RESULTS OF A NATIONAL SURVEY ON ETHICS EDUCATION IN GENERAL-SURGERY RESIDENCY PROGRAMS

BACKGROUND: Medical ethics is a required part of the curriculum in all medical schools in the United States, and an essential component of t he educational guidelines for most postgraduate residency programs. Cu rrently, general surgery does not specify ethics education in its esse ntial curriculum for surgical training. This study was designed to det ermine the existing educational activities in ethics for residents in general surgery, as well as to characterize the attitudes of surgical educators about the role of ethics teaching in residency training. MET HODS: An 80-item questionnaire was mailed to the program directors of all accredited general surgery residencies in the United States. They were requested to provide information about their teaching activities in ethics, their resources for ethics instruction, and their attitudes about the importance of education in clinical ethics for surgical res idents. RESULTS: The survey had a 71% response rate with a representat ive distribution of programs based on size, geographic location, and c ommunity versus university affiliation. Fifty-six programs (28%) offer ed no formal ethics education, 94 (48%) held one teaching event in eth ics, and 48 (24%) conducted two or more activities. The format for ins truction in ethics included grand rounds (50%), resident conferences ( 41%), and ethics rounds (9%). Residencies with a faculty surgeon havin g expertise or special interest in ethics had a greater number of ethi cs teaching activities (P <0.05), whereas programs with a hospital eth icist were more likely to provide ethics rounds (P <0.01). A standardi zed curriculum in ethics was favored by 85% of respondents with critic al content in end-of-life decisions, managing ethical conflict, and in formed consent. The majority of program directors were opposed to (50% ) or undecided (20%) about inclusion of ethics questions on the Americ an Board of Surgery Inservice Training Examination (ABSITE) and Qualif ying Examination in General Surgery. CONCLUSIONS: The majority of prog ram directors of general surgery residencies support the teaching of c linical ethics and favor a standardized curriculum. However, most resi dencies in general surgery do not include ethics instruction as part o f their on-going, regular educational schedule. (C) 1997 by Excerpta M edica, Inc.