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may be included in a learning portfolio, a method that has been shown to promote
professional growth and development [ 27 ]. Real-time observations by faculty of
residents interacting with patients may also be included in their portfolio to provide
feedback on the resident’s abilities to handle ethical dilemmas.
Ethics Morbidity and Mortality Conferences
Recently, the use of ethics morbidity and mortality (M&M) case discussions was
integrated into five general surgery sites at the University of Toronto [ 24 ]. This
consisted of 30 min per month allocated during M&M conference where the case
discussed is selected because of the inherent ethical dilemma rather than a tradi-
tional complication. The scope of issues discussed was extremely wide ranging
from patient requesting an inappropriate intervention to the conflict of obligations
in surgical teaching. Residents present the case as they would a standard M&M,
along with a literature review of a relevant ethics dilemma that arises out of the
case. Prior to this intervention, learners saw ethics content as abstract and unim-
portant to everyday practice (Snelgrove, et al. unpublished data [ 24 ]). After the
intervention, learners felt that ethics could be taught and enhanced their awareness
and ability to tackle issues in real life. This occurred through the learning of a new
language which allowed dialogue, debriefing, and critical reflection to occur [ 24 ].
Components of successful “Ethics M&M Rounds” included maintaining a safe
learning environment; discussing relevant, real-time cases; and having good fac-
ulty moderation.
Addressing Limited Resources to Teach Ethics
While case-based learning has been identified as an important modality for teaching
surgical ethics [ 9 , 12 ], it is not always effectively used across residency programs.
A lack of faculty support has been identified as a critical barrier in the implementa-
tion of surgical ethics educational sessions [ 9 ]. While this may simply be an issue of
faculty interest, there may be additional challenges posed by instructors having a
lack of formal training in ethics and related disciplines. In an effort to consolidate
limited faculty resources, case-based learning may also be considered using tele-
conferencing or Webinar capabilities that allows sharing of moderators (ethics-
trained faculty or clinicians with a strong interest in teaching ethics) among many
learners. The moderators would then be prepared to ask questions to the presenter
or other participating sites, as well as further case discussion and exploration of
relevant ethical principles. Multiple-choice polling can be done in real time through
audience response systems. After completion of a session, learning and feedback by
participants can be further facilitated through web-based methods of sharing arti-
cles, surveys, and assessment tools.
While standard case-based conferences are often seen as ideal for discussions
among groups for reasons of convenience, they can also serve to enhance
S. Ganai and K.M. Devon