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Table 1. Ophthalmology Graduate Medical Education Policies Regarding Disclosure of Resident Involvement in Ophthalmic Surgery
Table 1. Ophthalmology Graduate Medical Education Policies Regarding Disclosure of Resident Involvement in Ophthalmic Surgery
Table 2. Program Directors' Perspectives Regarding Resident Disclosure Policies
Table 2. Program Directors' Perspectives Regarding Resident Disclosure Policies
1.
Wisner DM, Quillen DA, Benderson DM, Green MJ. Patient attitudes toward resident involvement in cataract surgery.  Arch Ophthalmol. 2008;126(9):1235-1239PubMedArticle
2.
Vallance JH, Ahmed M, Dhillon B. Cataract surgery and consent: recall, anxiety, and attitude toward trainee surgeons preoperatively and postoperatively.  J Cataract Refract Surg. 2004;30(7):1479-1485PubMedArticle
3.
Versluis MA, van der Linden PJ. Patients' attitude towards residents' participation during gynaecological surgery.  Eur J Obstet Gynecol Reprod Biol. 2010;153(2):203-206PubMedArticle
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Crawford GH, Gutman A, Kantor J, James WD. Patients' attitudes toward resident participation in dermatology outpatient clinics.  J Am Acad Dermatol. 2005;53(4):710-712PubMedArticle
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Scott IU, Smalley AD, Kunselman AR. Ophthalmology residency program leadership expectations of resident competency in retinal procedures and resident experience with retinal procedures.  Retina. 2009;29(2):251-256PubMedArticle
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Ahmed Y, Scott IU, Greenberg PB. A survey of the role of virtual surgery simulators in ophthalmic graduate medical education.  Graefes Arch Clin Exp Ophthalmol. 2011;249(8):1263-1265PubMedArticle
Research Letters
July 2012

Disclosure of Resident Involvement in Ophthalmic Surgery

Author Affiliations

Author Affiliations: Program in Liberal Medical Education (Ms Chen) and Division of Ophthalmology, Warren Alpert Medical School (Ms Chen and Dr Greenberg), Brown University, and Section of Ophthalmology, Providence VA Medical Center (Ms Chen and Dr Greenberg), Providence, Rhode Island; and Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania (Dr Scott).

Arch Ophthalmol. 2012;130(7):932-934. doi:10.1001/archophthalmol.2011.1905

An important objective of ophthalmic graduate medical education (GME) is to provide sufficient surgical training to ophthalmology residents so they are competent to enter comprehensive ophthalmic practice. This objective, however, must be balanced with a commitment to provide high-quality patient care, which includes respecting patients' preferences to be informed about the degree of resident involvement in their eye surgery.14 Currently, the prevalence and details of disclosure policies regarding resident participation and barriers to their implementation in US ophthalmology GME programs are unknown. To help benchmark current practices and assist programs in formulating strategies to implement full disclosure policies, we surveyed US ophthalmology GME program directors (PDs) to determine current practices and policies regarding disclosure of resident involvement in ophthalmic surgery.

Methods

After receiving a study exemption from the Providence VA Medical Center Institutional Review Board, the FREIDA online database (http://www.ama-assn.org/go/freida) was used to identify all ophthalmology GME programs accredited by the Accreditation Council for Graduate Medical Education. Each facility was called to verify the PD's contact information. An anonymous survey including multiple-choice and Likert-style questions (Table 1 and Table 2) was created at http://www.surveymonkey.com. The survey link was sent to all US ophthalmology GME PDs.

Results

One hundred seventeen PDs were surveyed; results are summarized in Table 1 and Table 2. The response rate was 45.3% (53 of 117 PDs). Fourteen of the 53 PDs (26%) reported that their program had an established policy on disclosing the level of resident involvement in ophthalmic surgery. In programs with an established policy, the PDs indicated that the primary responsibility for informing patients about the level of resident involvement in surgery belonged to attending physicians (7 of 13 PDs [54%]) or resident physicians (7 of 13 PDs [54%]); in programs without an established policy, 31 of 39 PDs (79%) indicated that the attending physician should have the primary responsibility to inform patients about resident involvement in surgery. Most PDs (30 of 47 [64%]) agreed that patients prefer to be asked permission in advance for a resident to participate in their ophthalmic surgery. More than half of the PDs (27 of 47 [57%]) also agreed that patients prefer complete disclosure regarding the level of resident involvement. About half the PDs (23 of 47 [49%]) agreed that disclosure of resident involvement reduces consent for resident involvement and decreases opportunities for resident surgical training. Medicolegal risk and insufficient time were not considered barriers to disclosure.

Comment

This study suggests that a minority of US ophthalmology GME programs have an established resident disclosure policy. Also, the presence or absence of a policy may affect who PDs believe should have the primary responsibility to inform patients about trainee involvement in their ophthalmic surgery: only half the PDs in programs with policies indicated that the attending has the primary responsibility, whereas most PDs in programs without policies believe that the attending should have the primary responsibility. In addition, the potential loss of resident surgical cases, the lack of guidance from ophthalmological societies, and perceived patient anxiety may be more important barriers to disclosure than medicolegal risk or lack of time.

The study has several limitations. First, the survey response rate of 45.3% may limit the generalizability of the results; however, this rate is comparable to the response rates of 32% and 48% in 2 recent surveys of US ophthalmology PDs.5,6 Second, the multiple-choice format of the survey may have caused bias and prevented us from uncovering other potential barriers to disclosure. Third, we did not investigate how a resident's role in a program—eg, as a primary caregiver in a county hospital vs an assistant physician in a faculty practice—may have affected the divergence in PD attitudes on resident disclosure. This study underscores the need for further research to determine how a formal disclosure policy affects the degree to which patients at teaching hospitals are informed about resident participation in their ophthalmic surgery and how different disclosure policies affect patient consent for resident participation and resident surgical training opportunities.

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Article Information

Correspondence: Dr Greenberg, Section of Ophthalmology, Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908 (paul_greenberg@brown.edu).

Author Contributions: Dr Greenberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Financial Disclosure: None reported.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs or the US government.

References
1.
Wisner DM, Quillen DA, Benderson DM, Green MJ. Patient attitudes toward resident involvement in cataract surgery.  Arch Ophthalmol. 2008;126(9):1235-1239PubMedArticle
2.
Vallance JH, Ahmed M, Dhillon B. Cataract surgery and consent: recall, anxiety, and attitude toward trainee surgeons preoperatively and postoperatively.  J Cataract Refract Surg. 2004;30(7):1479-1485PubMedArticle
3.
Versluis MA, van der Linden PJ. Patients' attitude towards residents' participation during gynaecological surgery.  Eur J Obstet Gynecol Reprod Biol. 2010;153(2):203-206PubMedArticle
4.
Crawford GH, Gutman A, Kantor J, James WD. Patients' attitudes toward resident participation in dermatology outpatient clinics.  J Am Acad Dermatol. 2005;53(4):710-712PubMedArticle
5.
Scott IU, Smalley AD, Kunselman AR. Ophthalmology residency program leadership expectations of resident competency in retinal procedures and resident experience with retinal procedures.  Retina. 2009;29(2):251-256PubMedArticle
6.
Ahmed Y, Scott IU, Greenberg PB. A survey of the role of virtual surgery simulators in ophthalmic graduate medical education.  Graefes Arch Clin Exp Ophthalmol. 2011;249(8):1263-1265PubMedArticle
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