Advertisement

Patient perspective on the participation of ophthalmology residents in their cataract surgery

      Abstract

      Objective

      To determine the proportion of patients consenting to resident participation in cataract surgery and to identify factors predictive of consent.

      Design

      Prospective cross-sectional study.

      Participants

      The 330 consecutive patients referred for cataract evaluation from February–April 2021 to 3 surgeons at a tertiary care referral centre in London, Ontario.

      Methods

      Using a standardized disclosure script, individuals were asked about resident participation in their cataract surgery. A phone survey and medical record review were conducted to obtain clinical and demographic information. Predictors of consent were assessed using logistic regression modelling.

      Results

      Responses were received from 279 individuals (85% response rate), with a mean age of 71.7 ± 8.6 years, and 113 were female. The consent rate was 71%. Prior negative experience with any medical trainee was an independent predictor for refusing resident participation (odds ratio [OR] = 3.10; 95% CI, 1.32–7.28; p = 0.009). Nonconsenters also had more prior negative experiences with other physicians (35% vs 23%; p = 0.031) and knew someone who had had a problem after eye surgery (36% vs 22%; p = 0.016). Individuals with an occupation involving apprenticeship (OR = 2.87; 95% CI, 1.08–7.67; p = 0.035) and those with a preoperative acuity of 20/200 or worse (OR = 2.78; 95% CI, 1.03–7.14; p = 0.043) were more likely to consent.

      Conclusions

      Patients should be explicitly asked about resident involvement. Negative experiences can make individuals reluctant to have learners involved in their future care. Patient education describing the apprenticeship model in medicine may increase consent.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Levin AV.
        Le secret de l'enseignement de la chirurgie.
        Can J Ophthalmol. 2009; 44: 642-645
        • Wisner DM
        • Quillen DA
        • Benderson DM
        • Green MJ.
        Patient attitudes toward resident involvement in cataract surgery.
        Arch Ophthalmol. 2008; 126: 1235-1239
      1. Canadian Medical Protective Association. https://www.cmpa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians. Accessed June 24 2021.

        • Nguyen TN
        • Silver D
        • Arthurs B.
        Consent to cataract surgery performed by residents.
        Can J Ophthalmol. 2005; 40: 34-37
        • Gan KD
        • Rudnisky CJ
        • Weis E.
        Discussing resident participation in cataract surgery.
        Can J Ophthalmol. 2009; 44: 651-654
        • Thylefors B
        • Chylack Jr, LT
        • Konyama K
        • et al.
        A simplified cataract grading system. The WHO Cataract Grading Group.
        Ophthalmic Epidemiol. 2002; 9: 83-95
        • Sharda RK
        • Sher JH
        • Chan BJ
        • Kobetz LE
        • Mann KD.
        A comparison of techniques: informed consent for resident involvement in cataract surgery.
        Can J Ophthalmol. 2012; 47: 113-117
        • Corwin AM
        • Rajkumar JN
        • Markovitz BJ
        • et al.
        Association of preoperative disclosure of resident roles with informed consent for cataract surgery in a teaching program.
        JAMA Ophthalmol. 2019; 137: 1045-1051
        • Vallance JH
        • Ahmed M
        • Dhillon B.
        Cataract surgery and consent: recall, anxiety, and attitude toward trainee surgeons preoperatively and postoperatively.
        J Cataract Refract Surg. 2004; 30: 1479-1485
        • Pager CK.
        Expectations and outcomes in cataract surgery.
        Arch Ophthalmol. 2004; 122: 1788
        • Sinkowitz-Cochran RL.
        Survey design: to ask or not to ask? That is the question.
        Clin Infect Dis. 2013; 56: 1159-1164