A 64-year-old woman comes to an academic teaching hospital due to abdominal pain and nausea. Physical examination shows low-grade fever and right lower quadrant abdominal tenderness. CT scan of the abdomen is consistent with acute appendicitis and a laparoscopic appendectomy is planned. The surgeon discusses the risks and benefits of the procedure and alternate treatment options. The patient agrees to undergo the surgery. The surgeon plans to delegate certain noncritical components of the surgery to the senior resident. Which of the following is the most appropriate approach regarding the resident's involvement in the care of this patient?

Question

A 64-year-old woman comes to an academic teaching hospital due to abdominal pain and nausea.  Physical examination shows low-grade fever and right lower quadrant abdominal tenderness.  CT scan of the abdomen is consistent with acute appendicitis and a laparoscopic appendectomy is planned.  The surgeon discusses the risks and benefits of the procedure and alternate treatment options.  The patient agrees to undergo the surgery.  The surgeon plans to delegate certain noncritical components of the surgery to the senior resident.  Which of the following is the most appropriate approach regarding the resident's involvement in the care of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c1e9_8655_8f63_51f6e8b59d31_MD0005_00 Informed consent is the process in which a physician provides the information necessary for a patient to make an educated health care decision. In academic institutions, where trainees are involved in patient care to varying degrees, this should include a discussion about the trainees engaged in the patient's care and their expected roles. In this case, when obtaining consent for laparoscopic appendectomy, the attending surgeon should disclose to the patient that the senior resident may be involved in her surgical procedure, clarify the resident's anticipated role (eg, performing certain aspects of the surgery), and explain the attending surgeon's level of supervision. Such disclosure should be made even if the resident is already known to the patient because the patient may not otherwise anticipate the resident's participation, during which she will be unconscious and unable to give consent (Choice B). Lack of disclosure prior to the procedure may prompt a later finding that true informed consent was not obtained. Patients ultimately have the right to refuse trainee involvement in their care. Most, however, will accept trainee involvement, especially if they can participate in the conversation about what parts of their care are allocated to trainees. Visiting the patient with trainees prior to the procedure, demonstrating a collegial relationship with trainees in front of the patient, and emphasizing trainee supervision may further increase patients' acceptance of trainee participation. (Choices A, D, and E) Under ideal circumstances, trainee participation in this patient's operation would occur under the attending surgeon's direct supervision and add no additional risk to the procedure, and the surgeon would take full responsibility for the outcome of the operation. However, even in these circumstances, the patient has a right to know who will be performing her procedure (ie, both the attending surgeon and the senior resident) and to decide whether she is willing to consent to their involvement. Educational objective: In academic institutions, where trainees are involved in patient care to varying degrees, informed consent (eg, for surgery) should include a discussion about all the individuals involved in the patient's care and their expected roles. References: Training surgeons and the informed consent process: routine disclosure of trainee participation and its effect on patient willingness and consent rates. (http://www.ncbi.nlm.nih.gov/pubmed/21930977) Patients' perspectives on the extent of resident participation in the operating room for total hip or knee arthroplasty. (http://www.ncbi.nlm.nih.gov/pubmed/33680228)

A 64-Year-Old Woman Comes to an Academic Teaching Hospital Due