Acad Med. 2024 Aug 1;99(8):897-903. doi: 10.1097/ACM.0000000000005587. Epub 2023 Dec 19.
Because residents are frequently delegated the task of obtaining consent early in their training, the American Association of Medical Colleges describes "obtaining informed consent" as a core entrustable professional activity (EPA) for medical school graduates. However, prior studies demonstrated that residents frequently perform this task without receiving formal instruction or assessment of competency. This study sought to understand how attending physicians decide to delegate obtaining informed consent for surgical procedures to trainees.
The authors conducted a survey of attending surgeons at a university-based health care system of 6 affiliated teaching hospitals (October-December 2020) to collect data about current entrustment practices and attendings' knowledge, experience, and attitudes surrounding the informed consent process. Summary statistics and bivariate analyses were applied.
Eighty-five attending surgeons participated (response rate, 49.4%) from diverse specialties, practice types, and years in practice. Fifty-eight of 85 (68.2%) stated they "never" granted responsibility for the consent conversation to a trainee, and 74/81 (91.4%) reported they typically repeated their own consent conversation whenever a trainee already obtained consent. The most common reasons they retained responsibility for consent were ethical duty (69/82, 84.1%) and the patient relationship (65/82, 79.3%), while less than half (40/82, 48.8%) described concerns about trainee competency. Reflecting on hypothetical clinical scenarios, increased resident competency did not correspond with increased entrustment ( P = .27-.62). Nearly all respondents (83/85, 97.7%) believed residents should receive formal training; however, only 41/85 (48.2%) felt additional training and assessment of residents might change their current entrustment practices.
Attendings view informed consent as an ethical and professional obligation that typically cannot be entrusted to trainees. This practice is discordant with previous literature studying residents' perspectives. Furthermore, resident competency does not play a predominant role in this decision, calling into question whether informed consent can be considered an EPA.
由于住院医师在培训早期经常被委派获取同意书的任务，美国医学院协会将“获得知情同意”描述为医学院毕业生的一项核心可委托专业活动（EPA）。然而，先前的研究表明，住院医师在执行这项任务时经常没有接受正式的指导或能力评估。本研究旨在了解主治医生如何决定将手术知情同意书的签署任务委托给受训者。
作者对一个大学医疗系统的 6 家附属教学医院的主治外科医生进行了一项调查（2020 年 10 月至 12 月），以收集关于当前委托实践的数据，以及主治医生在知情同意过程中知识、经验和态度的相关信息。采用了汇总统计和双变量分析。
共有 85 名主治外科医生（回应率为 49.4%）参与了调查，他们来自不同的专业、实践类型和从业年限。85 名主治医生中有 58 名（68.2%）表示他们“从未”将同意书的讨论责任授予住院医师，而 74/81（91.4%）表示他们通常在住院医师已经获得同意时重复自己的同意书讨论。他们保留同意书责任的最常见原因是伦理责任（69/82，84.1%）和医患关系（65/82，79.3%），而不到一半（40/82，48.8%）的医生表示担心住院医师的能力。在考虑假设的临床情景时，住院医师的能力增加并没有对应增加的委托（P=.27-.62）。几乎所有的受访者（83/85，97.7%）都认为住院医师应该接受正式培训；然而，只有 41/85（48.2%）的受访者认为额外的培训和对住院医师的评估可能会改变他们目前的委托实践。
主治医生将知情同意视为一种道德和专业义务，通常不能委托给受训者。这种做法与之前研究住院医师观点的文献不一致。此外，住院医师的能力在这一决策中并没有起到主要作用，这使得知情同意是否可以被视为 EPA 受到质疑。
