Training surgeons and informed consent

According to a study that appears in Archives of Surgery, between 85% and 94% of patients were willing to sign forms permitting medical residents to assist surgeons, but many will not consent to giving residents a major role during surgery.1 Fewer patients consented when the form offered more detailed information about the education level or role of the student.

For the study titled, "Training surgeons and the informed consent process," researchers compiled data from 316 questionnaires completed by patients from a tertiary-level U.S. Army hospital and referral center. The study population consisted of all patients who were scheduled for an elective surgical procedure and who had arrived at the general surgical clinic for their final preoperative evaluation

Most of the patients that were polled (91.2%) said that their care involving residents in a teaching hospital would be "equivalent to or better than that of a private hospital." When asked whether they would allow a student to participate in a surgical procedure, 85.0% agreed to an intern, and 94.0% agreed to a resident.

The percentage of patients who consented to the residents' role went down when patients were "given specific, realistic scenarios involving trainee participation." For example, only 57.6% consented when a junior resident would be assisting a staff surgeon, and when a staff surgeon would be assisting the resident, only 32.1% of those patients polled gave consent. That percentage dropped even further to 25.6% when a staff surgeon would be observing the resident and dropped to 18.2% when the resident would be performing the procedure without the staff surgeon present.

It is not common for patients to be made aware of a resident's role in surgical procedures, but those questioned in the study "overwhelmingly" thought they should be informed and said that the information could "change their decision of whether to consent."

The authors of the study determined that policy makers should consider the variation in willingness of patients to be treated by physicians in training.

"We believe that broad calls for routine mandated disclosure should be carefully planned and analyzed prior to implementation to avoid any adverse effects on surgical training," the researchers say.

Reference

  1. Porta C, Sebesta J, Brown T, et al. Training surgeons and the informed consent process. Arch Surg 2011. Doi:10.1001/archsurg.2011.235.