Do Interns Learn On-The-Job How to Obtain Proper Informed Consent for Surgical Procedures?

IF 2.6 3区医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES

Journal of Surgical Education Pub Date : 2024-07-17 DOI:10.1016/j.jsurg.2024.06.005

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引用次数: 0

Abstract

OBJECTIVE

Obtaining surgical informed consent (SIC) is a critical skill most residents are expected to learn “on-the-job.” This study sought to quantify the effect of 1 year of clinical experience on performance obtaining SIC in the absence of formal informed consent education.

DESIGN

In this case-control cohort study, PGY1 and PGY2 surgical residents in an academic program were surveyed regarding their experiences and confidence in obtaining SIC; then assessed obtaining informed consent for a right hemicolectomy from a standardized patient.

SETTING

Single academic general surgery residency program in Buffalo, NY.

PARTICIPANTS

Ten PGY1 and eight PGY2 general surgery residents were included in the study, after excluding residents with additional years of training.

RESULTS

PGY2 residents had significantly more experience obtaining SIC compared to PGY1 residents (median response: “>50” vs “between 6 and 15,” p = 0.001), however there was no difference in self-reported confidence in ability obtaining SIC (mean 3.2/5 in PGY1 vs 3.4/5 in PGY2, p = 0.61), self-reported knowledge of SIC (mean 3.1/5 in PGY1 vs 3.6/5 in PGY2, p = 0.15), performance on a test regarding SIC (mean score 9.0/20, SD 3.9 for PGY1 vs mean score 9.6/20, SD 3.5, t = 0.387, p = 0.739) or performance during a standardized patient interview (mean 11.2/20, SD 2.78 for PGY1 vs mean 11.4/20, SD 1.51 for PGY2, p = 0.87). In the interviews all residents addressed general risks (bleeding/infection), however both groups performed worse in addressing procedure-specific risks including anastomotic leak as risk for hemicolectomy.

CONCLUSIONS

A year of clinical training between PGY1 to PGY2 did not improve performance in obtaining surgical informed consent when lacking formal education, despite self-confidence in their ability. A curriculum covering the content, delivery and assessment of informed consent should be initiated for residents upon arrival to surgical training.

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实习生是否在工作中学习如何在手术过程中获得适当的知情同意？

目的：获取手术知情同意书（SIC）是大多数住院医师在 "在职 "期间必须掌握的一项关键技能。本研究旨在量化在没有接受过正规知情同意教育的情况下，1 年临床经验对获得 SIC 表现的影响：在这项病例对照队列研究中，调查了一个学术项目中的 PGY1 和 PGY2 外科住院医师在获得 SIC 方面的经验和信心；然后评估了从标准化病人处获得右半结肠切除术知情同意的情况：地点：纽约州布法罗市的一个普通外科住院医师学术项目：研究纳入了 10 名 PGY1 和 8 名 PGY2 普外科住院医师，但排除了接受过更多年培训的住院医师：与 PGY1 住院医师相比，PGY2 住院医师在获取 SIC 方面的经验明显更丰富（回答中位数：">50" vs "6-15 之间"，p = 0.001），但在获取 SIC 能力的自我报告信心（PGY1 平均 3.2/5 vs PGY2 平均 3.4/5，p = 0.61）、自我报告的 SIC 知识（PGY1 平均 3.1/5 vs PGY2 平均 3.4/5，p = 0.61）方面没有差异。PGY1 的平均值为 3.1/5，PGY2 为 3.6/5，p = 0.15）、SIC 测试成绩（PGY1 的平均值为 9.0/20，SD 为 3.9，PGY1 为 9.6/20，SD 为 3.5，t = 0.387，p = 0.739）或标准化患者访谈成绩（PGY1 的平均值为 11.2/20，SD 为 2.78，PGY2 的平均值为 11.4/20，SD 为 1.51，p = 0.87）。在访谈中，所有住院医师都谈到了一般风险（出血/感染），但两组住院医师在谈到特定手术风险（包括血液结肠切除术的吻合口漏风险）时表现较差：结论：尽管住院医师对自己的能力充满信心，但在缺乏正规教育的情况下，PGY1 到 PGY2 之间一年的临床培训并不能提高他们在获得手术知情同意书方面的表现。住院医师在接受外科培训时，应开设涵盖知情同意的内容、实施和评估的课程。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Education EDUCATION, SCIENTIFIC DISCIPLINES-SURGERY

CiteScore

5.60

自引率

10.30%

发文量

261

审稿时长

48 days

期刊介绍： The Journal of Surgical Education (JSE) is dedicated to advancing the field of surgical education through original research. The journal publishes research articles in all surgical disciplines on topics relative to the education of surgical students, residents, and fellows, as well as practicing surgeons. Our readers look to JSE for timely, innovative research findings from the international surgical education community. As the official journal of the Association of Program Directors in Surgery (APDS), JSE publishes the proceedings of the annual APDS meeting held during Surgery Education Week.