Elsevier

Current Surgery

Volume 59, Issue 1, January–February 2002, Pages 115-118
Current Surgery

2001 APDS spring meeting
Residents seeking informed consent: Are they adequately knowledgeable?

https://doi.org/10.1016/S0149-7944(01)00591-8Get rights and content

Abstract

Purpose

The purpose of this study was to determine the extent to which first-year surgical residents are prepared to obtain informed consent from patients. The study was designed to answer the following research questions: 1) Are first-year residents who are asked to obtain informed consent sufficiently knowledgeable about the risks, benefits, and alternatives of the procedures? 2) Can first-year residents accurately answer the questions patients may pose about these procedures?

Methods

First-year residents (n = 18) were asked to list the risks, benefits, and alternatives for open inguinal hernia repair, laparoscopic cholecystectomy, total thyroidectomy, esophagogastrectomy, and abdominal aortic aneurysm repair, assuming the procedures were elective on otherwise healthy individuals. Residents were also asked to answer questions that patients may pose about each of the procedures. The basic minimum risks, benefits, and alternatives to be listed and answers to the questions were validated by asking faculty representing general (n = 6) and vascular (n = 3) surgery to complete the questionnaires.

Results

Few residents were able to correctly list all risks, benefits, and alternatives of any of the procedures. Less than one-half of the questions that patients may ask about the procedures were correctly answered.

Conclusions

Even though first-year residents are commonly obtaining consent for surgical procedures, many are unable to provide patients with the correct descriptions of the risks, benefits, and alternatives. Nor were they able to correctly answer common questions. Surgical faculty must take more time to educate first-year residents on the appropriate issues in informed consent for the procedures being performed.

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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