According to a report published Online First by Archives of Surgery, one of the JAMA/Archives journals, a survey of patients who received treatment in a teaching facility conveyed that patients preferred to be informed if a trainee participated in their care. Consent rates seem to vary depending on scenarios describing increased levels of resident participation.
As stated in the background in the article, the concept of surgeon-patient interaction before surgery can be traced back as far as ancient Greece but nowadays, the modern system involves a more formal system of informed consent. According to the authors:
“Currently, no widely accepted guidelines or policies exist for providing information regarding the role of surgical trainees to the patient during the informed consent process. The accepted standard is to provide information that ‘a reasonable patient’ would want and would need to know to make an informed decision, but this counseling may vary widely by health care professional, setting, and type of surgical procedure.”
To assess patient perceptions and willingness to participate in surgical resident education and training programs, Christopher R. Porta, M.D., and colleagues from Madigan Army Health System, Tacoma, Wash., carried out an anonymous survey at a tertiary-level U.S. Army hospital and referral center. Of 500 questionnaires distributed, 316 (63.2%) were returned and included in the assessment which revealed, that most patients showed no preference for a private hospital versus a teaching hospital. Of those who did, 24.9% percent reported to prefer a teaching hospital compared to 8.8% who preferred a private facility for overall care. The preference of hospital treatments for minor surgical procedures reported 28.2% of patients in favor of a teaching hospital compared with 12% to a private facility.
24.7% preferred a teaching hospital for major surgical procedures compared with and 26.6% respectively. Of those patients who reported to have a preference, 91.2% thought that teaching hospitals would provide equivalent or better care than a private hospital.
The vast majority of patients said that they preferred to be informed of resident participation in their surgical procedure irrespective of the procedure being major (95.7%) or a minor surgery (87.5%).
94% of participants said they would consent to a surgical resident being involved, however, there was a differentiation; while 85% agreed to a surgical intern being involved, 79.9 % agreed to medical student involvement. The participants were provided with specific scenarios involving trainee participation, which revealed that 57.6% of patients consented to having a junior resident act as the first assistant, 25.6% consented to the resident acting as the operation surgeon with direct staff observation, and 18.2% consented to resident participation without direct staff observation.
In a concluding statement the authors say that, “patients routinely would prefer to be informed regarding details of trainee participation in their care, and that this information would significantly affect their willingness to consent.” They continue explaining that, “Although most patients express an overall willingness to participate in surgical education, wide variations can be observed in the actual consent rates for specific training situations. This decreased willingness to consent and the potential effect on training programs must be considered when discussing policy initiatives aimed at improving informed consent.”
Written by Petra Rattue