Patient Attitudes Toward Resident Involvement in Cataract Surgery

Wisner, Douglas; Quillen, David A.; Benderson, David M; Green, Michael J.

doi:10.1001/archopht.126.9.1235

Cited by 35 publications

(6 citation statements)

References 11 publications

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“…It is generally agreed that patients should be made fully aware of who is doing their procedure, particularly as their involvement increases . Most patients feel a general consent form is sufficient for residents’ presence in the operating room, but fewer agree it would suffice for assistance or performance of the surgery and prefer full disclosure instead …”

Section: Discussionsupporting

confidence: 76%

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Association of Preoperative Disclosure of Resident Roles With Informed Consent for Cataract Surgery in a Teaching Program

et al. 2019

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IMPORTANCE Cataract surgery is the most commonly performed intraocular surgery. Academic centers have mandates to train the next surgeon generation, but resident roles are often hidden in the consent process. OBJECTIVE To investigate associations of full preoperative disclosure of the resident role with patient consent rates and subjective experience of the consent process. DESIGN, SETTING, AND PARTICIPANTS Full scripted disclosure of residents' roles in cataract surgery was delivered by the attending surgeon. Qualitative analysis was conducted from recorded interviews of patients postoperatively regarding consent process experience and choice of whether to allow resident participation. Associations were sought regarding demographic characteristics and consent rates. Patients were recruited though a private community office. Surgery was performed at a single hospital where resident training was routinely conducted. The study included systemically well patients older than 18 years with surgical cataract. They had no previous eye surgery, English fluency, and ability to engage in informed consent decision-making and postsurgery interview. Patients were ineligible if they had monocular cataracts, required additional simultaneous procedures, had history of ocular trauma, or had cataracts that were surgically technically challenging beyond the usual resident skill level. INTERVENTIONS Eligible patients received an informed consent conversation by the attending physician in accordance with a script describing projected resident involvement in their cataract surgery. Postoperatively, patients were interviewed and responses were analyzed with a quantitative and thematic qualitative approach. MAIN OUTCOMES AND MEASURES Consent rates to resident participation and qualitative experience of full disclosure process. RESULTS Ninety-six patients participated. Participants were between ages 50 and 88 years, 53 were men (55.2%), and 75 were white (85.2%). A total of 54 of 96 participants (56.3%; 95% CI, 45.7%-66.4%) agreed to resident involvement. There were no associations between baseline characteristics and consent to resident involvement identified with any confidence, including race/ethnicity (60% [45 of 75] in white patients vs 30.8% [4 of 13] in nonwhite patients; difference, 29.2%; 95% CI, −0.7% to 57.3%; Fisher exact P = .07). Thematically, those who agreed to resident involvement listed trust in the attending surgeon, contributing to education, and supervision as contributing factors. Patients who declined stated fear and perceived risk as reasons. CONCLUSIONS AND RELEVANCE Our results suggest 45.7% to 66.4% of community private practice patients would consent to resident surgery. Consent rates were not associated with demographic factors. Because residents are less often offered the opportunity to do surgery on private practice patients vs academic center patients, this may represent a resource for resident education.

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Section: Discussionsupporting

confidence: 76%

“…Our report suggests that 54 of 96 patients (56.3%; 95% CI, 45.7%-66.4%) would consent with full disclosure. This is supported by other studies, both with surgeries and emergency department procedures . This was also seen in parental consent regarding their children, a situation which one might think even more sensitive .…”

Section: Discussionmentioning

confidence: 93%

Association of Preoperative Disclosure of Resident Roles With Informed Consent for Cataract Surgery in a Teaching Program

et al. 2019

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“…Wisner and colleagues found that most patients are willing to agree to resident involvement in surgical procedures. 7 However, a study from the United States showed that participants have a low level of willingness to allow residents to perform invasive procedures. 1 In our study, the lowest percentages regarding residents' involvement in patient care were related to invasive tasks such as a skin biopsy and malignant tumor excision (37.6% and 29.5%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Perceptions, Attitudes, and Satisfaction concerning Resident Participation in Health Care among Dermatology Outpatients

