Division of Thoracic Surgery, Department of Surgery, JFK University Medical Center, Hackensack Meridian School of Medicine, Hackensack Meridian Health (HMH) Network, Edison, New Jersey.
Medical College, Aga Khan University, Karachi, Pakistan.
J Surg Educ. 2023 Aug;80(8):1075-1088. doi: 10.1016/j.jsurg.2023.05.016. Epub 2023 Jun 17.
Ethics education in surgical residencies is often delivered in an informal and nonstructured manner as part of a "hidden curriculum", leading to few residencies routinely including it in their core curriculum. This systematic review aimed to summarize the delivery modes, curriculum, structure, and effectiveness of ethics educational interventions for surgical trainees.
We performed a comprehensive database search including MEDLINE, Embase, Scopus and CENTRAL to search for articles describing the implementation of ethics educational interventions for general surgery or subspecialty trainees.
A total of 14 studies were included. Only 2 centers performed targeted needs assessment. Curricula covered included informed consent, the doctor-patient relationship, breaking bad news, decision-making, end-of-life care, conflicts of interest, considering patients' personal contexts, and surgical research ethics. Modes of delivery varied across studies, including case-based learning, group discussions, didactic lectures, reading material, role-playing, simulated patients, and ethics morbidity and mortality (M&M) meetings. Evaluations were most commonly via surveys exploring knowledge and self-reported confidence, with only 3 studies measuring actual trainee performance using objective structured clinical examinations. In general, the educational interventions increased trainees' confidence/preparedness in handling ethical dilemmas.
We recommend comprehensive local needs assessment to guide curricular development and designing specific learning objectives and measurable milestones to ensure evaluation. Educational interventions are best delivered in a graduated manner with the complexity of the topic mirroring residents' real-life clinical responsibilities and experiences. Teaching modalities should be tailored according to the nature of the curricular content being taught to make the learning experience more interactive and effective.
外科住院医师的伦理教育通常以“隐性课程”的形式以非正式和非结构化的方式进行，导致很少有住院医师将其纳入核心课程。本系统评价旨在总结外科受训者伦理教育干预措施的实施方式、课程、结构和效果。
我们进行了全面的数据库搜索，包括 MEDLINE、Embase、Scopus 和 CENTRAL，以搜索描述一般外科或亚专科受训者实施伦理教育干预措施的文章。
共纳入 14 项研究。只有 2 个中心进行了有针对性的需求评估。课程涵盖的内容包括知情同意、医患关系、告知坏消息、决策、临终关怀、利益冲突、考虑患者的个人背景以及外科研究伦理。教学模式在研究之间有所不同，包括基于案例的学习、小组讨论、专题讲座、阅读材料、角色扮演、模拟患者和伦理医疗差错和不良事件（M&M）会议。评估最常见的是通过调查探索知识和自我报告的信心，只有 3 项研究使用客观结构化临床考试来衡量实际受训者的表现。一般来说，这些教育干预措施提高了受训者处理伦理困境的信心/准备度。
我们建议进行全面的本地需求评估，以指导课程开发，并设计具体的学习目标和可衡量的里程碑，以确保评估。教育干预措施最好以渐进的方式进行，主题的复杂性反映了住院医师的实际临床责任和经验。教学方式应根据所教授课程内容的性质进行调整，以提高学习体验的互动性和有效性。
