What hysterectomy [corrected] patients want to know about the roles of residents and medical students in their care

Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review

BACKGROUND

Surgical residents in France lack a clear pedagogical framework for achieving autonomy in the operating room. The progressive acquisition of surgical autonomy is a determining factor in the confidence of operators for their future independent practice. Currently, there is no autonomy scale commonly used in Europe. The objective of this study is to identify existing tools for quantifying the autonomy of residents and the factors that influence it.

MATERIALS AND METHODS

We conducted a qualitative systematic review following the recommendations of the Systematic Review Without Meta-Analysis (SWiM) guidelines. Publications were extracted from the MEDLINE (PubMed), EMBASE, and PSYCINFO databases. All publications without date restrictions up to July 2022 were identified.

RESULTS

Among the 231 identified publications, 21 met the inclusion criteria. Seventeen publications used a graded autonomy assessment tool by the student and/or the teacher, while 4 used evaluations by an observing third party. We found 8 different autonomy scales, with the Zwisch Scale representing 57.1% of the cases. Factors influencing autonomy were diverse, including the work context, experience, and gender of the resident and their teacher.

DISCUSSION

We found heterogeneity in the tools used to "measure" the autonomy of a resident in the operating room. The SIMPL tool or the Zwisch Scale appear to be the most frequently used tools. The relationship between autonomy, performance, confidence, and knowledge may require multidimensional tools that encompass various areas of competence, but this could make their daily application more challenging. The factors influencing autonomy are numerous; and understanding them would improve teaching in the operating room. There is a significant lack of data on surgical autonomy in France, as well as a lack of evaluation in the field of gynecology-obstetrics worldwide.

Survey of Informed Consent Procedures in Urology: Disclosing Resident Participation to Patients

AbstractThe American Urological Association (AUA) and American College of Surgeons (ACS) codes of professionalism require surgeons to disclose the specific roles and responsibilities of trainees to patients during the informed consent process. The objective of this study is to analyze how these requirements are met by urology training programs. An anonymous electronic survey was distributed to the program directors (PDs) of the 143 Accreditation Council for Graduate Medical Education urology residency programs in the United States in 2021. Information was collected regarding program demographics, aspects of the program's consent process, and the disclosure to patients of the role and participation of residents in their surgery. There were 49 responses to the survey (34.3% response rate). Nearly 70 percent of PDs reported that attending physicians lead the consent process. The topics covered during consent discussion include possible complications (25%), expected recovery time (23%), length of the surgery (22%), the people involved (18%), and their specific roles (7%). Many PDs do not explicitly discuss trainee involvement (48.8%) or when a resident is to perform the majority of the case (87.8%). The majority of PDs (78.8%) communicate medical student involvement, but 73.2 percent reported having a patient decline participation of a trainee after describing their role. Despite the AUA and ACS codes of professionalism, many urologists do not disclose resident involvement in surgery to patients. Further discussions are needed to explore how to better balance resident education and patient autonomy.

Patient Perceptions of Trust in Trainees During Delivery of Surgical Care: A Thematic Analysis

OBJECTIVE

Trust is an essential element of an effective physician-patient relationship. There is limited literature examining trust between trainees and patients in the surgical setting. The goal of this study was to investigate how otolaryngology patients perceive trust in trainees during delivery of surgical care.

DESIGN

We extracted trainee-specific data from a larger, qualitative interview study examining trust in the surgeon-patient relationship. We then used realist thematic analysis to explore preoperative otolaryngology patients' perceptions of trust in trainees during delivery of surgical care.

SETTING

Department of Otolaryngology-Head and Neck Surgery at Michigan Medicine in Ann Arbor, MI, a tertiary academic medical center.

PARTICIPANTS

Using convenience sampling, adults 18 years or older scheduled to undergo elective otolaryngologic surgery between February and June 2019 were invited, and 12 agreed to participate in the study.

RESULTS

All participants (n = 12) self-identified as White/Caucasian with a mean age of 60 years (range, 28-82). Participants were 50% (n = 6) female and 50% (n = 6) male. Thematic analysis of participants' perspectives about trust in trainees during delivery of surgical care revealed 3 themes. Trust in trainees is conditional based on (i) level of trainee involvement; (ii) trust in the attending surgeon; and, (iii) trust in the institution.

