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Routine Disclosure of Trainee Participation and Its Effect on Patient Willingness and Consent Rates

Christopher R. Porta, MD; James A. Sebesta, MD; Tommy A. Brown, MD; Scott R. Steele, MD; Matthew J. Martin, MD

Arch Surg. 2012;147(1):57-62. doi:10.1001/archsurg.2011.235

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 consented 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.

Author Affiliations: Department of Surgery, Madigan Army Health System, Tacoma, Washington.

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