This scenario presents a professional challenge due to the inherent tension between patient autonomy, the physician’s duty of care, and the potential for financial conflicts of interest. Oncoplastic surgery often involves complex decision-making where patient preferences, surgical outcomes, and the availability of specific techniques or implants can influence the treatment plan. Navigating these factors requires careful judgment to ensure the patient’s best interests are prioritized while adhering to ethical and regulatory standards. The best professional approach involves a thorough, unbiased discussion with the patient about all viable oncoplastic surgical options, including their respective risks, benefits, and expected outcomes. This discussion must be free from any undue influence related to financial incentives or personal gain. The surgeon should present a range of evidence-based treatment choices, empowering the patient to make an informed decision based on their individual circumstances and values. This aligns with the ethical principles of informed consent and patient autonomy, and regulatory frameworks that mandate transparency regarding potential conflicts of interest. An approach that prioritizes a specific surgical technique or implant solely because it offers a financial benefit to the surgeon or their institution, without a clear clinical superiority for the patient, is ethically unacceptable. This constitutes a conflict of interest that can compromise objective medical judgment and potentially lead to suboptimal patient care. Such an action violates the duty to act in the patient’s best interest and can breach regulatory requirements concerning financial disclosures and avoidance of self-dealing. Another professionally unacceptable approach is to downplay the risks or limitations of a preferred surgical option while exaggerating the benefits, especially if this preference is driven by financial considerations. This misrepresentation undermines the principle of informed consent, as the patient cannot make a truly informed decision if they are not provided with complete and accurate information. It also violates the physician’s ethical obligation to be truthful and transparent with their patients. Finally, failing to adequately explore or present alternative oncoplastic surgical approaches that might be equally or more suitable for the patient, simply because they do not offer the same financial advantages, is also professionally unsound. This limits the patient’s choices and can lead to a treatment plan that is not truly aligned with their needs or preferences, potentially resulting in poorer long-term outcomes. Professionals should employ a decision-making framework that consistently places patient well-being above all other considerations. This involves a commitment to transparency, open communication, and a thorough evaluation of all treatment options based on clinical evidence and patient-specific factors, independent of any personal or institutional financial incentives. Regular self-reflection on potential conflicts of interest and adherence to institutional conflict of interest policies are crucial components of ethical practice.

Scenario Analysis: This scenario presents a professional challenge related to the integrity and accessibility of a high-stakes fellowship exit examination. Ensuring that only eligible candidates participate is paramount to maintaining the credibility of the certification process and protecting public safety. Misinterpreting or circumventing eligibility criteria can lead to unqualified individuals obtaining credentials, potentially compromising patient care. Careful judgment is required to balance the desire to support candidates with the absolute necessity of adhering to established examination standards. Correct Approach Analysis: The best professional practice involves a rigorous and transparent verification of all eligibility requirements as stipulated by the Comprehensive North American Oncoplastic Surgery Fellowship Exit Examination’s governing body. This includes a thorough review of the candidate’s completed fellowship training, board certification status in a relevant specialty, and any other documented prerequisites. Adherence to these established criteria ensures that the examination serves its intended purpose of validating a high level of competence in oncoplastic surgery for those who have met the defined standards. This approach aligns with the ethical obligation to uphold professional standards and protect the public by ensuring that only demonstrably qualified individuals are certified. Incorrect Approaches Analysis: One incorrect approach involves accepting a candidate’s self-declaration of meeting all requirements without independent verification. This bypasses the essential due diligence expected in a credentialing process. It fails to uphold the principle of accountability and risks allowing individuals who do not meet the objective standards to proceed, thereby undermining the examination’s validity and potentially jeopardizing patient safety. Another incorrect approach is to grant provisional eligibility based on an incomplete application, with the expectation that missing documentation will be provided later. While flexibility can be beneficial, allowing participation in a high-stakes exit examination without all prerequisites being definitively met introduces an unacceptable level of risk. This approach compromises the integrity of the examination process and deviates from the established framework designed to ensure a consistent and fair evaluation of all candidates. A further incorrect approach is to waive specific eligibility criteria due to perceived extenuating circumstances without explicit authorization from the examination’s governing board. Such unilateral decisions can create inconsistencies in the application of standards, leading to perceptions of unfairness and potentially opening the door to subjective bias. This undermines the objective nature of the examination and erodes trust in the certification process. Professional Reasoning: Professionals facing such situations should always prioritize adherence to the established rules and guidelines of the examination. A systematic approach involving clear documentation, verification of all credentials, and consultation with the examination board for any ambiguities or requests for exceptions is crucial. The decision-making process should be guided by the principles of fairness, transparency, and the paramount importance of maintaining the integrity of the certification process for the benefit of the public.

