Teoh Mary, Lee Daniel Jia Wei, Cooke David, Nyandoro Munyaradzi G
General and Colorectal Surgery, Sir Charles Gairdner Hospital, Perth, AUS.
General Surgery, Fiona Stanley Hospital, Perth, AUS.
Cureus. 2023 Jun 26;15(6):e40958. doi: 10.7759/cureus.40958. eCollection 2023 Jun.
Background Surgical informed consent (SIC) is paramount in modern-day litigious surgical practice, yet numerous complaints remain about the consenting process. This paper investigated current attitudes, enablers, and barriers to obtaining SIC in clinical practice for doctors-in-training (DiT). Methodology Self-reported SIC practice among DiT (N=1,652) across three metropolitan health service regions in Western Australia (WA) was surveyed using a de-identified 20-item multiple response ranking, dichotomous quantitative and qualitative online survey. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 27 (IBM Corp., Armonk, NY, USA). Results The response rate was 23% (n=380). There was an even distribution of key demographics across all three health regions; the median postgraduate year (PGY) was two. Only 57.4% of DiT strongly felt comfortable and confident obtaining a SIC. Of the responders, 67.4% correctly identified key SIC components. There were significant positive associations between comfort and confidence with obtaining SIC and the seniority level of the DiT (p<0.001), identification of SIC components (p<0.001), and prior training in SIC (p<0.001). Most DiTs highlighted the necessity for formal SIC training with a preference for interactive workshops supported by e-learning modules. Conclusions Most DiTs can identify the key factors that constitute a valid SIC; however, the practical conversion of this skill could be better. The key enablers to improved SIC techniques were well-supported departments, with further training and clear guidelines within the institutions. The identified barriers were time constraints, inexperience, and a lack of senior support. Future practices and interventions should address these key barriers while promoting the enablers of sustainable and efficient SIC practice.
背景 在现代诉讼性外科手术实践中，手术知情同意（SIC）至关重要，但关于同意过程仍有众多投诉。本文调查了临床实习医生（DiT）在临床实践中获取SIC的当前态度、促进因素和障碍。方法 使用一份20项的无身份识别多项反应排序、二分法定量和定性在线调查问卷，对西澳大利亚州（WA）三个大都市卫生服务地区的DiT（N = 1652）的自我报告SIC实践进行了调查。使用社会科学统计软件包（SPSS）27版（美国纽约州阿蒙克市IBM公司）对数据进行分析。结果 回复率为23%（n = 380）。所有三个卫生地区的关键人口统计学特征分布均匀；研究生年级中位数（PGY）为2年。只有57.4%的DiT强烈感觉在获取SIC时感到舒适和自信。在回复者中，67.4%正确识别了SIC的关键组成部分。在获取SIC时的舒适度和信心与DiT的资历水平（p < 0.001）、SIC组成部分的识别（p < 0.001）以及SIC的先前培训（p < 0.001）之间存在显著正相关。大多数DiT强调了正式SIC培训的必要性，倾向于由电子学习模块支持的互动研讨会。结论 大多数DiT能够识别构成有效SIC的关键因素；然而，这项技能的实际转化可以更好。改进SIC技术的关键促进因素是得到充分支持的部门，机构内有进一步的培训和明确的指导方针。已识别的障碍是时间限制、经验不足和缺乏上级支持。未来的实践和干预措施应在促进可持续和高效SIC实践的促进因素的同时，解决这些关键障碍。
