Ethics Education in Neurosurgery Residency: Program Directors' Perspectives on Perceived Gaps in the Curriculum.

OBJECTIVE: Bioethics teaching is not formally included in most neurosurgery residency curricula, and prior studies have not examined the perceived need for such training. DESIGN: We conducted a cross-sectional survey of North American neurosurgery residency program directors (PDs) to evaluate the status of ethics education, identify barriers to its inclusion, and assess the perceived need for formal ethics training within residency programs. SETTING: An electronic survey was distributed to all North American neurosurgery PDs. PARTICIPANTS: The questionnaire assessed the current format and frequency of ethics education, PDs' experiences with ethical dilemmas, perceived preparedness of graduating residents, and barriers to implementation. RESULTS: Forty-five PDs responded. Respondents had a median of 15 years in neurosurgical practice and 4.5 years as PDs, with programs averaging 14 residents. The most common ethical dilemmas encountered involved end-of-life care, surrogate decision-making, informed consent, and access to healthcare. Ethics education averaged one hour across the entire duration of residency, most often delivered through informal discussions or case-based sessions; 60% of programs had no assigned readings. A majority (58%) of PDs believed that residents receive insufficient ethics education, citing lack of time (80%) and faculty expertise (42%) as primary barriers. Most PDs (71%) supported making ethics education mandatory, though no significant associations were found between PD experiences, hours of instruction, or perceived resident preparedness. CONCLUSIONS: Ethical dilemmas are common in neurosurgical practice, yet structured bioethics education during residency remains limited. Given the identified gaps and barriers, incorporating bioethics into the core neurosurgical curriculum may better prepare residents to navigate ethically complex clinical situations.