Ethical and Legal Considerations for Recording in the Operating Room: A Systematic Review.

INTRODUCTION: The integration of high-resolution video into surgical practice has fostered widespread interest in capturing surgical video recordings for the purposes of patient care, medical training, quality improvement, and documentation. The capture, analysis, and storing of such recordings inherently impact operating room (OR) activities and introduce potential harms to patients as well as members of the surgical team, which can be analyzed from both ethical and legal perspectives. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed was conducted. The citations of included articles were then reviewed to find any articles not captured by our initial search. RESULTS: 62 Articles were included in the review (52 from PubMed search and 10 from citation review). Prevalent key issues in the literature at present include privacy, consent, ownership, legal use and discoverability, editing, data security, and recording's impact on the surgical team. CONCLUSIONS: This review aims to spark proactive discussions of the ethical and legal implications of recording in the OR, which will guide transformation as the medical field adapts to new and innovative technologies without compromising its ideals or patient care.

Talking with Patients about Surgical Trainees.

AbstractTraining of resident physicians is essential for the care of future patients. While surgical trainee involvement is necessary, its disclosure to patients can often be omitted or underplayed by surgeons. The informed consent process and the underlying ethical principles make evident that patients should be informed of trainee involvement. In this review we explore the importance of disclosure, current themes in practice, and the optimal discussion for which we should strive.

Public Perceptions and Informational Needs Regarding Surgical Residents.

OBJECTIVE: Identify what topics are of most interest to patients regarding surgical residents. DESIGN: Survey of general public describing a hypothetical surgery and then assessing comfort level with resident involvement in surgery, reactions to disclosure statements regarding resident involvement, and desires for additional information. This data was used to produce an amended statement about surgical residents and their involvement in a hypothetical surgery to determine the impact of increased information on participant comfort. SETTING: Online survey via Mechanical Turk. PARTICIPANTS: Our sample was broadly representative of the United States based on race and age, but with higher education level than United States census data. RESULTS: Using a combination of hierarchical clustering, weighted averages, and VAS scoring, questions that were most highly valued by participants were related to what the resident will be doing in the operation and the impact of resident involvement. Participants who had a past negative experience with residents assigned higher importance to all questions, even those that may be seen as not clinically relevant. Increasing the amount of proactively provided information did not have a significant effect on comfort (p = 0.219) when compared to our baseline statement, except with those who reported past negative experience with residents (p = 0.039). CONCLUSIONS: These results demonstrate that the majority of potential patients want to know specific details about the residents' skills, what they will be doing in their surgery, and the impact of their participation. Surgeons should be attuned to patients with past negative experiences, who may desire more information. Additional information alone may not be sufficient to comfort some patients, and future research should consider information delivery styles and interpersonal effects on patient comfort level.

The Reevaluation of AΩA: Updating the Outdated.

Medical schools across the country are reconsidering the place of Alpha Omega Alpha Medical Honor Society (AΩA) as evidence of disparities in membership selection continues to mount. Although AΩA national leadership responded to backlash with a reaffirmation of their motto "Be Worthy to Serve the Suffering," and their commitment to diversity, little meaningful progress has been made to this end. By continuing as an organization based on exclusivity, AΩA is an outdated institution that contributes to the structural racism observed in multiple domains of medical education. As we continue to move away from elements of medical education that perpetuate these inequities (e.g., USMLE Step 1 and USMLE Step 2 Clinical Skills Examinations), the place of AΩA in medical education must be re-examined. Several leaders in diversity and inclusion have led the charge by suspending AΩA participation at their institutions (at least 16 U.S. medical schools) and this trend should continue without drastic changes to AΩA. Rather than pushing responsibility to individual chapters, AΩA national leadership must make significant changes to national selection criteria in order to provide appropriate oversight. We propose that AΩA leadership: (1) convene a national task force to review current selection criteria and make actionable recommendations, (2) incorporate standardized diversity goals into selection criteria to hold chapters accountable and limit internal bias, and 3) report diversity and inclusivity statistics annually to the public to promote organizational accountability. Ultimately, meaningful action is necessary for AΩA to remain an honor and to support the development of inclusive leaders in medicine.

Engaging the next generation of physician-informaticians through early exposure to the field: successes and challenges associated with starting a novel clinical informatics interest group.

Clinical informatics remains underappreciated among medical students in part due to a lack of integration into undergraduate medical education (UME). New developments in the study and practice of medicine are traditionally introduced via formal integration into undergraduate medical curricula. While this path has certain advantages, curricular changes are slow and may fail to showcase the breadth of clinical informatics activities. Less formal and more flexible approaches can circumvent these drawbacks. Interest groups (IGs), which are organized through the Association of American Medical College Careers in Medicine (CiM) program, exemplify the informal approach. CiM IGs are student-led groups that provide exposure to different specialty options, acting as an adjunct to the traditional medical curriculum. While the primary purpose of these groups is to assist students applying to residency programs, we took a novel approach of using an IG to increase student exposure to an area of medicine that had not yet been formally integrated at our institution. IGs provide unique advantages to formal integration into a curriculum as they can be more easily setup and can quickly respond to student interests. Furthermore, IGs can act synergistically with UME, acting as proving grounds for ideas that can lead to new courses. We believe that the lessons and takeaways from our experience can act as a guide for those interested in starting similar organizations at their own schools.