In Reply.—The purpose of the article1 was to determine whether surgical procedures can be performed safely by residents in a teaching institution. We found that surgery by residents under the appropriate supervision of a responsible attending surgeon was not associated with increased morbidity, mortality, or duration of hospitalization. We did not address the problem of the informed consent, since it is inherent in teaching institutions for residents to take part in operations. Furthermore, policies of informed consent are determined by the institution review boards, and the concepts and implications may be different in Israel, the United States, or other countries. However, it is our duty to inform the public of safety measurements, as well as the outcome of surgical procedures performed by residents in teaching institutions.
Sharma et al propose that other variables are needed to monitor the performance of surgical residents in the operating room setting. We