Teaching Ethics in Surgical Training Programs Using a Case-Based Format

Purpose: To fulfill a curricular need and to address the ACGME competencies of Professionalism and Systems-based practice, we have developed a case-based approach to teaching ethics to trainees at Washington University in Saint Louis. Development of the Activity and Materials: For the past 5 years, we have used a case-based approach to discuss ethical dilemmas with residents in an interactive conference format. Attendees and participants include medical students, residents, fellows, and surgical attendings, as well as members of the hospital ethics committee, nurses, chaplains, and attendings and trainees from other disciplines. Residents and students collect the cases from their daily experiences and discuss them with the group on a monthly basis. Evaluation Component: Attitudinal surveys of trainees were completed just before the initiation of the conferences and again 5 years later. Implementation Dates and Experience to Date: The program was initiated in October 2002 and is ongoing. The format and the participants have evolved somewhat over this time period. That evolution and some lessons learned are described in this article. Conclusion: Our experiences have shown that a case-based approach to teaching ethics to surgical trainees is feasible, relevant, and important to the education of trainees in the current environment.