Training Surgeons and the Informed Consent Process

Abstract

Objectives: To examine patient perceptions and willingness to participate in resident education and to assess the effect on patient willingness and consent rates.Design: Anonymous questionnaire designed to capture demographics, overall opinions of teaching programs, and willingness to consent to various scenarios of trainee participation. Descriptive and univariate analyses were performed.Setting: Tertiary-level referral center.Patients: Three hundred sixteen individuals scheduled for elective surgery. Main Outcome Measures: Consent rates for various scenarios.Results: Of the 316 patients who completed the questionnaire, most expressed overall support of resident training: 91.2% opined that their care would be equivalent to or better than that of a private hospital, 68.3% believed they derived benefit from participation, and most con-sented to having an intern (85.0%) or a resident (94.0%) participate in their surgical procedure. However, when given specific, realistic scenarios involving trainee participation, major variations in the consent rate were observed. Affirmative consent rates decreased from 94.0% to 18.2% as the level of resident participation increased. Patients also were more willing to consent to the participation of a senior resident (83.1%) vs a junior resident (57.6%) or an intern (54.5%). Patients overwhelmingly opined that they should be informed of the level of resident participation and that this information could change their decision of whether to consent.Conclusions: Most patients expressed approval of teaching facilities and resident education. However, consent rates were significantly altered when more detailed information was provided and they declined with increasing levels of resident participation. Providing detailed informed consent is preferred by patients but it could adversely affect resident participation and training.

Training surgeons and the informed consent discussion in paediatric patients: a qualitative study examining trainee participation disclosure

“…Trainees felt such disclosures were not made for fear of limiting their participation. This belief is supported by reports indicating the amount of trainee participation in procedures patients agreed to declined as the degree of involvement increased 8 21. Both trainees and surgeons noted that trainee involvement was listed as part of the consent form used by the hospital, but indicated parents often did not make note of this statement.…”

“…A critical component of the consent discussion is disclosure and identification of the surgeon performing the procedure. Although this is a relatively straightforward practice in non-teaching healthcare facilities, the extent to which trainee participation is disclosed is controversial 8. Previous reports have demonstrated patients are unaware of the involvement of medical students and residents in their care 20.…”

“…Firdouse et al 14 also found that parent anxiety did not increase when trainee participation was covered during the consent discussion. In contrast, Porta et al 8 found rates of willingness to consent declined significantly when it was disclosed that trainees would be acting as the operating surgeon. A decrease in consent rate was also seen as the level of trainee became more junior.…”

“…It is clear from the literature that patients would prefer a greater level of information regarding the role of trainees in their operative care,8–12 but specifics surrounding the content and depth have yet to be determined. Gan et al found that when scripted disclosure was used during the informed consent process to indicate that trainees would be involved, 95% of patients agreed to trainee participation in their operation 13.…”

Caring for the Incarcerated: An Orthopedic Perspective

“…The amount of intraoperative resident involvement is largely unappreciated by the general public, and although few patients object to the idea of medical education, many hesitate at the idea of a junior resident performing the procedure. 14,15 The extent to which this matter should be included on the informed consent and in the preoperative discussion has been the subject of some debate. It has been noted previously that prisoners' drug use, lower social status, older age, and unconsciousness have contributed to supervisors' willingness to shift responsibility to trainees during surgery.…”