实习医生是否在职场中学习如何获得手术程序的适当知情同意？
Do Interns Learn On-The-Job How to Obtain Proper Informed Consent for Surgical Procedures?
机构信息
Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
Department of Health Professions Education, Massachusetts General Hospital School of Healthcare Leadership, Boston, MA; Department of Surgery, Baylor Scott and White Health, Temple, TX.
出版信息
J Surg Educ. 2024 Sep;81(9):1215-1221. doi: 10.1016/j.jsurg.2024.06.005. Epub 2024 Jul 17.
OBJECTIVE
Obtaining surgical informed consent (SIC) is a critical skill most residents are expected to learn "on-the-job." This study sought to quantify the effect of 1 year of clinical experience on performance obtaining SIC in the absence of formal informed consent education.
DESIGN
In this case-control cohort study, PGY1 and PGY2 surgical residents in an academic program were surveyed regarding their experiences and confidence in obtaining SIC; then assessed obtaining informed consent for a right hemicolectomy from a standardized patient.
SETTING
Single academic general surgery residency program in Buffalo, NY.
PARTICIPANTS
Ten PGY1 and eight PGY2 general surgery residents were included in the study, after excluding residents with additional years of training.
RESULTS
PGY2 residents had significantly more experience obtaining SIC compared to PGY1 residents (median response: ">50" vs "between 6 and 15," p = 0.001), however there was no difference in self-reported confidence in ability obtaining SIC (mean 3.2/5 in PGY1 vs 3.4/5 in PGY2, p = 0.61), self-reported knowledge of SIC (mean 3.1/5 in PGY1 vs 3.6/5 in PGY2, p = 0.15), performance on a test regarding SIC (mean score 9.0/20, SD 3.9 for PGY1 vs mean score 9.6/20, SD 3.5, t = 0.387, p = 0.739) or performance during a standardized patient interview (mean 11.2/20, SD 2.78 for PGY1 vs mean 11.4/20, SD 1.51 for PGY2, p = 0.87). In the interviews all residents addressed general risks (bleeding/infection), however both groups performed worse in addressing procedure-specific risks including anastomotic leak as risk for hemicolectomy.
CONCLUSIONS
A year of clinical training between PGY1 to PGY2 did not improve performance in obtaining surgical informed consent when lacking formal education, despite self-confidence in their ability. A curriculum covering the content, delivery and assessment of informed consent should be initiated for residents upon arrival to surgical training.
目的
获取手术知情同意书（SIC）是大多数住院医师期望在“工作中”学习的一项关键技能。本研究旨在量化 1 年临床经验对缺乏正规知情同意教育的情况下获取 SIC 的影响。
设计
在这项病例对照队列研究中，我们调查了学术项目中的 PGY1 和 PGY2 外科住院医师的经验和对获取 SIC 的信心；然后，他们从标准化患者那里评估了获取右半结肠切除术知情同意的情况。
地点
纽约州布法罗市的一家学术普外科住院医师培训计划。
参与者
在排除了接受额外培训的住院医师后，本研究纳入了 10 名 PGY1 和 8 名 PGY2 普通外科住院医师。
结果
PGY2 住院医师在获取 SIC 方面的经验明显多于 PGY1 住院医师（中位数回答：“>50”与“6-15”，p=0.001），但在获取 SIC 能力方面的自我报告信心无差异（PGY1 为 3.2/5，PGY2 为 3.4/5，p=0.61），自我报告的 SIC 知识（PGY1 为 3.1/5，PGY2 为 3.6/5，p=0.15），关于 SIC 的测试成绩（PGY1 的平均得分为 9.0/20，标准差为 3.9，PGY2 的平均得分为 9.6/20，标准差为 3.5，t=0.387，p=0.739）或标准化患者访谈中的表现（PGY1 的平均得分为 11.2/20，标准差为 2.78，PGY2 的平均得分为 11.4/20，标准差为 1.51，p=0.87）。在访谈中，所有住院医师都谈到了一般风险（出血/感染），但两组在谈到特定于手术的风险时表现不佳，包括吻合口漏作为半结肠切除术的风险。
结论
在缺乏正规教育的情况下，从 PGY1 到 PGY2 的 1 年临床培训并没有提高获取手术知情同意的能力，尽管他们对自己的能力充满信心。对于接受手术培训的住院医师，应该开设涵盖知情同意的内容、传递和评估的课程。
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