Most Patients Want Experienced Surgeons, Not Trainees

Most support teaching hospitals, but few want a junior resident performing their operation

FRIDAY, Sept. 23 (HealthDay News) -- Hospital patients want to know whether medical trainees are participating in their surgery, according to a new study.

Researchers found that although most patients would allow residents and medical students to be involved in their operation, rates of consent vary depending on the type of surgery and the trainee's level of participation. The findings, they concluded, could have a significant impact on teaching programs.

"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 authors wrote. "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."

In conducting the study, researchers from Madigan Army Health System in Tacoma, Washington analyzed anonymous surveys from 316 patients to find out how they felt about surgical resident education and training programs.

The study, published online Sept. 19 in the Archives of Surgery, found most patients did not care if they were treated in a private hospital or a teaching one. The 91.2 percent of the patients who said they had a preference in where they were treated said they believed the care they would receive in a teaching hospital would be just as good or better than that in a private hospital.

Despite being supportive of teaching facilities, the vast majority of patients said they wanted to be informed if a trainee was going to participate in their operation, whether the procedure was considered major (95.7 percent) or minor (87.5).

Although 94 percent of the patients questioned said they would allow a surgical resident to be involved in their surgery, just 85 percent would agree to a surgical intern being included and only about 80 percent would allow a medical student to participate in their care.

When asked what role they would allow junior residents to have in their care, 57.6 patients said they could act as the first assistant. Only 25.6 percent said they would allow a junior resident to perform the operation if there was direct staff supervision, and a still smaller percentage -- 18.2 percent agreed the resident could participate without direct staff observation.

The study's authors concluded that informed consent is important to surgical patients, and their unwillingness to allow trainee participation in certain situations could have a significant impact on teaching facilities.

"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," the authors wrote.

More information

The National Institutes of Health provides more information on informed consent.

Mary Elizabeth Dallas SOURCE: JAMA/Archives, news release, Sept. 19, 2011.

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