Should you know if a trainee does your eye surgery?

EYE care programmes around the US do not seem to have clear rules on whether to tell patients that a doctor in training will be involved with their eye surgery, a new study says.

Researchers found that when they asked the directors of eye programs, only about one in four said their programs had a policy to tell patients. The majority, however, agreed that patients would prefer to know or be asked permission first.

One of the barriers, the researchers found, between doctors telling patients that a doctor in training, also known as a resident, would be involved was the fear that patients would say no. The directors said that would limit the number of learning opportunities for residents.

Dr Ayman Naseri, who wrote an editorial accompanying the new study in the Archives of Ophthalmology, said those opportunities are important for the residents' development.

"We have to train the next generation of surgeons and the best setting to do that is a setting where they are supervised in a structured educational environment with experienced teachers," said Naseri, resident programme director and vice chair of the department of opthalmology at the University of California, San Francisco.

In his editorial, Naseri writes stopping them from shadowing a more experienced surgeon only postpones their learning. By then, he writes, the surgeons may be out on their own, inexperienced and without supervision.

But while the authors of the new study say resident programs must of course provide training, they also need to respect a patient's wishes.

To find out whether programmes had policies in place, the new study's researchers, led by Allison Chen, of Brown University's Warren Alpert Medical School in Providence, Rhode Island, sent surveys to the 117 directors of opthalmology programs that are sanctioned by the Accredited Council for Graduate Medical Education (ACGME), which oversees medical training programmes in the US.

Of the 53 directors that responded, 14 said their programme had some sort of policy in place when it comes to informing patients about residents being involved with surgeries.

Seven of those directors said that it was the senior doctor's responsibility to tell the patient that a resident would be helping with their surgery. The other seven said it was the resident's responsibility.

About 40 per cent said telling patients would increase a patient's anxiety level, while about half said patients would not want residents involved.

John Nylen, ACGME's CFO and senior vice president, said the organisation's requirements say residents and faculty members "should inform patients of their respective roles in each patient's care."

Nylen added, however, that the organisation does not specify when or how that should be done.

Naseri, however, said patients are often kept awake during eye surgeries - such as cataract removal - and would know who is performing the procedure.

That, he said, may set eye surgeries apart from others that require a patient to be put to sleep.

Reuters