This scenario presents a professional challenge due to the inherent risks associated with oncoplastic surgery, which combines oncological principles with reconstructive techniques, often requiring specialized instrumentation and energy devices. Ensuring patient safety and optimal outcomes necessitates a thorough understanding and meticulous application of operative principles, alongside strict adherence to safety protocols for instrumentation and energy device usage. The challenge lies in balancing the complexity of the procedure with the need for precise execution and risk mitigation. The best professional approach involves a comprehensive pre-operative assessment and planning phase that includes a detailed review of the patient’s medical history, imaging, and tumor characteristics. This planning should extend to selecting appropriate instrumentation and energy devices based on the specific surgical technique, tissue type, and oncological margins required. Intra-operatively, meticulous technique, including proper tissue handling, precise dissection, and judicious use of energy devices to minimize thermal damage and preserve vital structures, is paramount. Post-operative care should focus on monitoring for complications and ensuring adequate oncological clearance and aesthetic outcome. This approach aligns with the fundamental ethical principles of beneficence and non-maleficence, as well as the professional standards of care expected in oncoplastic surgery, emphasizing patient safety and optimal results through careful planning and execution. An incorrect approach would be to proceed with the surgery without a thorough pre-operative assessment, relying solely on intra-operative findings. This fails to adequately prepare for potential challenges, increasing the risk of suboptimal oncological margins or complications due to unforeseen anatomical variations or tissue characteristics. Such an approach neglects the ethical imperative to plan for the patient’s best interest and may violate professional standards that mandate comprehensive pre-operative evaluation. Another incorrect approach is the indiscriminate use of high-power energy devices without considering the specific tissue type or the proximity of critical structures. This can lead to excessive thermal damage, increased risk of unintended injury to nerves or blood vessels, and compromised wound healing, directly contravening the principle of non-maleficence and potentially leading to adverse patient outcomes. Finally, an approach that prioritizes speed over precision, particularly in the use of instrumentation and energy devices, is professionally unacceptable. This haste can result in technical errors, inadequate tumor resection, or unnecessary tissue trauma, all of which compromise patient safety and the integrity of the oncological treatment. Professionals should employ a decision-making process that begins with a robust understanding of the patient’s specific condition and the oncoplastic procedure’s requirements. This involves a systematic evaluation of risks and benefits, the selection of appropriate tools and techniques, and a commitment to continuous vigilance and adaptation during the operation. Adherence to established surgical protocols and a proactive approach to identifying and mitigating potential complications are crucial for ensuring safe and effective patient care. QUESTION: Investigation of the optimal operative strategy for a complex breast cancer resection requiring significant tissue rearrangement, focusing on the safe and effective utilization of advanced energy devices and specialized instrumentation. OPTIONS: a) Conduct a thorough pre-operative assessment including imaging review and tumor mapping, followed by meticulous intra-operative technique with judicious use of energy devices tailored to tissue type and proximity to vital structures, and precise instrumentation for tissue handling and reconstruction. b) Proceed with the surgery based primarily on intra-operative findings, adapting the technique as the procedure unfolds without extensive pre-operative planning for specific instrumentation or energy device settings. c) Employ high-power settings on all energy devices to ensure rapid tissue coagulation and division, regardless of tissue characteristics or surrounding anatomy. d) Prioritize the speed of tumor resection and tissue mobilization, utilizing instrumentation and energy devices in a rapid, less precise manner to minimize operative time.

