383discussions of normative and applied ethics because of their focus on the narrative
aspects of clinical practice. Case-based teaching strategies can optimally provide
learners with models on how to think professionally about problems, allow them to
develop critical thinking skills, and enhance their ability to learn from their own
experiences, whether real or simulated [ 8 ]. Case studies allow conversation of the
moral principles at stake, with discussion of the stakeholders, conflicting rights and
values, and clinicians’ reasoning, as well as their obligations, interpersonal skills,
and decision-making [ 26 ]. Case-based methods allow development of problem-
solving skills in a safe environment for learners to receive feedback; understand
conflicting attitudes, beliefs, and values; and allow social collaboration for analysis
and discussion [ 7 ].
By teleconferencing surgical ethics case conferences across multiple institutions,
we may be able to pool expertise in teaching ethics as well as capitalize on the
shared and diverse experience of surgeons on a national or even international level.
This would potentially create opportunities for mentorship in surgical ethics which
residents may not have at their home institution. Ultimately, encouraging surgical
ethics discourse will require training faculty on how to effectively teach surgical
ethics. While opportunities are limited, the ACS Division of Education offers a
structured fellowship in surgical ethics at the Maclean Center for Clinical Medical
Ethics of the University of Chicago [ 1 ]. The University of Toronto offers a “Teaching
the Teachers” retreat offering interactive workshops for their faculty and residency
coordinators directed toward facilitating teaching bioethics [ 14 ]. The challenge of
teaching surgical ethics will only be facilitated through prioritizing ethics within the
surgical curriculum and fostering enthusiasm and interest in including ethics dis-
course in the daily practice of surgeons.
Summary
Although seemingly routine, the act of choosing to perform an operation is a moral
decision requiring agency. While surgeons encounter ethical dilemmas frequently,
they are not always well equipped to manage and discuss problems that are often
unique to their discipline. Despite increasing interest in providing surgical residents
a formal education in ethics, current curricula may be difficult to implement or be
dependent on the presence of motivated faculty. We recommend a mixed-methods
modular ethics curriculum that centers around traditional case-based learning meth-
odology, focusing on the M&M conference. Via multi-institutional collaboration,
we foresee using teleconferencing as a tool to enhance ethics education over a net-
work of residency programs using distance learning techniques; however, even
these methods will compete for learner and faculty time. Further research needs to
be performed on the value and effectiveness of various modalities for teaching sur-
gical ethics. Teaching surgical ethics should be prioritized as it appears to be of
importance for maintaining professional conduct by surgeons, fostering the surgeon-
patient relationship, and improving patient-centered outcomes, but further inquiry
must be performed to verify this and show how to do this effectively.
21 Teaching Surgical Ethics