K. A. Marsden1, L. C. Kaldjian3, E. M. Carlisle2 1University Of Iowa,Carver College Of Medicine,Iowa City, IA, USA 2University Of Iowa,Division Of Pediatric Surgery/Department Of Surgery,Iowa City, IA, USA 3University Of Iowa,Carver College Of Medicine/Program In Bioethics And Humanities,Iowa City, IA, USA
Introduction: There is an ever increasing focus on the development of medical school ethics curricula. While much effort has focused on the preclinical years, several groups have worked to identify ethical issues medical students face during their clinical rotations. This work has largely focused on internal medicine, pediatrics, and OBGYN clerkships. Little data is available regarding ethical issues students encounter on the surgery clerkship. Identification of such issues will allow preclinical and clinical course directors to refine ethics curricula to insure students are prepared to address the ethical issues they are most likely to encounter on the surgical rotation. To this end, we performed a content analysis of ethical issues encountered by medical students on a surgical clerkship.
Methods: All medical students on the surgical clerkship at a university hospital between April 2017 and June 2018 submitted a written reflection regarding an ethical issue encountered during the clerkship. Two independent investigators performed content analysis of each reflection. References to core ethical principles (beneficence, non-maleficence, justice, autonomy) were tabulated, and ethical issues were classified into 10 main categories and 58 subcategories based on a modified version of a published rubric.
Results: 140 reflections were reviewed. 6 were removed due to lack of focus on an ethical issue. 134 reflections underwent content analysis. Non-maleficence was the predominant core ethical principle mentioned, however this was closely followed by justice. Regarding ethical issues, students wrote about challenges with decision making (28%), communication among healthcare team members (14%), justice (12%), communication between providers, patients and families (10%), issues in the operating room (9%), informed consent (9%), professionalism (5%), supervision/student specific issues (5%), documentation issues (1%), and miscellaneous/other (7%).
Conclusion: Our analysis identified ethical issues that are of concern to students on the surgical clerkship. Consistent with prior analysis of students on other rotations, our work demonstrates that students express most concern with issues related to decision making. Unlike their peers on other clerkships, surgical students express increased concern with ethical issues surrounding informed consent, communication between treatment teams, and justice. Interestingly, fewer surgical students expressed concern about disrespectful treatment of patients by providers than did students on other clerkships. However, more surgical students expressed concern related to ambiguity about their role/responsibility on the surgical team, as well as the challenge of balancing delivery of efficient yet high-quality care. Integration of these specific ethical concerns into preclinical and clinical ethics curricula may help prepare medical students for the ethical issues that they will encounter on the surgical clerkship.