CONCLUSION

Trust in trainees during delivery of surgical care is conditional on types of tasks trainees perform, bounded by trust in their attending surgeon, and positively influenced by institutional trust. Trainees and surgical educators must look to innovative methods to engender trust more efficiently in the clinic and immediate pre-operative setting. Such approaches can have a positive impact on patient outcomes, facilitate stronger trainee-attending interpersonal relationships, and empower surgeons to practice the professional values integral to surgical care.

Surgical Inpatient's Attitudes Toward Resident Participation: All About Expectations

OBJECTIVE

Determine whether an educational video can improve surgical inpatients' attitudes toward resident participation in their care.

METHODS

Patients admitted to the Trauma/Emergency General Surgery Service at University Hospital (San Antonio, Texas) were randomly divided into control and intervention groups. Patients in the intervention group viewed a short educational video about the role and responsibilities of medical students, residents, and attending surgeons. All patients then completed a previously published survey.

RESULTS

A total of 140 patients responded to the survey (control = 81 and intervention = 59 patients). Overall, 86.4% of patients were welcoming of resident participation. Patients who were expecting residents to be involved in their care had attitudes that are more favorable on almost all survey questions regardless of their study condition. However, patients in the intervention group who expected resident involvement in their care had more favorable attitudes about senior residents (postgraduate year 3-5) assisting in routine or complicated surgery than those in the control group who were expecting resident involvement (both p ≤ 0.001). This same group of patients also had more favorable attitudes about surgical outcomes and overall surgical health when residents are involved (p = 0.004, p = 0.001, respectively). Most patients (79%) said they had no residents previously involved in their care, or they were unsure if residents were previously involved.

CONCLUSIONS

Patient expectation of resident involvement is one of the most important factors influencing perceptions of inpatients about resident participation in surgery. Our goal should be early and frequent discussion with patients about resident involvement in order to foster an atmosphere of trust, including full transparency regarding resident involvement in surgical procedures. An educational video may help introduce the roles of trainees and attending surgeons but should not be used in lieu of direct discussion with patients.

Resident Involvement in Plastic Surgery: Divergence of Patient Expectations and Experiences with Surgeon's Attitudes and Actions

BACKGROUND

As surgical educators, we need to balance the training of our future colleagues against the best possible outcomes and expectations of our patients. Although the legal and ethical standards for disclosure regarding trainee involvement in delivery of surgical care are well established, it is unclear if patient experiences reflect current principles of medical ethics. The attitudes and behavior of surgeons regarding informed consent and patient expectations about resident involvement also remain uncertain.

METHODS

One hundred and five patients surveyed within 6 weeks following their surgery to assess their experiences and expectations regarding resident involvement in their surgery. Three hundred and eight-three members of the Canadian Society for Plastic Surgery received online surveys concerning their attitudes and behaviors regarding the involvement of residents and fellows in trauma, elective, and cosmetic surgery.

RESULTS

Only half of patients were informed that residents may be involved in their surgery and only half were aware if it occurred. This is consistent with the finding that only half of surgeons indicate that specifically requesting consent for trainee involvement during surgery is required for residents to assist or operate. If specifically asked, most patients would agree to have a resident assist in their surgery, but the majority would not agree to have the resident perform the surgery. This is contrary to the finding that more than two-thirds of surgeons report willingness for the trainee to operate independently, with supervision, on trauma or elective patients. Two-thirds of patients felt it was essential that they specifically be asked for permission regarding resident involvement and that this question should be posed by the primary surgeon. Interestingly, only half of surgeons report that patients can decline trainee involvement in their trauma or elective surgery, but the majority of surgeons reported that cosmetic surgery patients could decline resident involvement. Patients also indicated that they would be upset if they subsequently found out that residents assisted or performed their surgery without their specific consent.

CONCLUSIONS

Canadian plastic surgeons indicate a clear commitment to intraoperative surgical training of residents and fellows, although this willingness declines precipitously when it involves cosmetic surgery patients. Unfortunately, the reported attitudes and behaviors of the surgeons are not consistent with the expectations of their patients, or the legal and ethical demands regarding informed consent.

Video-Based Patient Education Improves Patient Attitudes Toward Resident Participation in Outpatient Surgical Care

OBJECTIVE

Decipher if patient attitudes toward resident participation in surgical care can be improved with patient education using a video-based modality.

