University of Alberta Hospital, Edmonton, AB, Canada; Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Centre for Faculty Development, St. Michael's Hospital and University of Toronto, University of Toronto, Toronto, ON, Canada.
J Am Coll Surg. 2020 Aug;231(2):244-248.e3. doi: 10.1016/j.jamcollsurg.2020.04.038. Epub 2020 May 29.
Surgeons face ethical tensions daily, yet ethics education continues to prove challenging. Two possible reasons for these challenges may be the different conceptions of knowledge between technical training vs those that underpin ethical practice, and the potential devaluing of ethics as a focus for education given false assumptions about its inherent nature. This study implemented and evaluated an innovation meant to prioritize and contextualize ethics in surgical learning and practice.
After implementation of Ethics Morbidity and Mortality (M&M) rounds as an educational intervention, a qualitative evaluation consisted of interviews with 12 residents and 9 faculty. Analysis was informed by principles of constructivist grounded theory and the theoretical framework of Habermas' 3 types of knowledge: technical, practical, and emancipatory. For comparative purposes, analysis was conducted of how participants described ethics and ethics education and learning in relation to the traditional ethics teaching model vs the M&Ms.
In the traditional model, ethics teaching was seen as disconnected from real life, and not valuable. Within M&Ms, ethics was viewed as integral to practice, engaging, valuable, and relevant. In the traditional model, ethics principles were seen as acquired through role modeling and as a fixed part of character. Within M&Ms, ethics principles were seen as learnable and transformable parts of identity.
Traditional teaching of surgical ethics may result in physicians armed with knowledge, but unable to apply it. Our findings suggest that incorporating ethics into M&Ms allows not only learning the tools of ethics, but the knowledge that ethical principles were becoming integrated into professional identity.
外科医生每天都面临着伦理上的紧张，然而伦理教育仍然具有挑战性。这些挑战的两个可能原因可能是技术培训与支撑伦理实践的知识之间的概念不同，以及由于对其内在本质的错误假设，可能会贬低伦理作为教育重点的价值。本研究实施并评估了一项创新措施，旨在将伦理置于外科学习和实践的优先地位并使其具体化。
在实施《伦理发病率和死亡率（M&M）》作为教育干预措施后，对 12 名住院医师和 9 名教员进行了定性评估。分析受到建构主义扎根理论原则和哈贝马斯三种知识类型（技术、实践和解放）的理论框架的启发。为了进行比较，分析了参与者如何将伦理和伦理教育与学习与传统伦理教学模式与 M&M 相关联来描述伦理和伦理教育与学习。
在传统模式中，伦理教学被视为与现实生活脱节，没有价值。在 M&M 中，伦理被视为实践的组成部分，引人入胜、有价值且相关。在传统模式中，伦理原则被视为通过角色扮演获得的，是性格的固定部分。在 M&M 中，伦理原则被视为可学习和可改变的身份部分。
传统的外科伦理教学可能导致医生掌握知识但无法应用。我们的研究结果表明，将伦理纳入 M&M 不仅允许学习伦理工具，还允许了解到伦理原则已被纳入专业身份。
