计为完全在线课程。我们认为，采用外科视角，即由外科医生开发的用于探讨与外科相关临床伦理问题的手术伦理学课程，是我们项目的一个重要主题和目标。未来的挑战将是以有效的方式呈现这一视角，要么改进课程交付系统，要么可能采用混合式教学方法。