DESIGN

A survey using a 5-pt Likert scale was created, piloted, and distributed in general and colorectal surgery outpatient clinics that had residents involved with patient care at 2 facilities, both with control and intervention groups. The intervention group viewed a short video (∼4 min) explaining the role, education, and responsibilities of medical students, residents, and attending surgeons prior to answering the survey.

SETTING

General and colorectal surgery outpatient clinics at the University of Texas Health San Antonio, Texas.

PARTICIPANTS

A total of 383 responses were collected, all clinic patients were eligible.

RESULTS

The majority of patients (82%) welcomed resident participation in their health care. Eighteen percent of patients did not expect residents to be involved in their care. Patients had favorable views of residents participating during their surgical procedures with 77% responding "agree" or "strongly agree" to a senior resident assisting with a complicated procedure. Patients who viewed the video versus control were less concerned with how much of the procedure the resident would perform (76% vs 86%, p = 0.010). Patients who viewed the video felt less inconvenienced (p = 0.004).

CONCLUSIONS

The majority of patients are welcoming to resident participation in their surgical care but only 54% were expecting resident involvement at their clinic visit. Early explanation with an educational video of resident roles, education, and responsibilities may help bridge the gap and improve patient experience.

It All Depends on Who Does What: A Survey of Patient and Family Member Comfort With Surgical Trainees Operating

OBJECTIVE

To measure patient and family member comfort with surgical trainees of varying levels performing different portions of surgery.

DESIGN, SETTING, AND PARTICIPANTS

An electronic survey dividing surgery into 6 steps (prepping and positioning, initial incision, deep dissection, critical portions, deep suturing, and closing incision), differentiating surgical trainees by 4 levels of experience (medical student, intern, resident, and fellow), and specifying whether or not an attending surgeon is in the operating room (OR) was given to 200 patients and family members in the surgical waiting area of a single academic medical center. Responses were on a 7-point Likert scale from "Not Comfortable at All" to "Completely Comfortable".

RESULTS

Patient and family member comfort significantly increased as trainee experience increased. It reached a nadir for all trainees performing "critical portions" of surgery. However, their average response was "Comfortable" for residents and fellows performing any surgical step when the attending surgeon is present in the OR. The percentage of "Comfortable" responses was significantly lower for all trainee levels performing any surgical step when the attending surgeon is absent from the OR.

CONCLUSIONS

Patient and family member comfort with surgical trainees operating varies based on the trainee's level of experience, the step the trainee performs, and whether or not the attending surgeon is present in the OR. Patients and family members are on average "Comfortable" with surgical residents and fellows performing any surgical step when the attending surgeon is present.

The Effect of Patient Education on the Perceptions of Resident Participation in Surgical Care

OBJECTIVE

To decipher if patient attitudes toward resident participation in their surgical care can be improved with patient education regarding resident roles, education, and responsibilities.

DESIGN

An anonymous questionnaire was created and distributed in outpatient surgery clinics that had residents involved with patient care. In total, 3 groups of patients were surveyed, a control group and 2 intervention groups. Each intervention group was given an informational pamphlet explaining the role, education, and responsibilities of residents. The first pamphlet used an analogy-based explanation. The second pamphlet used literature citations and statistics.

SETTING

Keesler Medical Center, Keesler AFB, MS. University of Texas Health Science Center at San Antonio, San Antonio, TX.

PARTICIPANTS

A total of 454 responses were collected and analyzed-211 in the control group, 118 in the analogy pamphlet group, and 125 in the statistics pamphlet group.

RESULTS

Patients had favorable views of residents assisting with their surgical procedures, and the majority felt that outcomes were the same or better regardless of whether they read an informational pamphlet. Of all the patients surveyed, 80% agreed or strongly agreed that they expect to be asked permission for residents to be involved in their care. Further, 52% of patients in the control group agreed or strongly agreed to a fifth-year surgery resident operating on them independently for routine procedures compared to 62% and 65% of the patients who read the analogy pamphlet and statistics pamphlet, respectively (p = 0.05). When we combined the 2 intervention groups compared to the control group, this significant difference persisted (p = 0.02).

CONCLUSION

Most patients welcome resident participation in their surgical care, but they expect to be asked permission for resident involvement. Patient education using an information pamphlet describing resident roles, education, and responsibilities improved patient willingness to allow a chief resident to operate independently.

