Training to proficiency in surgery using simulation: is there a moral obligation?

A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The ‘learning curve’ in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.

You Are the Perfect Age: An Inquiry into Surgical Ethics during the Arc of a Career

There is an old saying that history only makes sense in retrospect. I am sure that I am as susceptible to this adage as any other person. However, I will tell the story of my long history as an amateur medical ethicist, which is, to this day, how I would describe myself. My interest in the ethics of medicine, particularly as these ethical principles apply to interventions or procedures, started at a young age, fairly frequently going to the hospital with my father, a General and Thoracic Surgeon. I think that I found myself agreeing to accompany him, when invited, presuming that doing so would be a chance to spend some time with my dad, who was, throughout my childhood, either a surgical resident or a busy practicing surgeon. I will admit that I probably also figured that, at least late at night on the way home, we would stop by some establishment where we could get burgers and fries. However, I will start my reminiscences and reflections on these issues with a more recent story, as it prompted me to think back on my perceptions of those experiences of my youth.