Scenario Analysis: This scenario is professionally challenging due to the inherent unpredictability of trauma, the need for rapid, evidence-based decision-making under pressure, and the ethical imperative to provide optimal patient care while managing limited resources. The critical care setting demands a systematic approach to resuscitation that prioritizes life-saving interventions and minimizes potential harm. The complexity arises from the need to integrate advanced trauma life support (ATLS) principles with specific oncoplastic considerations, particularly when a patient with a known malignancy presents with acute trauma. Correct Approach Analysis: The best professional practice involves a systematic, ABCDE approach to resuscitation, as outlined by ATLS guidelines, while concurrently initiating a rapid assessment for oncological emergencies or complications that might be exacerbated by trauma. This includes immediate airway management, breathing support, circulation assessment with hemorrhage control, neurological evaluation, and exposure with environmental control. Simultaneously, a focused history and physical examination should aim to identify any signs of tumor progression, metastasis, or treatment-related complications that could be contributing to the patient’s instability. Prompt communication with the oncology team is crucial for a holistic management plan. This approach is correct because it adheres to established, life-saving trauma protocols while acknowledging the unique vulnerabilities of an oncology patient, ensuring that both acute life threats and underlying oncological issues are addressed concurrently and ethically. Incorrect Approaches Analysis: One incorrect approach would be to solely focus on the trauma resuscitation without any consideration for the patient’s oncological history. This fails to recognize that the underlying malignancy or its treatment could be a contributing factor to the patient’s presentation or could complicate resuscitation efforts (e.g., coagulopathy from chemotherapy, immunosuppression increasing infection risk). This approach is ethically deficient as it does not provide comprehensive care tailored to the individual patient’s complex medical profile. Another incorrect approach would be to delay essential trauma resuscitation to conduct an exhaustive oncological workup. This prioritizes a less immediate concern over life-threatening injuries, violating the fundamental principles of trauma care. The ATLS protocol mandates immediate stabilization of ABCs, and any delay in addressing these critical issues due to a focus on the oncological aspect would be a direct contravention of best practice and ethically unacceptable due to the high risk of preventable mortality. A third incorrect approach would be to initiate aggressive resuscitation measures without consulting the oncology team, especially if there is suspicion of a tumor-related complication. This could lead to interventions that are contraindicated or less effective in the context of the patient’s malignancy or its treatment, potentially causing harm and delaying appropriate oncological management. This demonstrates a failure in interdisciplinary communication and collaborative care, which is essential for complex patient management. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a rapid, systematic assessment of the patient’s airway, breathing, circulation, disability, and exposure (ABCDE). This should be followed by a concurrent, focused assessment for any oncological factors that may be contributing to the patient’s condition or complicating resuscitation. Prompt communication and collaboration with relevant specialists, such as the oncology team, are paramount. This integrated approach ensures that immediate life threats are addressed while also considering the patient’s underlying disease and treatment history for optimal, individualized care.

This scenario presents a professional challenge due to the inherent risks associated with oncoplastic surgery, specifically the potential for significant postoperative complications that can impact patient outcomes and require immediate, expert intervention. The surgeon must balance the immediate need for patient care with the ethical and professional obligations to ensure continuity of care and appropriate resource utilization. Careful judgment is required to determine the most effective and responsible course of action. The best approach involves immediate consultation with the on-call oncoplastic surgeon who has direct knowledge of the patient’s case and the specific surgical procedure performed. This ensures that the patient receives care from the most qualified individual who can accurately assess the complication, understand the nuances of the surgery, and initiate the most appropriate management plan. This aligns with the ethical principle of beneficence, ensuring the patient receives the best possible care, and professional responsibility to manage complications competently. Furthermore, it adheres to guidelines emphasizing the importance of experienced personnel managing complex postoperative issues. An incorrect approach would be to delay definitive management by attempting to manage the complication solely with the general surgical resident without immediate senior oncoplastic input. This is professionally unacceptable as it risks suboptimal management due to the resident’s potentially limited experience with rare or complex oncoplastic complications. It could also violate professional standards that mandate appropriate supervision and consultation for complex cases, potentially leading to patient harm and a breach of the duty of care. Another incorrect approach is to discharge the patient home with instructions to follow up in the clinic if symptoms worsen. This is ethically and professionally unsound as it abandons the patient during a critical postoperative period when complications are most likely to manifest and require urgent intervention. This action fails to uphold the principle of non-maleficence by potentially exposing the patient to significant harm due to delayed or absent treatment. Finally, an incorrect approach would be to transfer the patient to a different hospital without first stabilizing the patient and ensuring a smooth handover of care to a specialist at the receiving facility. This could be considered a breach of professional responsibility and potentially violates guidelines regarding patient transfer, as it may not be in the patient’s best interest and could lead to a breakdown in communication and continuity of care, increasing the risk of adverse events. Professionals should employ a decision-making framework that prioritizes patient safety and well-being. This involves a rapid assessment of the situation, immediate consultation with the most appropriate specialist, clear communication, and a commitment to providing definitive care. When faced with a significant postoperative complication, the primary consideration should always be the patient’s immediate needs and the availability of specialized expertise to address those needs effectively and ethically.

