Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, Hartford Hospital, Hartford, Connecticut.
Research Administration, Hartford Hospital, Hartford, Connecticut.
J Surg Educ. 2019 Jul-Aug;76(4):1146-1152. doi: 10.1016/j.jsurg.2018.12.005. Epub 2019 Jan 2.
The practice of obstetrics and gynecology poses specific ethical challenges for informed consent (IC). Data regarding resident confidence with the IC process are lacking. Our objective was to evaluate obstetrics and gynecology residents' education, experience, and confidence related to IC.
This was a cross-sectional survey of obstetrics and gynecology residents. Descriptive analyses were performed using mean and standard deviation or frequency expressed as a percentage. The results were analyzed for statistical significance using chi-square or Fisher's exact tests for categorical variables and Student t or Mann-Whitney U tests, as appropriate, for continuous variables; all results yielding p < 0.05 were deemed statistically significant.
Electronic survey.
Two hundred eighty-one trainees completed the survey. The majority of participants were female (84.3%) and from an academic training program (65.1%). Two hundred seventy-seven trainees (98.6%) reported that they had obtained IC for operating room procedures; the majority had first done this in the first postgraduate year (PGY) (n = 258, 91.8%). Trainees most commonly obtain IC for resident and general gynecology attending cases. Most trainees primarily learn how to obtain IC via observation of their coresidents and attendings. Nearly 90% of trainees have obtained IC for a procedure for which they were unsure of all the risks. One hundred seventy-three trainees (61.6%) reported that they would like to have more training in IC. Increasing PGY was significantly associated with increasing confidence in obtaining IC for gynecologic, obstetric, and office procedures (all p < 0.01). There were no differences based on PGY in frequency of reviewing who will perform the surgical procedure (p = 0.75), how trainees will be involved in the procedure (p = 0.35), review of alternative treatments (p = 0.91), or in documentation of the IC process (p = 0.16).
Based on the findings of this survey study, education related to the IC process is warranted and curriculum development should be the focus of future study.
妇产科实践对知情同意（IC）提出了具体的伦理挑战。关于住院医师对 IC 过程的信心的数据尚缺乏。我们的目的是评估妇产科住院医师在 IC 方面的教育、经验和信心。
这是一项对妇产科住院医师的横断面调查。使用均值和标准差或频率（以百分比表示）进行描述性分析。使用卡方检验或 Fisher 确切检验对分类变量进行分析，使用 Student t 检验或 Mann-Whitney U 检验（视情况而定）对连续变量进行分析；所有结果 p 值<0.05 均被认为具有统计学意义。
电子调查。
281 名受训者完成了调查。大多数参与者为女性（84.3%），来自学术培训项目（65.1%）。277 名受训者（98.6%）报告他们已经获得了手术室程序的 IC；大多数人在研究生第二年（PGY）（n=258，91.8%）首次进行了此项操作。住院医师最常获得主治医生和普通妇科住院医师病例的 IC。大多数住院医师主要通过观察他们的住院医师和主治医生来学习如何获得 IC。近 90%的住院医师在获得对他们不确定所有风险的程序的 IC。173 名住院医师（61.6%）报告他们希望在 IC 方面接受更多培训。PGY 的增加与获得妇科、产科和办公室程序的 IC 的信心增加显著相关（均 p<0.01）。PGY 对是否审查谁将执行手术程序（p=0.75）、住院医师将如何参与手术程序（p=0.35）、审查替代治疗方法（p=0.91）或 IC 过程的文件记录（p=0.16）的频率没有差异。
基于这项调查研究的结果，需要对与 IC 过程相关的教育进行研究，课程开发应成为未来研究的重点。