Impact of educational messages on patient acceptance of male medical students in OB-GYN encounters

INTRODUCTION

Although training in obstetrics and gynecology is a key part of medical education, male students receive less extensive experience, due in part to patient refusals. However, there is limited work seeking to reduce patient refusal rates of male students. The current study examined the efficacy of two messages at increasing male medical student acceptance into a well-woman visit.

METHODS

A total of 656 college women participated in a simulation study where they viewed a video of a nurse asking for permission to have a male medical student participate in their well-woman visit. The 30.5% of women who refused student participation (n = 181) were randomly assigned to view a video of the nurse either describing students' medical knowledge and technical skills training (e.g. training in performing pelvic exams) or empathic skills training (e.g. training in communication about sensitive issues). They were again asked if they would be willing to have the student participate.

RESULTS

Both messages similarly increased student acceptance with 44.8% of those receiving the empathic skills training message and 48.9% of those who received the medical/technical skills training message accepting student participation, χ(2) (1, N = 181) = 0.3, p = 0.58.

DISCUSSION

Educational messages about medical student training delivered in an engaging fashion by a credible source are a potentially effective tool to increase male student acceptance into sensitive patient encounters. Future work should test these messages in real-world settings as part of a focus on patient education to increase comfort with student participation.

How do Perceptions of Autonomy Differ in General Surgery Training Between Faculty, Senior Residents, Hospital Administrators, and the General Public? A Multi-Institutional Study

OBJECTIVE

Identify barriers to resident autonomy in today's educational environment as perceived through 4 selected groups: senior surgical residents, teaching faculty, hospital administration, and the general public.

DESIGN

Anonymous surveys were created and distributed to senior residents, faculty, and hospital administrators working within 3 residency programs. The opinions of a convenience sample of the general public were also assessed using a similar survey.

SETTING

Keesler Medical Center, Keesler AFB, MS; the University of Texas Health Science of San Antonio, TX; and the University of Nebraska Medical Center, Omaha, NE.

PARTICIPANTS

A total of 169 responses were collected: 32 residents, 50 faculty, 20 administrators, and 67 general public.

RESULTS

Faculty and residents agree that when attending staff grant more autonomy, residents' self-confidence and sense of ownership improve. Faculty felt that residents should have less autonomy than residents did (p < 0.001). When asked to reflect on the current level of autonomy at their institution, 47% of residents felt that they had too little autonomy and 38% of faculty agreed. No resident or faculty felt that residents had too much autonomy at their institution. The general public were more welcoming of resident participation than faculty (p = 0.002) and administrators (p = 0.02) predicted they would be. When the general public were asked regarding their opinions about resident participation with complex procedures, they were less welcoming than faculty, administrators, and residents thought (p < 0.001). The general public were less likely to think that resident involvement would improve their quality of care (p < 0.001).

CONCLUSION

Faculty and senior residents both endorse resident autonomy as important for resident development. The general public are more receptive to resident participation than anticipated. However, with increasing procedural complexity and resident independence, they were less inclined to have residents involved. The general public also had more concerns regarding quality of care provided by residents than the other groups had.

Surgeons' Experiences With Patients' Concerns Regarding Trainees

OBJECTIVE

Little is known about surgeons' attitudes toward patients' concerns about the role of trainees in their care. The nature of the discussion between surgeons and their patients about trainees and the effect on how patients are cared for is an important part of patient-centered care. We aim to elucidate surgeons' attitude toward patients' concerns regarding trainee involvement in their care.

DESIGN

An electronic, web-based 15-question survey (SurveyMonkey) was used.

SETTING

Surveys were sent to 528 e-mail accounts of the members of the Massachusetts Chapter of the American College of Surgeons. Surgeon demographics, the frequency and nature of patients' concerns about trainees, and the reactions to these concerns by surgeons were explored.

PARTICIPANTS

Of the 528 surgeons surveyed, 109 completed the online survey. Most specialties of surgery were represented.

RESULTS

We analyzed 109 responses (21% response rate). Most surgeons from a variety of specialties were involved with teaching medical students and residents. Half the respondents trained fellows as well. Patients' concerns are raised more often in the community setting where surgeons are more likely to alter their practice.

