title: 2016 CAPS ethics session/Ein debate: 1. Regionalization of pediatric surgical care 2. Ethical introduction of surgical innovation 3. Addressing stress in a surgical practice: resiliency, well-being, and burnout.
abstract: The following is the conference proceeding of the Second Ein Debate from the 48th Annual Meeting of the Canadian Association of Paediatric Surgeons held in Vancouver, BC, from September 22 to 24, 2016. The three main topics for debate, as prepared by the members of the CAPS Ethics Committee, are: 1. Regionalization of care: pros and cons, 2. Innovation in clinical care: ethical considerations, and 3. Surgeon well-being: caring for the caregiver. The authors of this paper, as participants in the debate, were assigned their positions at random. Therefore, the opinions they express within this summary might not reflect their own viewpoints. In the first discussion, arguments for and against the regionalization of pediatric surgical care are discussed, primarily in the context of a case of BA. In the pro argument, the evidence and lessons learned from different European countries are explored as well as different models to provide the best BA care outside of large teaching centers. In the counterargument, the author explains how regionalization of care could be detrimental for the patient, the family, the regional center, and for the health care system in general. In the debate on surgical innovation the authors define surgical innovation. They review the pertinent ethical principles, explore a model for its implementation, and the role of the institution at which the innovation is proposed. In the third section, surgeon well-being is examined, and recent literature on surgeon resiliency and burnout both at the attending and resident level is reviewed.
authors.affiliation: Division of Pediatric Surgery, Virginia Commonwealth University/Medical College Of Virginia, Richmond, VA, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Bagwell
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Chiu
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada. Electronic address: Annie.fecteau@sickkids.ca.
authors.forename: Annie
authors.initials: A
authors.lastname: Fecteau
authors.affiliation: Division of General and Thoracic Surgery, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Mueller
authors.affiliation: Department of Surgery, Janeway Children's Hospital, St. John's, NL, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: Department of Surgery, Northwest Permanente and Oregon Health & Science University, Portland, OR, USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Zigman
mesh_terms: D002055:Burnout, Professional / Q000517:prevention & control* / Q000523:psychology; D002170:Canada; D002648:Child; D003695:Delivery of Health Care / Q000941:ethics / Q000458:organization & administration*; D006801:Humans; D010372:Pediatrics / Q000941:ethics / Q000458:organization & administration*; D055500:Resilience, Psychological; D012955:Societies, Medical; D013043:Specialties, Surgical / Q000941:ethics / Q000458:organization & administration*; D066231:Surgeons / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D035703:Therapies, Investigational / Q000941:ethics*
keywords: BA; Burnout; Ethics; Pediatric surgery; Regionalization of care; Surgeon well-being; Surgical innovation