title: Patient understanding of the role of the orthopedic resident.
abstract: BACKGROUND
  Patients have identified the knowledge of a physician's level of training as important. Previous studies show equally poor patient's understanding of the medical education hierarchy. Given the importance to the patient and the possible effect on patient satisfaction, it is critical to evaluate patient's understanding of the orthopedic educational hierarchy. The specific aim of this study is to evaluate patient's understanding of the role of an orthopedic resident as it pertains to their orthopedic care.
  
  
  METHODS
  Adult, English-speaking patients presenting to an outpatient academic orthopedic practice completed surveys similar to those utilized in prior research on this topic. Each questionnaire compiled demographics, questions assessing knowledge of the role of the resident in patient care, and questions to assess the patient's preferences regarding resident physician's role in their care. The knowledge section of the questionnaire was scored with 1 point given to each correct answer. The individual questions with the worst scores from the entire patient population were further evaluated to find demographic predictors of success. In addition to percent correct responses for the entire population, a linear regression model was used to evaluate the effect of age, gender, level of education, ethnicity, and number of academic visits on the knowledge section score.
  
  
  RESULTS
  One hundred seventy-four (n = 174) patients completed the survey. Among them, 40% were male, 27% had a high school education or less, 82% were Caucasian, and for 18% it was their first visit to an academic hospital. The average score for the knowledge section was 10.2 (standard deviation±4.0) out of a possible of 16. Linear regression controlling for noted demographic variables revealed higher level of education to be predictive of a better score (coefficient 3.2; 95% confidence interval 1.9-4.7). The 3 worst scoring questions were regarding knowledge of (1) residents having completed medical school, (2) residents performing surgery with attending supervision, and (3) whether or not residents were actually doctors. For these questions higher level of education correlated with more correct answers (p = 0.005, p = 0.001, p = 0.000, respectively). Among the patients, 90% agreed that it was important for them to know the level of training of their physicians and 76% felt it was okay for residents to "learn" on them as long as they were supervised.
  
  
  CONCLUSIONS
  Patient's knowledge of the role the resident physician provides, in their care, is variable. Higher levels of education appear predictive of better understanding. Patients have difficulty discerning where residents fit in the medical hierarchy. Despite this misunderstanding, patients find it very important that they know the physician's level of training. Given the patient's high priority of knowing the level of training of the doctors who care for them and their frequent misunderstanding of the medical hierarchy, steps should be taken to better educate patients as to who is caring for them. Besides being important for patient's informed consent, it may improve patient satisfaction.
authors.affiliation: Vanderbilt University Medical Center, Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute, Nashville, Tennessee 37232-8774, USA. kenneth.p.unruh@vanderbilt.edu
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Unruh
authors.forename: Sravan C
authors.initials: SC
authors.lastname: Dhulipala
authors.forename: Ginger E
authors.initials: GE
authors.lastname: Holt
mesh_terms: D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010361:Patients / Q000523:psychology*; D010819:Physician's Role; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011795:Surveys and Questionnaires