2001 APDS spring meetingResidents seeking informed consent: Are they adequately knowledgeable?
Introduction
Informed consent is a cornerstone of the ethical practice of medicine. By requiring patients to give informed consent before any elective surgical procedure is performed, the autonomy of patients is preserved. Despite the critical nature of informed consent as a theoretical concept in surgical practice, practical problems remain in the informed consent process.
In many teaching hospitals, first-year surgical residents are frequently asked to obtain informed consent from patients undergoing elective surgical procedures. In order to give informed consent, patients must be 1) provided sufficient information to make an informed decision, 2) be competent to give consent, 3) be aware of right to refuse treatment, and 4) voluntarily agree to the procedure.1, 2, 3, 4 The central component of part 1) is that patients must be given adequate information to understand the risks, benefits, and alternatives of the procedure being proposed. In order to pass such information on to patients, surgical residents must have an in-depth understanding of the procedure for which they are obtaining informed consent so that they can appropriately characterize the risks, benefits, and alternatives for patients.
We sought to determine the extent to which first-year residents are adequately prepared to obtain informed consent from patients. In particular, we sought to answer 2 questions: 1) Are surgical residents adequately knowledgeable about the risks, benefits, and alternatives of the procedures that they commonly obtain consent for? 2) Can residents accurately answer common questions that patients may ask about these procedures?
Section snippets
Methods
First-year surgical residents were asked to complete an anonymous questionnaire about 5 common elective surgical procedures: open inguinal herniorrhaphy with mesh, laparoscopic cholecystectomy, total thyroidectomy, esophagogastrectomy, and abdominal aortic aneurysm repair. Part 1 of the questionnaire assessed whether the resident had ever obtained informed consent for the procedure listed. Part 2 of the questionnaire asked residents to list the risks, benefits, and alternatives for each of the
Results
Eighteen first-year surgical residents completed the questionnaire. Because residents had rotated on different surgical services at the time that they completed the questionnaires, the answers to part 1 (whether they had personally obtained informed consent for the procedure listed) ensured that all had had at least a minimum of experience with the surgical procedures listed.
Residents were more likely to list all the benefits of the procedures than all the risks or alternatives of the
Conclusions
These data suggest that first-year surgical residents do not have sufficient knowledge to adequately communicate information about surgical risks, benefits, and alternatives to patients. Furthermore, first-year surgical residents are not able to correctly answer most questions that may be typically posed by patients about the procedures.
Some investigators have argued that the environment in a busy hospital with the time constraints forced on surgical residents place significant obstacles to an
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