Ethics Education in Neurosurgery Residency: Program Directors' Perspectives on Perceived Gaps in the Curriculum

Area of Science:

• Medical Education
• Bioethics
• Neurosurgery

Background:

• Bioethics education is largely absent from neurosurgery residency curricula.
• Previous studies have not addressed the perceived necessity for ethics training in this specialty.

Purpose of the Study:

• To evaluate the current state of bioethics education in North American neurosurgery residency programs.
• To identify barriers hindering the integration of ethics training.
• To assess the perceived need for formal bioethics education among program directors.

Main Methods:

• A cross-sectional electronic survey was distributed to all North American neurosurgery program directors (PDs).
• The survey assessed current ethics education formats, frequency, PD experiences with ethical dilemmas, and perceived resident preparedness.
• Barriers to implementing ethics education were also investigated.

Main Results:

• Forty-five PDs responded, reporting an average of one hour of ethics education throughout residency, often informal.
• Common ethical dilemmas involved end-of-life care, surrogate decisions, informed consent, and healthcare access.
• A majority of PDs (58%) found resident ethics education insufficient, citing time constraints (80%) and lack of faculty expertise (42%) as key barriers.
• 71% of PDs supported mandatory ethics education.

Conclusions:

• Ethical challenges are prevalent in neurosurgical practice, yet formal bioethics education remains inadequate.
• Addressing identified barriers is crucial for enhancing resident preparedness in navigating complex ethical situations.
• Integrating structured bioethics into the core neurosurgery curriculum is recommended.