CONCLUSIONS

Although patients' concerns about trainee involvement are infrequent, they arise enough to deserve specific attention in the current patient-centric environment. Surgeons successfully negotiate to have trainee involvement in the vast majority of cases. Specific guidelines should be developed and adopted to ensure that patients consent to trainee involvement and understand the role of trainees and their supervision.

Patient attitudes toward resident participation in cosmetic vs reconstructive outpatient consultations

OBJECTIVES

The goal of residency programs is to provide trainees with exposure to all aspects of their chosen field so that they exit the program ready to be independent practitioners. However, it is common in some plastic surgery residency training programs to exclude residents from participation in consultations with patients who are seeking cosmetic surgery. The purpose of this study was to determine whether cosmetic surgery patients had a different view about resident involvement than reconstructive surgery patients and to evaluate what factors might be linked to patient attitudes on this topic.

PARTICIPANTS

All new patients older than 18 years presenting to either academic or nonacademic locations were asked to complete the voluntary survey at their initial consultation.

SETTING

The study was conducted at both the Ohio State University (academic) and Advanced Aesthetic and Laser Surgery (private practice) in Columbus, Ohio.

DESIGN

The survey asked patients to identify their surgical concern as either cosmetic or reconstructive and to indicate the location on their body where they were having surgery. Additionally, a series of statements regarding resident involvement was presented with a 5-point Likert-type rating system to assess each patient's attitudes about a range of factors, such as resident sex and seniority.

RESULTS

In total, 119 patients participated in the study by completing the survey. Of this population, 59.7% (n = 71) were classified as reconstructive surgery patients and 40.3% (n = 48) were classified as cosmetic surgery patients. Based on responses, it was determined that reconstructive surgery patients were more approving of resident involvement in their care than cosmetic surgery patients were. When other factors were analyzed, the patients seeking breast surgery were found to be more apprehensive about resident participation than non-breast surgery patients were.

CONCLUSION

Although there were some differences in the way resident participation was perceived by cosmetic and reconstructive surgery patient populations, neither group strongly believed that resident participation decreased the quality of patient care. Based on these findings, plastic surgery training programs should begin to allow residents to become more involved in the care of cosmetic surgery patients.

Shared decision making and informed consent for hysterectomy

This article provides an overview of the components of the informed consent process for surgery including the components specific to hysterectomy. Shared decision making and informed consent for hysterectomy rely on a mutual understanding by the patient and surgeon of the goals, risks, benefits, and alternatives as well as the choice of hysterectomy technique. The importance of a patient-centered approach is emphasized with an explanation of several communication methods and resources for decision aids that will help to ensure that patients have a good understanding of the items listed above and are able to provide informed consent.

Outcomes of hysterectomies performed by supervised residents vs those performed by attendings alone

OBJECTIVE

The objective of the study was to compare the outcomes of hysterectomies performed by residents under supervision of a teaching physician with those performed by attendings alone.

STUDY DESIGN

This was a retrospective cohort analysis of hysterectomies performed at the Greater Baltimore Medical Center from 2004 to 2006.

RESULTS

Of 159 nonteaching and 265 teaching cases, there was no significant difference in any of the surgical outcomes, except mean operating room time in minutes (94.8 [+/- 47.0] vs 107.4 [+/- 42.4]; P = .005), seromas (2.5% vs 0%; P = .02), and others (5% vs 0.8%; P = .007) in nonteaching vs teaching cases, respectively. The demographics and comorbidities were similar. The mean operating room time difference of 13 minutes was not clinically significant.

CONCLUSION

Although teaching hysterectomies take a bit longer to perform, there were no greater adverse outcomes.

Neurosurgery patients' feelings about the role of residents in their care: a qualitative case study

Object

The role of residents in surgery is not clearly explained to patients. The authors undertook a study to explore the level of knowledge and anxiety in patients regarding residents' involvement in their surgery.

Methods

Qualitative case study methodology was used. Thirty face-to-face interviews of patients were conducted prior to elective neurosurgery. Interviews were transcribed and subjected to modified thematic analysis by 4 reviewers. The majority of patients had a postsecondary education, and there was substantial religious and ethnic diversity among them. Most underwent craniotomy for brain tumor.

Results

Six prominent themes arose from the analysis: 1) the level of knowledge about residents is low; 2) the level of anxiety about residents is low; 3) it is desirable for patients to meet the residents before surgery; 4) residents' educational needs are understood and supported; 5) anxiety was not increased by the interview; and 6) patients trust in the medical system.

