Doctor, will you do my operation? 

Discussing the role of surgical trainees with your patients

Patients can perceive trainee involvement in their surgery as a potential detriment to receiving high-quality health care.

Each surgical trainee must move beyond the assistant role to primary, then independent surgeon, and this is accomplished through hands-on experience. Still, most patients have apprehension at the thought of a less experienced surgeon performing parts, or all, of their operation. This is not a new fear.

A Canadian study of interviews with surgical trainees and staff surgeons in a paediatric hospital reported the majority of surgeons and surgical trainees don’t voluntarily disclose the degree of participation the surgical trainees have during the informed consent discussion with parents.

There have even been other scenarios reported that efforts have even been made to make the patient believe that qualified specialists performed the operation, when in fact, it was a surgical trainee.

So, why is this occurring?

Patients (and yes, doctors too) suspect that operations carried out by surgical trainees attract a higher surgical complication rate than operations carried out by specialists.

In fact, many studies have shown that trainee participation has a small to no negative effect. There is a lack of good-quality evidence that suggests that operations performed by trainees have a higher risk of surgical complications.

A study found no association between trainee involvement and major perioperative complication among patients undergoing laparoscopic or abdominal hysterectomy, although there were increased odds of complication among patients undergoing vaginal hysterectomy, albeit small. This may be due to the small number of cases to operate on in the study.

Another study showed resident and fellow involvement during pelvic reconstructive surgery is associated with longer operating times, but does not increase the risk of complications within 30 days of the procedure.

A common outcome from these studies assessing trainee complication rates is the longer operation times. To mitigate the effect of trainee participation on complications, efforts should focus on increasing the effectiveness of the surgical procedure, which is reflected in the operative time, as captured in SurgicalPerformance.

Recent data has found higher rates of burnout have been associated with a greater risk of involvement in medical errors in surgical trainees. A 2022 review of studies assessed burnout in surgical trainees, and found higher levels of burnout than their non-surgical peers and attending or consultant surgeons. A limitation of this research is it’s cross-sectional, mostly based on self-report and mainly within the USA.

Determining the best way to discuss the role of surgical trainees, registrars, and fellows and their participation in surgical care is a common challenge that surgeons face. Transparency and disclosure of procedure-specific complications rates to patients may assist. However, this will require surgeons and their trainees to become aware of the incidence of their procedure-specific complication rates.

With SurgicalPerformance, several statistical methods are used to compare surgical outcomes with comparison groups and to display the incidence of adverse events over time.