title: Informed consent: exploring surgical residents' beliefs, attitudes and practices.
abstract: Patients rely on the knowledge and skill of the physician proposing treatment to relay information and inform their decision-making. In academic medical centres (AMCs), surgical trainees frequently request consent on behalf of an attending surgeon. There is a paucity of knowledge regarding the frequency of this practice and any associated impacts on surgical trainees. This study poses the following queries: (1) Are surgical residents requesting informed consent (IC) while perceiving themselves to possess insufficient knowledge to facilitate the IC process? (2) If yes, what motivates a resident to request IC with inadequate knowledge? (3) Do residents experience an emotional response? (4) What, if any, support mechanisms are sought? Surgical residents in a Canadian urban AMC (n = 38) completed a survey designed to assess how surgical trainees complete the process of IC as well as probe beliefs and attitudes associated with its execution. This study finds that surgical residents frequently seek consent from patients while perceiving themselves insufficiently informed to discuss the risks and benefits of proposed procedures. The majority of participants (82%) indicated that they had personally requested consent while believing themselves inadequately aware of relevant surgical risks. Surgical trainees see this as a significant issue, feel motivated to complete the IC process due to perceived pressures, experience emotional distress and commonly seek collegial support. A cohort of residents from various surgical departments reported requesting IC while possessing inadequate knowledge to inform patient decision-making. Management of this reality could better ensure that the surgical environment both safeguards patients and enhances trainee education.
authors: JD, MA, is a clinical and research ethicist at Sunnybrook Health Sciences Centre and the University of Toronto, Joint Centre for Bioethics, in Toronto, Ontario.
authors: Sally
authors: S
authors: Bean
authors: MD, FRCPC, is associate professor, Department of Pediatrics and Child Health, University of Manitoba, in Winnipeg, Manitoba.
authors: Bryan
authors: B
authors: Magwood
authors: PhD, is associate professor of clinical epidemiology, Department of Surgery, Faculty of Medicine, at the University of Manitoba.
authors: Ahmed A
authors: AA
authors: Abdoh
authors: MD, FRCSC, is chief of the Department of Otolaryngology Head and Neck Surgery, Sunnybrook Campus, at the University of Toronto.
authors: Joseph
authors: J
authors: Chen
authors: MD, FRCSC, is assistant professor, Department of Otolaryngology Head and Neck Surgery, at the University of Manitoba. He can be contacted by e-mail at jordanhochman@hotmail.com.
authors: Jordan
authors: J
authors: Hochman
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D013502:General Surgery; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000523:psychology*; D007396:Internship and Residency; D008297:Male; D011795:Surveys and Questionnaires