Conclusions

Patients appear to be unaware of the role of residents in their surgical care but do not seem anxious about it. Trust in the medical system helps patients proceed with risky operations. Surgeons could be more forthcoming with patients about the role of residents.

[Surgery training of gynecologic residents: master and student in the operating room]

OBJECTIVES

Describe the surgical training of gynecologic residents in the operating room, by collecting the opinion of French gynecologists.

MATERIALS AND METHODS

A questionnaire investigating this subject was put on a web site. Every French gynecologist could answer the questionnaire from a duration of six months. The data of the inquiry were studied by comparing five groups: residents (group 1), fellows (group 2), seniors of public hospital (group 3), and seniors of private hospitals (group 4), or, groups 2, 3 and 4 together, as Group A.

RESULTS

Six hundred and fifty-seven gynecologists answered the inquiry. For the residents, lack of time and senior's weak educational motivation are the explanations most frequently retained in order to explain that residents do not operate. For group A, it is rather the residents' skills which is the most important fact to have residents operate. Residents more often practice surgery in general public hospital that in faculty hospital. For 31% of all the referees, heads of departments do not incite their teams to have residents operate. Nearly 25% of all the investigated believe that a man operates more than a woman in resident curriculum. Besides, by analyzing the answers of groups 1 and 2, we were able to correlate resident seniority at their first practice of 13 surgical operations. For 26% of the group A, residents operate less than they do during their own studies. Finally, all the investigated confirm the lack of surgical assessment in the resident curriculum.

DISCUSSION AND CONCLUSION

Decision to let the resident operate remains too dependent on senior personal appreciation and does not seem to join a strategy of training. Opinions of surgical training in the operating room is different between residents and seniors. Operating time increases when residents operate but there is no effect on quality of care. These results show again the necessity of a formal teaching and assessment, in a resident program with objectives, collecting every resident's surgery volume. These educational improvements will contribute certainly to the professionalization of residents.

Medical students' involvement in outpatient clinical encounters: a survey of patients and their obstetricians-gynecologists

PURPOSE

To study women's prior exposure to medical students during office visits, and the association between this and other factors in the likelihood of patients consenting to medical students' involvement in obstetrical-gynecological (ob-gyn) care. Physicians also were surveyed regarding their perceptions of patients' preferences.

METHOD

In 1999-2000, an anonymous questionnaire was distributed for one week to all women scheduled for an ob-gyn visit and to their providers at six community campuses of Michigan State University College of Human Medicine. The questionnaire asked for patients' demographic information and prior experience with medical students, factors important when deciding to allow medical students to participate in their care, and how knowledge of medical students' involvement influences patients' choice of an ob-gyn.

RESULTS

Seventy-two physicians and 1,059 patients returned the questionnaire. Four hundred eighty-eight (49%) patients reported prior experience with medical students. Patients and physicians rated interpersonal skills as most important when deciding about medical students' participation. Forty-three (63%) physicians thought students should participate in the history and physical examination compared to 299 (31%) patients. Prior experience with medical students was a major facilitating factor for medical students' involvement while patients' needs were a limiting factor. Patients' age and medical students' gender also predicted patients' attitudes.

CONCLUSIONS

Most women would allow medical students to participate in their care, a finding moderated by a number of factors. A small proportion of women were biased against participation of male medical students. Physicians overestimated patients' ratings and might themselves be a source of bias regarding medical students' involvement.

Patients' willingness to allow residents to learn to practice medical procedures

PURPOSE

Consent for teaching procedures has been the focus of ethical discussion recently. Patients may consent to a procedure but be unaware that the procedure is to be performed by a resident, perhaps for the first time. In such cases, patients have not specifically consented to the practice of teaching medical procedures. The authors studied patients' awareness of resident training and willingness to allow residents to perform procedures on them.

METHOD

A survey was administered to a convenience sample of 202 Vanderbilt University Medical Center emergency department patients from February to April 2000. Three procedures (intubation, lumbar puncture, and sutures) were demonstrated. Patients were asked about their awareness of residents' training and willingness to allow a resident to perform the procedures for the first time versus the tenth time.

