Sugarman Jeremy, Taylor Holly, Jaff Michael R, Sullivan Timothy M
Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA.
Ann Vasc Surg. 2011 Oct;25(7):867-72. doi: 10.1016/j.avsg.2011.03.014. Epub 2011 Jun 15.
Live case demonstrations (LCDs) are now prevalent in medical education courses despite ethical concerns including that they may expose patients to undue risk. However, there are limited data regarding many aspects of LCDs to help inform policies and guidelines regarding them.
We conducted an Internet-based survey of clinicians who have served as faculty or attended the 2009 and 2010 professional meetings sponsored by VIVA (Vascular Interventional Advances).
There were 106 VIVA 2009 respondents and 165 VIVA 2010 respondents. Observing an LCD was more valuable than watching a prerecorded video for most (70% in 2009; 82% in 2010) respondents. About one-third of respondents thought that LCD patients are exposed to more risk than non-LCD patients. Respondents who had been operators were more likely to agree that LCD patients are exposed to more risk (p = 0.001 in 2009; p = 0.022 in 2010). Approximately one-third of respondents in 2009 and one-half in 2010 thought that patients experience direct medical benefit in an LCD. The majority (71% in 2009; 76% in 2010) indicated that they would support the decision of a family member or friend to be an LCD patient, few (44% in 2009; 58% in 2010) indicated that they personally would agree to be an LCD patient.
This survey provides new insights into the value and risk of LCDs. Obtaining the perspective of patients would be extremely valuable in helping to ensure that the ethical aspects of LCDs are addressed properly and thoroughly.
尽管存在伦理问题，包括可能使患者面临不必要的风险，但现场病例演示（LCDs）目前在医学教育课程中很普遍。然而，关于LCDs许多方面的数据有限，难以据此制定相关政策和指南。
我们对曾担任教员或参加过由VIVA（血管介入进展）主办的2009年和2010年专业会议的临床医生进行了一项基于互联网的调查。
2009年有106名VIVA受访者，2010年有165名VIVA受访者。对于大多数（2009年为70%；2010年为82%）受访者而言，观察LCD比观看预先录制的视频更有价值。约三分之一的受访者认为LCD患者比非LCD患者面临更多风险。曾担任手术操作者的受访者更有可能认同LCD患者面临更多风险（2009年p = 0.001；2010年p = 0.022）。2009年约三分之一的受访者以及2010年约一半的受访者认为患者在LCD中能获得直接医疗益处。大多数（2009年为71%；2010年为76%）表示他们会支持家庭成员或朋友成为LCD患者的决定，很少（2009年为44%；2010年为58%）表示他们个人会同意成为LCD患者。
这项调查为LCDs的价值和风险提供了新的见解。获取患者的观点对于确保妥善、全面地处理LCDs的伦理问题将极具价值。