This scenario presents a professional challenge due to the inherent tension between the immediate need for patient care and the established protocols for fellowship examinations. The pressure to demonstrate competence under examination conditions, coupled with the potential for patient harm if procedures are rushed or inadequately supervised, requires careful ethical and professional judgment. The fellowship examination is designed to ensure that graduating fellows possess the necessary skills and knowledge to practice independently and safely. Deviating from these established assessment procedures, even with good intentions, risks compromising the integrity of the examination and potentially exposing patients to an unacceptable level of risk. The best professional approach involves adhering strictly to the established examination protocol. This means ensuring that all required assessments, including the simulated oncoplastic case review and the subsequent viva voce examination, are completed as scheduled and in accordance with the guidelines set forth by the fellowship program. This approach prioritizes patient safety by ensuring that the fellow’s decision-making and technical skills are evaluated under controlled, standardized conditions. It upholds the integrity of the examination process, which is crucial for maintaining public trust in the qualifications of oncoplastic surgeons. Regulatory frameworks governing medical education and professional conduct emphasize the importance of standardized assessments and the ethical obligation to ensure patient safety above all else. An incorrect approach would be to proceed with the simulated surgery without the examiner present, intending to present the completed work for review later. This fails to meet the fundamental requirement of direct observation and assessment by the designated examiner, which is a cornerstone of any practical examination. It bypasses the opportunity for real-time feedback and evaluation of the fellow’s judgment and technical execution during the procedure, thereby compromising the validity of the assessment. Ethically, it could be viewed as an attempt to circumvent the examination process, potentially misleading the program about the fellow’s actual capabilities. Another incorrect approach would be to postpone the entire examination until the examiner is available, even if this significantly delays the fellow’s graduation and subsequent entry into practice. While patient safety is paramount, the examination structure is designed to be completed within a defined timeframe. Unnecessary delays can have significant professional and personal consequences for the fellow and may not be justifiable if alternative, compliant assessment methods are available. This approach fails to balance the need for rigorous assessment with the practical realities of professional development and patient care needs. A further incorrect approach would be to request a less experienced colleague to supervise the simulated surgery in place of the examiner. This undermines the authority and expertise of the designated examiner and introduces a variable that is not part of the standardized assessment. The examination is intended to evaluate the fellow’s performance against established benchmarks set by experienced practitioners. Substituting a supervisor with less experience compromises the reliability and fairness of the evaluation, potentially leading to an inaccurate assessment of the fellow’s competence. The professional reasoning framework for such situations should begin with a clear understanding of the examination’s objectives and the governing regulations. The primary consideration must always be patient safety and the integrity of the assessment process. When faced with logistical challenges, professionals should first explore all compliant options within the existing framework. If no compliant solution is immediately apparent, the next step is to consult with program directors or relevant governing bodies to seek guidance and explore potential accommodations that do not compromise the core principles of the examination. Open communication and a commitment to ethical conduct are essential in navigating these complex situations.