et al. 2014

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Background: A limited number of published studies have discussed patient attitudes toward resident physicians' participation in dermatology clinics. A literature search failed to identify any such study in the Middle East.Objective: The aim of this study was to explore patient perceptions and attitudes toward resident participation in dernnatology outpatient clinics.Methods: A self-administered questionnaire focused on patient attitudes toward dermatology resident participation was distributed randomly to all adult outpatients attending dermatology clinics at a university hospital in Saudi Arabia between July and September 2010.Results: The questionnaire was returned by 742 of 900 patients, for an 82% response rate. The mean patient age was 30.58 ± 11.67 years. Forty-two percent (311 of 742) of the respondents were male. The major reason for visiting the hospital was a medical dermatology consultation (80.4%). Only 35% of the patients self-reported an accurate understanding of the "resident" designation. In total, 86.4% of patients were satisfied with the residents' behavior. Furthermore, 98.4% of the patients were satisfied with the medical care provided by the residents. The patients agreed with resident participation in their health care. The majority of the patients expressed their willingness to provide a medical history and receive counseling from residents (87.6% and 86.3%, respectively). There was no gender-associated effect on the understanding of the resident position or the decision to receive a physical examination by a resident.Conclusion: Dermatology outpatients are satisfied and have positive perceptions and attitudes toward resident participation in the dermatology clinic.Contexte: Peu d'études publiées portent sur les attitudes des patients à l'égard de la participation des résidents en dermatologie, et un examen de la documentation n'a pas permis de relever d'étude en la matière, au Moyen-Orient.Objectif: L'étude visait à examiner les perceptions et les attitudes des patients à l'égard de la participation des résidents en dermatologie externe.Méthode: Un questionnaire à remplir soi-même, portant sur les attitudes des patients à l'égard de la participation des résidents en dermatologie a été remis au hasard à tous les adultes externes qui sont allés consulter en dermatologie, dans un hôpital universitaire, en Arabie Saoudite, de juillet à septembre 2010.Résultats: Au total, 742 patients sur 900 ont rempli le questionnaire, ce qui a porté à 82% le taux de réponse. L'âge moyen était de 30.58 ± 11.67 ans, et 42% (311 sur 742) des répondants étaient des hommes. Le principal motif de visite à l'hôpital était une consultation médicale en dermatologie (80.4%). Seuls 35% des patients ont indiqué avoir une bonne compréhension du titre de résident. En tout, 86.4% des répondants se sont dits contents du comportement des résidents. Qui plus est, 98.4% des patients étaient satisfaits des soins médicaux donnés par les résidents. Les patients étaient d'accord sur la participation des résidents à la prestation d...

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“…Previous studies have reported variable results regarding patients' willingness to have residents perform their cataract surgery, ranging from very low (16%) to very high (95%). 11 12 13 14 One study reported a range of 21 to 86% even among patients living in the same geographic location. 13 Another study reported that although most patients are willing to have residents assist with their cataract surgery if patients are fully informed and asked in advance, one-quarter of these patients reported they would be likely or very likely to seek treatment elsewhere if residents were the primary surgeon of their cataract surgery.…”

mentioning

confidence: 99%

“… 13 Another study reported that although most patients are willing to have residents assist with their cataract surgery if patients are fully informed and asked in advance, one-quarter of these patients reported they would be likely or very likely to seek treatment elsewhere if residents were the primary surgeon of their cataract surgery. 14 …”

mentioning

confidence: 99%

Impact of Video Describing Cataract Surgical Simulator Training on Patients' Perceptions of Resident Involvement in Cataract Surgery

Landis

Fileta

Kunselman

et al. 2021

Journal of Academic Ophthalmology

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Purpose The aim of this article is to investigate the impact of a 1-minute video describing resident training with a cataract surgical simulator on patients' perceptions regarding resident involvement in cataract surgery and to identify factors associated with patient willingness to have cataract surgery performed by a resident. Design Cross-sectional survey. Methods An anonymous Likert-style survey was conducted among 430 consecutive adult patients who presented for eye examination at the Penn State Health Eye Center. The survey included questions regarding demographics, understanding of the medical training hierarchy, and patient willingness to have a resident perform their cataract surgery. There were six questions regarding patient willingness to have residents perform their cataract surgery and the second question in this set informs the patient that residents are supervised by an experienced cataract surgeon. Patients were randomly assigned to one of two groups: patients in Group 1 completed the survey only, while patients in Group 2 watched a 1-minute video describing resident training with a cataract surgical simulator prior to completing the survey. Results Four hundred fourteen of the 430 patients (96.3%) completed the survey. Overall, 24.7% (n = 102) of respondents expressed willingness to allow an ophthalmology resident to perform their cataract surgery, and that proportion increased to 54.0% (n = 223) if the patient was informed that the resident would be supervised by an experienced cataract surgeon. Patients in Group 2 were twice as likely compared with patients in Group 1 to express willingness to allow an ophthalmology resident to perform their cataract surgery (odds ratio 1.92 [1.18–3.11], p = 0.009). Conclusions A thorough informed consent process including information regarding attending supervision and a brief video detailing resident training with a cataract surgery simulator may increase patient willingness to allow resident participation in cataract surgery.

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Patient Attitudes Toward Resident Involvement in Cataract Surgery

Cited by 35 publications

References 11 publications

Association of Preoperative Disclosure of Resident Roles With Informed Consent for Cataract Surgery in a Teaching Program

Association of Preoperative Disclosure of Resident Roles With Informed Consent for Cataract Surgery in a Teaching Program

Perceptions, Attitudes, and Satisfaction concerning Resident Participation in Health Care among Dermatology Outpatients

Impact of Video Describing Cataract Surgical Simulator Training on Patients' Perceptions of Resident Involvement in Cataract Surgery

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