Many Ethical Considerations if Surgeons Record Procedures
Videotaping surgeries is important for training and quality improvement, but there are multiple ethical concerns. “The legality area has been well-covered. But issues such as doctor-patient relationship and ethical frameworks need deep consideration at the patient, practitioner, institutional, and societal level,” according to Ronan Cahill, MB, BAO, BCh, professor of surgery at University College Dublin.
Cahill and colleagues conducted a systematic review of the literature, analyzing 25 publications on the ethics of OR recording.1 “Given the increasing capability and value in surgical recordings now in this age of AI, we wanted to understand what ethical considerations have been evaluated to date,” Cahill explains.
Beneficence, nonmaleficence, justice, and autonomy were key areas of focus in the publications. “We found that there has been only limited work recently, with a predominantly Western perspective, and with a focus on individual patient level and beneficial aspects,” Cahill notes.
Video training can be an ethical approach to improving health outcomes, says Julie M. Aultman, PhD, dean of the College of Graduate Studies and director of the medical ethics and humanities program at Northeast Ohio Medical University in Rootstown. “Videos complement the review and reflection of surgical practice that is traditionally done at morbidity and mortality conferences,” Aultman says.
Ideally, the surgical team uses the recordings in conjunction with quality improvement and risk management to assess efficiency, professionalism, communication, and leadership.
“Video training can help prevent medical errors and poor surgical outcomes through a review of safety protocols and checklists captured prior to and during a surgery,” Aultman says.
For interns and residents, video training is an important tool that can improve skills and confidence. “It can also improve their ability to receive constructive feedback from mentors and educators, and take ownership of mistakes or gaps of knowledge,” Aultman adds. For example, a second-year resident may learn an incorrect surgical procedure from a senior or chief resident or faculty member, but is uncomfortable calling out their poor training and any resultant errors. “Training videos can help improve surgical practices and outcomes, regardless of learners’ positions or statuses,” Aultman says.
For patients, video recordings can foster health literacy. Watching a video of a surgical procedure can be more informative than a verbal explanation of what is entailed. “This level of transparency could potentially alleviate fears, trepidations, and distrust,” Aultman offers.
IRBs provide oversight if video recordings are used in research. “But when it comes to educational training, or non-human subjects studies such as quality improvement projects, ethical oversight can vary depending on the clinical setting,” Aultman says.
According to Aultman, hospitals and graduate medical education departments should establish oversight committees to ensure videos are used appropriately, inform patients that video training is essential to improve patient safety and health outcomes, and develop safeguards to protect patient privacy (e.g., policies that require de-identification practices). Patients and their families (if patients lack capacity or awareness) should be aware that surgeries will be recorded, and that faces and other identifiable details are blurred, covered, or simply not captured or disseminated unless consent is granted by the patient or their proxy.
“The ethics of video recording should be integrated in graduate and continuous education modules so surgeons have self-governance when recording or utilizing videos,” Aultman adds.
1. Walsh R, Kearns EC, Moynihan A, et al. Ethical perspectives on surgical video recording for patients, surgeons and society: Systematic review. BJS Open 2023;7:zrad063.
Ideally, the surgical team uses the recordings in conjunction with quality improvement and risk management to assess efficiency, professionalism, communication, and leadership. The ethics of video recording should be integrated into graduate and continuous education modules.
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