Justice Education

Good Work
April 2024

The Good Surgeon: Character and Flourishing at Duke University School of Medicine

Wes Siscoe

“Thank goodness he died. We are really slammed tonight.”

Dr. Ryan Antiel, now an Assistant Professor of Pediatric Surgery at Duke University School of Medicine, couldn’t believe what his fellow resident had just said. Part of it, of course, was true. It was 3 in the morning, and they had been responding to emergencies all night. Their pagers wouldn’t stop going off, and after being thrown into a difficult gallbladder procedure, they immediately had to rush to the cardiac intensive care unit.

They were too late. They got there just as the patient passed, the victim of a complication related to his recent heart surgery. There was nothing else that could be done. 

As they were taking the elevator to see the next patient, a rare chance to catch their breath, Antiel’s fellow resident said that it was good that the patient had died. After all, they had just come from one emergency situation, and they were headed to another. 

Later that morning, before going home to get a few hours of sleep before the next call shift, they grabbed a quick breakfast. In the cool light of day, the resident realized just how callous he had been. “I can’t believe that I was relieved that he died, just so I didn’t have to deal with one more case,” he said. “Who have I become?”

That experience, along with many others throughout his residency, got Antiel thinking about how medical school and residency forms the character of future physicians. 

“Many students tell me that they don’t like the people they are becoming when they are in medical school and residency,” Antiel observed. “I believe that most students go into medicine for altruistic reasons. They develop a broad medical knowledge and technical competency. But they don’t pay attention to how residency is forming their character, partly because it is not emphasized, but partly because they simply don’t have the time. And by the time they complete their training, they step back and realize that they don’t like who they have become in the process.”

In order to address this concern, helping residents to not only learn the technical skills of surgery but also develop the moral capacity to serve their patients, Antiel is currently spearheading The Project on the Good Surgeon, a program for surgery residents at the Duke University School of Medicine that helps them consider both their ethical and technical formation as surgeons. The Project’s vision “is focused on helping residents rediscover meaning and purpose in their work, develop the character traits necessary to sustain their calling, and ultimately promote flourishing in their surgical practice.”

How does the Project seek to form its participants? The primary goal of the program is to provide the time and the insights residents need to think about how they are being shaped. In order to provide that time for reflection, participants meet monthly for dinner and discussion, building a support network as a way of facilitating and reinforcing a focus on community and character. Within this supportive community,residents consider a number of questions, including why they wanted to become a surgeon in the first place, how to encounter their patients as full people, how to move forward after failure, and how to grow and thrive amidst the challenges of modern medicine. 

To keep the conversation going, dinners are also supplemented by a curriculum from the arts and the humanities, centering conversations around art, poetry, history, theology, and philosophy and a number of other cultural activities. Residents think about creativity and the moral life through a performance of Rhapsody in Blue at the Carolina Ballet, and they take a figure drawing class to consider how seeing others just in terms of their bodies can be depersonalizing. Through these shared dinners and activities, participants consider the moral ecology of typical medical training, including its emphasis on market efficiency, total work mentality, and the centrality of accolades and accomplishment, along with the burnout and loneliness to which these can lead. 

“Training to become a surgeon is extremely difficult, both technically and morally,” Antiel observed. “Along with the demanding workload, the steep learning curve, and fatigue, surgical residents encounter suffering and death on a level that we’re otherwise shielded from in our culture, and that has immense power to affect who you are becoming. Surgical residency is primarily a moral education, where one hopefully develops the characteristics of a good surgeon. Instead of neglecting resident formation, we are putting character and flourishing front and center in surgical education.”

While the program is just getting started, the preliminary results are promising. Faculty report being more connected to their students, as emphasizing character and personal formation allows them to lean in and support their residents in ways they didn’t feel empowered to before.

And though Antiel is working at Duke, the long term goal is that the program will have an impact far beyond Durham, North Carolina. Currently, there is also a cohort of the Project at Wake Forest University, and the hope is that the insights of the Project on Good Surgeon will be able to influence a number of other institutions and medical specialties. The team is currently gathering quantitative and qualitative data to demonstrate the efficacy of the program, using well-validated metrics like the Harvard Human Flourishing Measure and other burnout and career satisfaction assessments.

“We hope that the work we are doing will provide residents the space to attend to their whole selves, to be reminded of their calling to do this work, and to provide them with the tools to retain their humanity in the midst of a medical training culture which can feel opposed to that,” said Antiel. “We don’t view the program as one more way to optimize work, or simply as a break from work for the sake of work. Instead, this is an opportunity for young surgeons to bring their whole selves to their work and to also consider the other spheres and vocations of their lives.”