RESULTS

In all, 60% of patients did not realize they could be the first person a resident performs a procedure on. Only 49% of the patients were completely comfortable being the first patient for sutures, 29% for intubation, and 15% for a lumbar puncture. Most patients felt they should be informed if it was the resident's first time performing procedures (66% for sutures, 69% for intubation, and 82% for lumbar puncture).

CONCLUSION

Not only do the majority of patients not know that they might be the first patient on whom a resident performs a procedure, more than two thirds believed they should be told if they are the first patient. Particularly for intubation and lumbar puncture, patients indicated that they would be uncomfortable being the first patient on whom these procedures were performed. These data raise ethical questions regarding physicians' obligations to inform patients about resident-performed procedures.

Women's perceptions of and experiences with medical student involvement in outpatient obstetric and gynecologic care in the United Arab Emirates

OBJECTIVE

The purpose of this study was to determine the experiences, satisfaction, and comfort of women with medical student participation in outpatient care during obstetric and gynecology clerkships.

STUDY DESIGN

A consecutive sample of 303 women who attended the clinic were interviewed before consultation; a structured questionnaire was used.

RESULTS

Two hundred sixty-four women (87.1%) accepted student involvement; 158 women (59.8%) and 173 women (66.5%), respectively, preferred female students or preceptors. Comfort levels were significantly lower with male students or preceptors in all skills that were tested (P <.0001), particularly pelvic examination and the discussion of sexual problems. Acceptance was associated significantly with older age (P <.0001), higher parity (P <.0001), higher education (P =.002), husband's occupation (P =.006), obstetric consultation (P <.0001), previous teaching encounters (P =.0006), recognition of the students' roles (P =.004), and satisfaction with clinical service (P = 0.01). Reasons for nonacceptance (n = 39 women, 12.9%) were concern about privacy during examination (53.8%) or counseling (25.6%) and the extent of the students' involvement (20.5%).

CONCLUSION

Most women agreed to participate in the teaching of obstetric and gynecologic skills to medical students.

Attitudes of patients towards the involvement of medical students in their intrapartum obstetric care

Data investigating patients' attitudes towards and expectations of medical students in an obstetric setting are limited. We have examined the attitudes of pregnant women towards the involvement of medical students in their intrapartum care. Ethics committee approval and informed patient consent were obtained. A survey of 203 antenatal patients was performed. Chi-squared tests were applied to discrete and Student's t-test to continuous data. Only 62% of antenatal patients were prepared to accept medical student participation in their intrapartum care, although 84% agreed that participation was important for student education. Of note, only 43% of patients were prepared to have a male medical student involved in their care. Only 54% of patients correctly identified that the description medical student referred to a doctor in training, others defining it to include nurses, midwives and other hospital staff in training. If increasing numbers of patients decline medical student participation in their intrapartum care, then alternative teaching strategies may be required. Medical educators need to ensure that patients are aware of the role of medical students in order to gain informed consent from patients for student participation in their care.

Patients' attitudes and comfort levels regarding medical students' involvement in obstetrics-gynecology outpatient clinics

PURPOSE

To identify patients' attitudes toward the role of medical students, their preferences regarding medical student involvement, and their comfort level with a medical student's presence during common clinical situations in obstetrics-gynecology.

METHOD

A self-administered questionnaire was distributed to patients waiting for an office visit with the obstetricians or gynecologists who served as preceptors for both male and female medical students. The questionnaire asked patients about their comfort levels with having medical students present during commonly encountered clinical situations. A random subsample of these patients were also asked whether they would allow a medical student to be present during future visits, and why or why not.

RESULTS

A total of 229 patients completed the survey and 124 responded to the supplemental survey. Sixteen respondents were excluded due to missing data or a lack of an adequate comparison group. A majority responded they would feel comfortable having a medical student present during most clinical situations. Almost half of the patients preferred to see the doctor and medical student together, while less than a quarter wanted to see just the physician. Patients with more experience with medical students were more likely to favor medical student involvement and would feel more comfortable having a medical student present during obstetrics or gynecology clinical situations.

CONCLUSION

Patients are willing to involve and feel comfortable with medical students in the obstetrics-gynecology clinic. However, physicians and clinics need to take steps to ensure that patient willingness and comfort are maintained by asking patients about their comfort with medical student involvement, clearly outlining the roles and responsibilities of participating medical students, and gradually increasing medical students' responsibilities as patients gain more experience with them.