Ethics Consultations as a Novel Approach to Needs Assessments in Surgical Ethics Curriculum Development

Previous studies suggest that nationally standardized surgical ethics curricula may not fully prepare surgical teams for complex ethical dilemmas encountered in clinical practice. Local needs assessments can bridge this gap by identifying areas for targeted training. Studies assessing institutional surgical ethics needs have utilized literature review, surveys, and interviews with staff, but not review of ethics consultation documentation. This study analyzes the ethical issues and contextual features underlying ethics consultations involving surgical specialties to assess their utility as a needs assessment tool and to inform formal ethics curriculum development.

A retrospective review of ethics consultations involving surgical teams between January 2014 and June 2024 was conducted using deductive conceptual content analysis to identify primary ethical themes and contextual features. Descriptive statistics were used to analyze data.

Ethics consultation documentation at Michigan Medicine, a tertiary academic medical center in Ann Arbor, Michigan.

The review included 51 pediatric consultations and 119 adult consultations.

Pediatric consultations involved 8 surgical subspecialties; adult consultations involved 11. Most consultations (58.8%) occurred during the preoperative period. In the pediatric cohort, the most common ethical themes were disagreements regarding goals of care (23.5%), treatment over objection or refusal (15.7%), and surrogate decision-making (13.7%). In the adult cohort, decision-making capacity (23.5%), surrogate decision-making (22.7%), and disagreements regarding goals of care (18.5%) were most prevalent. The most frequent contextual features were staff-family conflict (29.4%) in pediatric cases and communication issues (37.8%) in adult cases.

Review of ethics consultations is an effective method for identifying scenarios where surgical teams need additional support and could benefit from targeted ethics training. This work supports ongoing curricular development aimed at providing trainees with broad ethical foundations and adaptable, subspecialty-specific components. These enhancements ensure that education remains relevant to the complex, specialty-specific challenges faced during formative years of training.