Ethics, statistics and professionalism

Question 1

What is burnout

Answer 1

A multifaceted construct characterised by:

• emotional exhaustion
• depersonalization
• low sense of personal achievement

Question 2

Describe the principle of the surgeon as the feduciary

Answer 2

This is an underpinning principle of surgical ethics

• once a therapeutic relationship is created the onus is on the surgeon to always put the patients health needs above their own
  
  • provide vital care even payment is not assured
  • provide care even where there is a risk to the surgeon (pertinent in HIV, Covid etc)
  • care when the surgeon would rather be elsewhere
    
    • especially pertinent in complications

The principle guides almost every aspect of a surgeons conduct

Question 3

What are the ethical virtues of surgical practice

briefly interpret each

Answer 3

Integrity

• moral wholeness
• operate, teach and learn with strict focus on excellence

Compassion

• be alert to and respond to the pain and anxiety of patients and families

Self-effacement

• Put aside prejudice and preconception including ones own abilities to provide excellent and equitable care to all

Self-sacrifice

• excellence comes at a cost
• Percy described Dupuytren as “first among surgeons, least among men”

Question 4

What are the four ethical principles

briefly interpret each

Answer 4

Justice

• ensure fair and equitable provision of care

Beneficence

• act in a way to do the greatest and most relable good for the patient

Non-maleficence

• avoid harm, almost always balanced agaisnt beneficence in surgery as harm is inherent

Autonomy

• always and foremost, respect the patients right to autonomy and to choose the treatment option which is right for them

Question 5

What are the 10 core competencies of the RACS

Answer 5

Technical skills

Professionalism

Medical knowledge

Health advocacy

Collaboration and teamwork

Scholar and teacher

Judgement

Communication

Management and leadership

Cultural competence

Question 6

Lead time bias

Answer 6

Lead time is the length of time between the detection of a disease due to screening and its usual symptomatic presentation.

Lead time bias occurs if testing increases the perceived survival time without affecting the course of the disease.

Question 7

Length time bias

Answer 7

an overestimation of survival duration due to the relative excess of cases detected that are asymptomatically slowly progressing, while rapidly progressive disease presents with symptoms rather than screening

It is a form of selection bias

“If the same number of slow-growing and fast-growing tumors appear in a year, the screening test detects more slow-growers than fast-growers. If the slow growing tumors are less likely to be fatal than the fast growers, the people whose cancer is detected by screening do better, on average, than the people whose tumors are detected from symptoms (or at autopsy) even if there is no real benefit to catching the cancer earlier. That can give the impression that detecting cancers by screening causes cancers to be less dangerous even if less dangerous cancers are simply more likely to be detected by screening”

Question 8

How should bad news be delivered

Answer 8

SPIKES

• Set up the interview
• assess the Perception and understanding
• obtain the Invitation to discuss the news
• provide Knowledge and understanding
• provide Empathy and space for emotions
• Strategy and summary