RISE: Resident Initiative in Surgical Ethics. Creating A Comprehensive Curriculum for General Surgery Residents

Modern surgical practice presents increasingly complex ethical challenges, shaped by technological advancements and a shift toward shared decision-making and patient autonomy. While technical proficiency is essential, a strong foundation in ethics is critical for surgical residents. However, ethics education in many residency programs remains unstandardized and insufficient. To address this gap, we developed the RISE (Resident Immersion in Surgical Ethics) curriculum using Kern's 6-Step Approach to curriculum development.

A targeted local needs assessment was conducted using an anonymous, voluntary electronic survey of all general surgery residents. Findings informed the design of the RISE curriculum, which integrates 3 instructional components: (1) Quarterly Ethics Morbidity and Mortality (M&M) Forums utilizing the 4-box method for case-based analysis; (2) Case-Based Didactic Sessions incorporated into protected education time across a 2-year cycle; and (3) Role-Play Simulations with Standardized Patients, held after each didactic session to reinforce applied ethical reasoning. Post-implementation evaluation included surveys to assess changes in ethical knowledge, confidence, and the application of skills.

Pre-implementation data showed that although 98% of residents acknowledged the importance of ethics, only 28% felt confident in applying ethical principles, and 28% reported fewer than 2 ethics-related discussions in the prior year. Following implementation, 86% of residents reported improved understanding of core ethical concepts, 75% felt more confident navigating ethical dilemmas, and 91% attended 2 or more education sessions.

The RISE curriculum addresses critical gaps in surgical ethics education through a theory-driven, multimodal instructional approach that aligns with the needs of residents and the realities of clinical practice. Future iterations will expand to include advanced topics such as organ transplantation, brain death, medical aid in dying, and resource allocation, as well as interdisciplinary simulations and patient advocate involvement. These enhancements will ensure the curriculum remains responsive, comprehensive, and relevant to contemporary surgical practice.