Does the status of surgical resident compared to that of consultant have an impact on patient's satisfaction over the informed consent process?

OBJECTIVE: The informed consent process is a fundamental element of best practice in the surgical patient's care. The aim of the present study is to investigate the value of informed consent from the patient's perspective in a Teaching Hospital. In particular, the role of the Residents within this process is analyzed to compare their performance with that of Consultants. DESIGN: This is a prospective observational study based on a consecutive cohort of patients who were offered an elective surgical procedure during the period April 2015 - September 2015. SETTING: The study was conducted in the Surgical and Transplantation Unit of the University Hospital of Udine, Italy, accredited by the Joint Commission International. PARTICIPANTS: The study population consisted of 236 patients. The participants were asked on a voluntary basis to fill in a self-evaluating questionnaire after being requested to complete a written informed consent before the operation. RESULTS: In the present study we didn't register any significant difference of patient's satisfaction over informed consent when we evaluated the performance of Residents in comparison to Consultants. CONCLUSIONS: We believe that our positive results may be related to our educational training approach. However, adequate education of Residents about seeking informed consent is not sufficient to guarantee an effective informed consent process if it is not supported as a counterpart by the promotion of correct and positive patient knowledge and perception of the Residents' skills, clinical role and responsibilities. KEY WORDS: Educational program, Informed consent, Informed consent process, Patient's satisfaction, Resident.

Clinical strategies to aim an adequate safety profile for patients and effective training for surgical residents: The laparoscopic cholecystectomy model.

BACKGROUND: Training programs for resident surgeons represent a challenge for the mentoring activity. The aim of the present study is to investigate the impact of our training program for laparoscopic cholecystectomy on patient's safety and on the modulation of the residents' exposure to clinical scenario with different grades of complexity. MATERIAL AND METHODS: This is a retrospective study based on a clinical series of laparoscopic cholecystectomy performed in a teaching hospital. Study population was grouped according to the expertise of the attending primary operator among resident surgeons. Four groups were identified: consultant (C), senior resident (SR); intermediate level resident (IR); junior resident (JR). The intraoperative and postoperative outcomes were confronted to evaluate the patient's safety profile. RESULTS: 447 patients were submitted to LC: 96 cases were operated by a C, 200 by SR, 112 by IR and 39 by JR. The mean operative time was the longest for the JR group. A statistically higher rate of conversion to open approach was registered in C and IR groups in comparison to JR and SR groups. However, in C and IR groups, patients had worse ASA score, higher BMI and more frequent past history of previous abdominal surgery, cholecystitis or pancreatitis. Overall, it was not registered any statistically significant difference among the groups in terms of length of hospital stay and prevalence of major postoperative complications. CONCLUSION: Applying an educational model based on both graduated levels of responsibility and modulated grade of clinical complexity can guarantee an high safety profile.