Resident-driven Utilization of
the ACS Curriculum for
Teaching Ethics
Luke Brewster MD, PhD, MA
The Problem
• Surgical residents graduate from medical school
with varying exposure and understanding of ethical
principles.
• The acquisition of these skills are frequently
learned through modeling mentor behavior
– Can be widely divergent among practitioners
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Increased technologic capability
Decreased continuity of care
Failure of the SUPPORT investigations
Field of ethics under-represented by physicians and
surgeons in particular
Program Self-Assessment
• Beginning in 2004, our general surgery
residency program instituted a Palliative
Surgery/Ethics curriculum
• Self-assessment showed global deficiencies
in knowledge and confidence levels of our
residents
First Stage
• Annual lecture series at Resident Conference and
Surgical Grand Rounds
– Palliative Surgery
– End of Life Ethics
– The Family Conference
• “Breaking Bad News” workshops and mentoring
program
– Critical care rotations
• “Disclosure of Adverse Events” module for junior
residents
– In association with Edward Hines Jr. VA Hospital and the
Division of Education, American College of Surgeons
• Standardized withdrawal of support order set
– Computerized Order Set
Findings
• Resident comfort with ethical discussions
and decisions increased linearly with
training
• Resident knowledge and interpersonal skills
stagnated at entry level
Second Stage
• Annual Ethics Lecture by prominent ethicists
discussing Ethics in Surgery
– Dr. Angelos from University of Chicago, Department of
Surgery and MacLean Center for Clinical Ethics
• Developing a resident assessment tool to define
resident comfort and knowledge of basic ethical
principles
– Collaborative multi-institutional effort
• Emory Medical Center, University of Chicago, University
California at San Francisco, University of Rochester,
University of Pittsburgh
• Incorporating the ACS Surgery Ethics Curriculum
into Resident Conference
ACS Surgical Ethics Curriculum
• Competition of interests
– Mary McGrath, MD, MPH, FACS
• Professional Obligations of Surgeons
– Martin McKneally, MD, PhD, FACS, FRCSC
• Truth telling and the Surgeon-Patient Relationship
– Ira Kodner, MD, FACS
• Confidentiality
– Mark Siegler, MD, FACP
• End-of-Life Issues
– Peter Angelos, MD, PhD, FACS
• Substitute Decision Making
– Edmund Pellegrino, MD, MACP
Currently
• Validating the resident assessment tool at
our institution
• Beginning the resident assessment at our
collaborating institutions
• Following resident improvement in
knowledge and interpersonal skills over
residency training