Teaching medical ethics isn’t easy. Residents must understand new concepts, such as beneficence, nonmaleficence, and autonomy. Residency directors must find time to include ethical discussions in training schedules prescribed by work-hour limits, an increasing body of knowledge, core competency requirements, and new learning tools.
An email survey on ethics training and instruction for residents, conducted by the AAOS Ethics Committee in 2008, found that residency programs devoted less than 3.5 hours per year, on average, to medical ethics training. Respondents—orthopaedic department heads and program directors—also expressed a desire for additional resources to enhance ethics and professionalism education in orthopaedic residency programs.
In answer to that need, at the 2012 Annual Meeting, the AAOS Ethics Committee unveiled a new web-based ethics and professionalism program for orthopaedic residents.
Free through OrthoPortal.org
The new Resident Ethics Series: Issues and Scenarios for Discussion and Guidance covers multiple ethical issues that arise in the practice of orthopaedic surgery. Each topic is presented through a slide presentation and an accompanying text discussion. The entire series is available at no charge under the “eStudy and Resident Center” of the OrthoPortal and can be accessed at www.aaos.org/ethics
The ethical scenarios or cases and accompanying discussion questions are designed to foster an understanding of medical ethics, stimulate discussion, and encourage further exploration of common ethical dilemmas encountered during the practice of orthopaedic surgery. The text document contains additional background information and is keyed to the slides for easy use.
Ten scenarios have been developed by members of the Ethics Committee on the following topics:
- Patient Autonomy
- Informed Consent
- Surrogate Decision Making
- Disclosure with Adverse Outcomes
- Paying to Play
- Put Me Back in the Game, Doc
- Relationships with Industry
- Expert Witness Testimony
- The Older Surgeon
Additional topics have been identified and will be added in 2013. The Ethics Committee also plans to update these discussion scenarios on a regular basis.
The site also contains videos and case discussion guides on ethical issues in orthopaedic surgery and links to other AAOS ethics resources.
Why should residents care?
According to Kenneth C. Thomas, MD, who served on the Ethics Committee while a resident, “We need to care about ethics because we care about our patients, our profession, and the future of orthopaedic surgery.”
Although every situation may not have one “correct” answer, the AAOS Ethics Committee designed these discussion scenarios to help residents prepare for situations containing ethical and professional challenges by considering the issues in advance. In addition, due to various state laws, what is acceptable in one location may not be appropriate in another location.
Orthopaedic residents should know that, as surgeons, they have an obligation to know and follow the law in their communities. The Ethics Committee believes that the discussion elicited by these scenarios will help strengthen residents’ understanding of right and wrong and enable them to choose wisely when facing an ethical dilemma.
For more information on the Resident Ethics Series: Issues and Scenarios for Discussion and Guidance, visit www.aaos.org/ethics
Charles Carroll IV, MD, chairs the AAOS Ethics Committee.
What would you do?
Case 1: A 56-year-old patient undergoes lumbar spinal fusion. During the surgery, a pedicle screw is placed into the vertebral foramen. It is recognized and changed during the surgery. Postoperatively, the patient has a foot drop.
Case 2: What if the resident was left to close the wound, and a sponge is left in the patient that is recognized on a postoperative radiograph in the office at 2 weeks?
Case 3: During a routine decompression for a herniated disk, the surgeon inadvertently tears the dura. It is a small tear, easily repaired, and does not change the postoperative course.
Case 4: Your office nurse calls you about a patient with a postoperative wound that looks infected, and you ask the nurse to begin antibiotics. The nurse writes a prescription for a sulfonamide antibiotic. The patient fills the prescription and does not recognize that he is allergic to the medicine. He ends up in the emergency department, is treated, released, and changed to an appropriate antibiotic.
The above examples typify the scenarios developed for the Resident Ethics Series. Each would be the basis for a discussion, including consideration of the following questions:
- Should the physician apologize?
- How does an apology work?
- Why does an apology fail?
Disclosure with Adverse Outcomes, Resident Ethics Series: Issues and Scenarios for Discussion and Guidance, is available online at www.aaos.org/ethics