The review process indicates a need to assess the fellow’s ability to navigate complex operative planning in oncoplastic surgery, specifically focusing on structured approaches to risk mitigation. This scenario is professionally challenging because it requires balancing patient safety, optimal oncologic outcomes, and aesthetic considerations, all within the framework of established surgical best practices and ethical obligations. The fellow must demonstrate not only technical proficiency but also a robust understanding of pre-operative assessment and planning to anticipate and manage potential complications. The best approach involves a comprehensive, multidisciplinary pre-operative assessment that includes detailed patient history, physical examination, imaging review, and consultation with relevant specialists such as radiologists, pathologists, and medical oncologists. This structured planning process allows for the identification of patient-specific risk factors (e.g., comorbidities, previous treatments, tumor characteristics) and the development of a tailored surgical strategy. This strategy should explicitly outline contingency plans for potential intraoperative challenges and post-operative complications, thereby mitigating risks and ensuring the best possible outcome for the patient. This aligns with ethical principles of beneficence and non-maleficence, as well as professional standards for thorough patient care and informed consent. An approach that relies solely on the surgeon’s experience without formal, documented risk assessment and contingency planning is professionally unacceptable. This failure to systematically identify and address potential risks can lead to unexpected complications, suboptimal oncologic control, or poor aesthetic results, violating the duty of care owed to the patient. Similarly, proceeding with surgery without adequate pre-operative imaging review or consultation with necessary specialists represents a significant lapse in due diligence. This can result in misdiagnosis, inappropriate surgical planning, or failure to identify contraindications, all of which are ethically and professionally unsound. Finally, an approach that prioritizes aesthetic outcomes over oncologic clearance, or vice versa, without a balanced, integrated plan, demonstrates a failure to uphold the core principles of oncoplastic surgery and patient well-being. Professionals should employ a systematic decision-making process that begins with a thorough understanding of the patient’s condition and goals. This involves actively seeking information from all available sources, engaging in collaborative discussions with colleagues, and documenting the rationale behind the chosen surgical plan, including identified risks and mitigation strategies. This iterative process ensures that all aspects of patient care are considered, leading to safer and more effective surgical interventions.

Scenario Analysis: This scenario presents a common challenge in fellowship programs: balancing the need for rigorous assessment with the ethical imperative to support trainees. The program director must interpret the fellowship’s blueprint weighting and scoring policies in a way that is fair, transparent, and aligned with the program’s educational objectives, while also considering the individual circumstances of a struggling candidate. The risk of perceived bias or inconsistency in applying retake policies can damage the program’s reputation and create a demoralizing environment for all fellows. Correct Approach Analysis: The best approach involves a thorough review of the fellowship’s established blueprint weighting, scoring, and retake policies, coupled with a direct and supportive conversation with the candidate. This approach ensures that any decision is grounded in the program’s documented standards, promoting fairness and transparency. The program director should clearly communicate the specific areas where the candidate fell short according to the blueprint, explain how the scoring reflects those deficiencies, and outline the precise conditions and support available for a retake, as per the established policy. This upholds the integrity of the assessment process while offering a clear path forward for the candidate, aligning with the ethical obligation to provide constructive feedback and opportunities for remediation. Incorrect Approaches Analysis: One incorrect approach is to immediately grant a retake without a detailed review of the candidate’s performance against the blueprint and the established retake policy. This undermines the validity of the initial assessment and the scoring system, potentially creating a precedent where performance standards are not consistently applied. It also fails to provide the candidate with specific feedback on their deficiencies, hindering their ability to improve. Another incorrect approach is to deny a retake solely based on a single failed assessment without considering the established retake policy or the candidate’s overall progress and circumstances. This can be perceived as punitive and lacking in support, potentially violating ethical guidelines that encourage remediation and professional development. It also fails to acknowledge that the blueprint and scoring are designed to identify areas for improvement, not necessarily to be insurmountable barriers. A further incorrect approach is to modify the blueprint weighting or scoring retroactively to accommodate the candidate’s performance. This fundamentally compromises the integrity of the assessment framework. The blueprint and scoring are intended to be objective measures of competency. Altering them after an assessment creates an appearance of bias and erodes trust in the program’s evaluation processes for all fellows. Professional Reasoning: When faced with a candidate who has not met the passing threshold, professionals should first consult the program’s official documentation regarding assessment blueprints, scoring rubrics, and retake policies. This ensures adherence to established guidelines. Next, a transparent and objective evaluation of the candidate’s performance against these documented standards is crucial. Following this, a direct and empathetic conversation with the candidate is necessary to discuss the assessment results, identify specific areas for improvement, and clearly outline the available options for remediation, including any retake procedures and the support the program can offer. The decision-making process must prioritize fairness, transparency, and the educational development of the fellow, while upholding the program’s commitment to maintaining high standards of oncoplastic surgery.

