title: Gaining consent for carotid surgery: a simulation-based study of vascular surgeons.
abstract: OBJECTIVE
  Despite no formal training in consenting patients, surgeons are assumed to be competent if they are able to perform an operation. We tested this assumption for carotid endarterectomy (CEA).
  
  
  METHODS
  Thirty-two surgeons [Group 1: junior surgical trainees--performed 0 CEA's (n=11); 2: senior vascular trainees--1-50 CEA's (n=11); 3: consultant vascular surgeons - > 50 CEA's (n=10)] consented two patients (trained actors) for a local anaesthetic CEA. The performance was assessed at post hoc video review by two independent assessors using a validated rating scale and checklist of risk factors.
  
  
  RESULTS
  There was no difference in performance between the junior and senior trainees (1: median 91 range 64-121; 2: median 100.5 range 66-125; p=0.118 1 vs. 2 Mann-Whitney). There was a significant improvement between senior trainees and consultant surgeons (3: median 120 range 89-1 142; p=0.001 2 vs. 3). Few junior (1/11) and senior (2/11) trainees, and most (8/11) consultants, were competent. Inter-rater reliability was high (alpha=0.832). Consultant surgeons were significantly more likely to discuss cranial nerve injuries (p<0.0001 Chi-square test) as well as personal or hospital specific stroke risk (p<0.0001) than their junior counterparts. They were less likely to discuss infection (p<0.0001).
  
  
  CONCLUSIONS
  Senior trainees, despite being able to perform a CEA, were not competent in consent. The majority of consultant surgeons had developed competence in consenting even though they had no formal training.
authors.affiliation: Regional Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, UK. drsablack@hotmail.com
authors.forename: S A
authors.initials: SA
authors.lastname: Black
authors.forename: D
authors.initials: D
authors.lastname: Nestel
authors.forename: T
authors.initials: T
authors.lastname: Tierney
authors.forename: I
authors.initials: I
authors.lastname: Amygdalos
authors.forename: R
authors.initials: R
authors.lastname: Kneebone
authors.forename: J H N
authors.initials: JH
authors.lastname: Wolfe
mesh_terms: D000772:Anesthesia, Local; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000193:education; D005260:Female; D006801:Humans; D007258:Informed Consent; D007396:Internship and Residency; D008297:Male; D015588:Observer Variation; D016544:Patient Simulation; D012017:Referral and Consultation; D015203:Reproducibility of Results; D018570:Risk Assessment; D013647:Task Performance and Analysis; D013997:Time Factors; D014741:Video Recording