D105. Anatomical Training and Legacies of Abuse in Surgery (A.T.L.A.S.): Surgeons’ Ethical Decisionmaking around Problematic Resources in Surgery and Surgical Education

BACKGROUND: The precious nature of gifted human remains requires surgeons and trainees to turn to illustrations as their primary anatomical resources, resulting in the use of legacy resources compiled through the dissection of ungifted cadavers, often without disclosure. In this single-institution survey, we interrogate surgeons' ethical decisionmaking around anatomical resources when pertinent background details are made available. METHODS: 259 surgeons across surgical specialties were provided one of five vignettes describing an unnamed anatomical atlas with variable details about the consent of depicted subjects. Surgeons were asked whether they would be comfortable using the atlas in surgery and in trainee education and to indicate themes mirroring their rationale. RESULTS: With increasing ethical complexity, surgeons exhibited increasing discomfort using an atlas in education (p<0.005) but not in surgery.(p=0.07) Compared with general disclosure of unethical cadaver procurement practices, specific disclosure of exploited groups resulted in significantly decreased comfort with use in surgery and education.(p<0.05) Surgeons across-the-board implemented more outcomes-oriented rationale than value-based.(p<0.05) CONCLUSION: Our results demonstrate that even minimal details may influence surgeons' use of a resource in surgery and education. Surgeons' increased sensitivity to ethical concerns in education versus surgery underscores a surgeon's differing roles as physician and educator. Surgeons may select a resource for surgery based more heavily on clinical utility, prioritizing patient care. Meanwhile, surgeons may allow themselves latitude to curate resources for trainees based on more nuanced treatment of the resources. This suggests an imperative to provide relevant disclosures, empowering surgeons to make informed ethical decisions about the tools they use to heal and teach.