Eye care programs around the U.S. do not seem to have clear rules on whether to tell patients that a doctor in training will be involved with their eye surgery, a new study says.

Researchers found that when they asked the directors of eye programs, only about one in four said their programs had a policy to tell patients. The majority, however, agreed that patients would prefer to know or be asked permission first.

One of the barriers, the researchers found, between doctors telling patients that a doctor in training, also known as a resident, would be involved was the fear that patients would say no. The directors said that would limit the number of learning opportunities for residents.

Dr. Ayman Naseri, who wrote an editorial accompanying the new study in the Archives of Ophthalmology, said those opportunities are important for the residents’ development.

“We have to train the next generation of surgeons and the best setting to do that is a setting where they are supervised in a structured educational environment with experienced teachers,” said Naseri, resident program director and vice chair of the department of ophthalmology at the University of California, San Francisco.

In his editorial, Naseri writes stopping them from shadowing a more experienced surgeon only postpones their learning. By then, he writes, the surgeons may be out on their own, inexperienced and without supervision.

But while the authors of the new study say resident programs must of course provide training, they also need to respect a patient’s wishes.

NATIONAL REQUIREMENTS

To find out whether programs had policies in place, the new study’s researchers, led by Allison Chen, of Brown University’s Warren Alpert Medical School in Providence, Rhode Island, sent surveys to the 117 directors of ophthalmology programs that are sanctioned by the Accredited Council for Graduate Medical Education (ACGME), which oversees medical training programs in the U.S.

Of the 53 directors that responded, 14 said their program had some sort of policy in place when it comes to informing patients about residents being involved with surgeries.

Seven of those directors said that it was the senior doctor’s responsibility to tell the patient that a resident would be helping with their surgery. The other seven said it was the resident’s responsibility.

About 40 percent said telling patients would increase a patient’s anxiety level, while about half said patients would not want residents involved.

In an email to Reuters Health, John Nylen, ACGME’s CFO and senior vice president, said the organization’s requirements say residents and faculty members “should inform patients of their respective roles in each patient’s care.”

Nylen added, however, that the organization does not specify when or how that should be done.

THE WRONG QUESTION?

Naseri told Reuters Health, however, that patients are often kept awake during eye surgeries - such as cataract removal - and would know who is performing the procedure.

That, he said, may set eye surgeries apart from others that require a patient to be put to sleep.

Still, “I think full disclosure is the most ethical scenario,” he said.

Tod Chambers, associate professor of medical humanities and bioethics at Northwestern University Feinberg School of Medicine in Chicago, told Reuters Health in an email that - in some ways - asking whether patients should be told about residents being involved in surgeries is the wrong question.

“In teaching hospitals, residents are just one part of an entire series of people involved in patient care,” he said.

Instead, Chambers said that patients should be informed about receiving care at a teaching hospital, including the advantages of getting care there.

“While it is true that medical students and residents are learning as they care for patients, they also provide a system of checks and balances that results often in superior care,” said Chambers, who added that the senior doctor should be responsible for giving this information to the patient.

Ultimately, Naseri said, “People need to not be afraid to have trainees involved in their care. These trainees - in most cases - are intelligent, thoughtful and caring people.”

SOURCE: Archives of Ophthalmology, July 9, 2012

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