Consent to cataract surgery performed by residents

Abstract

Background: Surgical teaching seems to be in conflict with the contract between surgeon and patient. We carried out a study to determine the prevalence of consistent disclosure to patients that a resident will perform part or all of their cataract surgery procedure.A second objective was to investigate the effect of such disclosure on patients' willingness to undergo the procedure.Methods: We sent a survey to all 20 ophthalmologists working in our university-affiliated hospitals, inquiring about their practice of disclosure to patients regarding residents' involvement in surgery. Staff physicians were also asked to record their patients' consent to an operation performed partly or entirely by a trainee while under supervision.Results: Of the 20 surveys sent, only 5 (25%) were returned.Those who declined to participate in the study mentioned several reasons, including that such disclosure might increase a patient's anxiety level, that they might lose potential patients as patients might be reluctant to have trainees perform their surgery, and lack of time to talk to patients about these issues. Of the five ophthalmologists who completed the survey, four were part-time affiliated staff and one was a geographic full-time physician working in our institution. Four of the five ophthalmologists said that they do not consistently disclose residents' involvement to their patients. Of the 49 patients enrolled, only 8 (16%) agreed to undergo the procedure after being informed that a trainee would be actively involved.Interpretation: It is crucial to inform patients that residents may be involved in their surgery in order to avoid possible litigation. However, our results suggest that such disclosure may have a negative effect on surgical education because it could limit the number of cases available to trainees.