1. Gaining Consent for Carotid Surgery: A Simulation-Based Study of Vascular Surgeons.
- Author
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Black, S.A., Nestel, D., Tierney, T., Amygdalos, I., Kneebone, R., and Wolfe, J.H.N.
- Subjects
CAROTID artery surgery ,ENDARTERECTOMY ,SURGEONS ,INFORMED consent (Medical law) ,CLINICAL competence ,MEDICAL consultants ,SIMULATION methods in medical education - Abstract
Abstract: Aim: Despite no formal training in consenting patients, surgeons are assumed to be competent if they are able to perform an operation. We tested this assumption for carotid endarterectomy (CEA). Methods: Thirty-two surgeons [Group 1: junior surgical trainees – performed 0 CEA''s (n =11); 2: senior vascular trainees – 1–50 CEA''s (n =11); 3: consultant vascular surgeons – > 50 CEA''s (n =10)] consented two patients (trained actors) for a local anaesthetic CEA. The performance was assessed at post hoc video review by two independent assessors using a validated rating scale and checklist of risk factors. Results: There was no difference in performance between the junior and senior trainees (1: median 91 range 64–121; 2: median 100.5 range 66–125; p =0.118 1 vs. 2 Mann–Whitney). There was a significant improvement between senior trainees and consultant surgeons (3: median 120 range 89–1 142; p =0.001 2 vs. 3). Few junior (1/11) and senior (2/11) trainees, and most (8/11) consultants, were competent. Inter-rater reliability was high (α =0.832). Consultant surgeons were significantly more likely to discuss cranial nerve injuries (p <0.0001 Chi-square test) as well as personal or hospital specific stroke risk (p <0.0001) than their junior counterparts. They were less likely to discuss infection (p <0.0001). Conclusion: Senior trainees, despite being able to perform a CEA, were not competent in consent. The majority of consultant surgeons had developed competence in consenting even though they had no formal training. [Copyright &y& Elsevier]
- Published
- 2009
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