TOTB-07: ETHICS IN THE SURGICAL CLERKSHIP; AN EXERCISE IN MANAGING BIAS IN THE CARE OF SURGICAL PATIENTS
Natasha Keric, MD; Banner University Medical Center-Phoenix

What problem in education is addressed by this work?:
Ethical education, especially in the surgical realm, is not well developed at many institutions. During our third year surgery clerkship, we have a 1 hour Ethics session where ethical issues in the surgical clinical setting are discussed in a group consisting of 20 students, led by an Ethicist. Cases discussed are real and brought by the surgeon or provider attending the session. The case is anonymous to the Ethicist and most of the students, unless they were directly involved in the care of the patient. In a safe and supportive learning environment, students openly discuss and bring forth questions they have about the case, discuss bias, and gain a perspective on the difficult decisions that surgeons can face in treating their patients.

Describe the intervention:
The objectives of the session are to apply the ethical principles that students have learned in their first 2 years of medical school to a clinical setting in a supportive environment. Students are asked to discuss and understand the ethical issues related to surgical interventions, the process of informed consent for surgical procedures and the ethics of heroic surgical interventions for patients with a terminal illness or injury. As students discuss their thoughts, perceptions and ethical conflicts with a surgical case, the Ethicist helps the group exercise professional judgment utilizing the tools provided to them in their previous ethical courses.

Describe how this intervention could be applied at other institutions. Please specifically comment on identified barriers that could exist and how they could be overcome:
This informal session can be easily applied to other institutions as a one hour educational experience discussing an ethical surgical case led by an Ethicist. It provides an educational tool that most students, residents and even faculty do not experience in their training, but is much needed for their practice. It does not require a power point or advanced preparation other than bringing forth an ethical case, which can range from discussing informed consent, operating on a Jehovah's witness patient or withdrawal of care on a terminally ill patient. Barriers to overcome would be to ensure that the session is confidential, safe for students to bring forth their opinions and concerns and to have an Ethicist to help guide the discussion.