Santen Sally A, Hemphill Robin R, McDonald Morgan F, Jo Colleen O
Vanderbilt University School of Medicine, Nashville, Tennessee 37232-4700, USA.
Acad Med. 2004 Feb;79(2):144-7. doi: 10.1097/00001888-200402000-00010.
Consent for teaching procedures has been the focus of ethical discussion recently. Patients may consent to a procedure but be unaware that the procedure is to be performed by a resident, perhaps for the first time. In such cases, patients have not specifically consented to the practice of teaching medical procedures. The authors studied patients' awareness of resident training and willingness to allow residents to perform procedures on them.
A survey was administered to a convenience sample of 202 Vanderbilt University Medical Center emergency department patients from February to April 2000. Three procedures (intubation, lumbar puncture, and sutures) were demonstrated. Patients were asked about their awareness of residents' training and willingness to allow a resident to perform the procedures for the first time versus the tenth time.
In all, 60% of patients did not realize they could be the first person a resident performs a procedure on. Only 49% of the patients were completely comfortable being the first patient for sutures, 29% for intubation, and 15% for a lumbar puncture. Most patients felt they should be informed if it was the resident's first time performing procedures (66% for sutures, 69% for intubation, and 82% for lumbar puncture).
Not only do the majority of patients not know that they might be the first patient on whom a resident performs a procedure, more than two thirds believed they should be told if they are the first patient. Particularly for intubation and lumbar puncture, patients indicated that they would be uncomfortable being the first patient on whom these procedures were performed. These data raise ethical questions regarding physicians' obligations to inform patients about resident-performed procedures.
教学操作的知情同意最近一直是伦理讨论的焦点。患者可能会同意进行某项操作，但却未意识到该操作将由住院医师来执行，而且可能是首次由住院医师执行。在这种情况下，患者并未明确同意将其用于医学操作教学。作者研究了患者对住院医师培训的认知情况以及允许住院医师在其身上进行操作的意愿。
2000年2月至4月，对范德比尔特大学医学中心急诊科的202名患者进行了便利抽样调查。展示了三种操作（插管、腰椎穿刺和缝合）。询问患者对住院医师培训的认知情况，以及他们允许住院医师首次而非第十次在其身上进行操作的意愿。
总体而言，60%的患者未意识到自己可能是住院医师首次进行操作的对象。对于缝合，只有49%的患者完全愿意成为首例患者；插管为29%；腰椎穿刺为15%。大多数患者认为，如果是住院医师首次进行操作，他们应该被告知（缝合为66%，插管为69%，腰椎穿刺为82%）。
不仅大多数患者不知道自己可能是住院医师首次进行操作的对象，而且超过三分之二的患者认为如果他们是首例患者就应该被告知。特别是对于插管和腰椎穿刺，患者表示作为这些操作的首例患者会感到不舒服。这些数据引发了关于医生告知患者由住院医师进行操作的义务的伦理问题。