This scenario is professionally challenging because it requires a candidate to balance the intense demands of fellowship training with the strategic planning necessary for a competitive exit examination. The pressure to perform clinically while simultaneously preparing for a high-stakes assessment can lead to suboptimal study habits and potential burnout. Careful judgment is required to integrate preparation seamlessly into the existing demanding schedule without compromising patient care or personal well-being. The best approach involves a structured, phased preparation timeline that begins early in the fellowship and gradually increases in intensity. This approach acknowledges the breadth of knowledge required for oncoplastic surgery and the need for spaced repetition and consolidation of complex information. It prioritizes understanding over rote memorization by incorporating diverse learning methods such as reviewing core literature, attending relevant conferences, engaging in practice question banks, and seeking mentorship. This method aligns with ethical principles of professional development and lifelong learning, ensuring the candidate is not only prepared for the exam but also equipped with the foundational knowledge for future practice. It also respects the regulatory expectation that fellows develop comprehensive expertise. An incorrect approach involves delaying comprehensive preparation until the final months of the fellowship. This strategy creates an unrealistic expectation of absorbing vast amounts of information in a compressed timeframe, leading to superficial learning and increased stress. It fails to adhere to principles of effective learning and can result in a candidate who is inadequately prepared, potentially impacting patient safety if they enter practice without a solid grasp of the material. This approach also disregards the implicit ethical obligation to be thoroughly prepared for independent practice upon completion of training. Another incorrect approach is to solely rely on memorizing practice questions without understanding the underlying oncoplastic surgical principles. While practice questions are valuable tools, an over-reliance on them can lead to a candidate who can pass the exam through pattern recognition but lacks the deep conceptual understanding necessary for clinical decision-making. This approach is ethically problematic as it prioritizes exam performance over genuine competence and fails to meet the spirit of the fellowship’s educational objectives, which are to cultivate skilled oncoplastic surgeons. Finally, an approach that neglects to seek feedback or engage with mentors regarding preparation progress is also flawed. Professional development thrives on constructive criticism and guidance. Without this, a candidate may be unaware of their knowledge gaps or inefficient study methods. This isolation from the broader educational community can hinder optimal preparation and is contrary to the collaborative and mentorship-driven nature of medical training, which is implicitly supported by professional guidelines for fellowship education. Professionals should adopt a proactive and structured approach to exam preparation, integrating it into their fellowship journey from the outset. This involves creating a realistic study schedule, utilizing a variety of reputable resources, actively seeking feedback from peers and mentors, and prioritizing deep understanding of oncoplastic surgery principles over superficial memorization.

This scenario is professionally challenging because it requires balancing patient autonomy and informed consent with the surgeon’s professional judgment and the need for clear, unbiased communication. The fellowship director’s request introduces a potential conflict of interest and pressure to influence the patient’s decision, which can compromise the integrity of the informed consent process. Careful judgment is required to uphold ethical standards and patient rights. The best approach involves a direct and transparent discussion with the patient about all available treatment options, including their respective risks, benefits, and alternatives, without any undue influence or bias. This approach prioritizes patient autonomy and the principle of informed consent, which are foundational ethical tenets in medical practice. Specifically, it aligns with the ethical obligation to provide patients with complete and accurate information so they can make autonomous decisions about their care. This also upholds the professional standard of acting solely in the patient’s best interest, free from external pressures or perceived obligations to superiors. An approach that involves subtly guiding the patient towards a specific treatment option favored by the fellowship director, even if presented as “additional information,” fails to uphold the principle of unbiased information dissemination. This constitutes a breach of professional integrity and can be seen as manipulative, undermining the patient’s ability to make a truly informed decision. It also violates the ethical duty to avoid conflicts of interest and to ensure that patient care is not influenced by factors other than their medical needs. Another unacceptable approach is to defer entirely to the fellowship director’s directive and present only the information that supports their preferred option. This not only fails to provide the patient with a comprehensive understanding of their choices but also abdicates the surgeon’s responsibility to advocate for the patient’s best interests. It represents a significant ethical failure by prioritizing hierarchical pressure over patient welfare and the principles of informed consent. Finally, an approach that involves presenting all options but framing the fellowship director’s preferred option with an unwarranted emphasis on its perceived superiority, without objective justification, is also professionally unsound. This subtle bias can still unduly influence the patient’s decision-making process, thereby compromising the integrity of informed consent. Professionals should employ a decision-making process that begins with identifying potential conflicts of interest or external pressures. They must then prioritize ethical obligations, particularly the duty to the patient, which includes providing complete, unbiased information and respecting patient autonomy. When faced with directives that conflict with these principles, professionals should seek clarification, express concerns about ethical implications, and advocate for patient-centered care, even if it means respectfully disagreeing with a superior.