title: Training surgeons and the informed consent process: routine disclosure of trainee participation and its effect on patient willingness and consent rates.
abstract: OBJECTIVE
  To examine patient perceptions and willingness to participate in resident education and to assess the effect on patient willingness and consent rates.
  
  
  METHODS
  Anonymous questionnaire designed to capture demographics, overall opinions of teaching programs, and willingness to consent to various scenarios of trainee participation. Descriptive and univariate analyses were performed.
  
  
  METHODS
  Tertiary-level referral center.
  
  
  METHODS
  Three hundred sixteen individuals scheduled for elective surgery.
  
  
  METHODS
  Consent rates for various scenarios.
  
  
  RESULTS
  Of the 316 patients who completed the questionnaire, most expressed overall support of resident training: 91.2% opined that their care would be equivalent to or better than that of a private hospital, 68.3% believed they derived benefit from participation, and most consented to having an intern (85.0%) or a resident (94.0%) participate in their surgical procedure. However, when given specific, realistic scenarios involving trainee participation, major variations in the consent rate were observed. Affirmative consent rates decreased from 94.0% to 18.2% as the level of resident participation increased. Patients also were more willing to consent to the participation of a senior resident (83.1%) vs a junior resident (57.6%) or an intern (54.5%). Patients overwhelmingly opined that they should be informed of the level of resident participation and that this information could change their decision of whether to consent.
  
  
  CONCLUSIONS
  Most patients expressed approval of teaching facilities and resident education. However, consent rates were significantly altered when more detailed information was provided and they declined with increasing levels of resident participation. Providing detailed informed consent is preferred by patients but it could adversely affect resident participation and training.
authors.affiliation: Department of Surgery, Madigan Army Health System, 9040-A Fitzsimmons Ave, Tacoma, WA 98431-1100, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Porta
authors.forename: James A
authors.initials: JA
authors.lastname: Sebesta
authors.forename: Tommy A
authors.initials: TA
authors.lastname: Brown
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Martin
mesh_terms: D000328:Adult; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007258:Informed Consent / Q000706:statistics & numerical data*; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D011795:Surveys and Questionnaires