BJS-2025-0313
https://doi.org/10.58974/bjss/azbc076
Cutting edge blog
General
Comment on: Ethics of training surgeons
Khalid Hureibi
Department of Surgery, Kettering General Hospital
Ifrat Bakirov
Department of Surgery, Kettering General Hospital
24012025
Correspondence to: Khalid Hureibi (email: khalid.hureibi@nhs.net)
Kettering general Hospital
Rothwell Rd
Kettering NN16 8UZ
UK
_______
BJS, https://doi.org/10.1093/bjs/znae252, published 10 December 2024
_______
Dear Editor
We thank Dr Houghton and colleagues for conducting a comprehensive narrative review and, based on their findings, developing a general framework for ethical surgical training1. At this stage, given the limited availability of high-quality evidence on this topic, adopting such an approach is both appropriate and valuable. However, as trainers with a keen interest in this topic, we have identified the following practical points as particularly relevant.
The authors cited evidence from the literature suggesting that outcomes in teaching hospitals are equal, or even superior to those in non-teaching hospitals. However, caution must be exercised when drawing this conclusion, as the association is complex and cannot be solely attributed to the presence of trainees. Teaching hospitals differ from non-teaching hospitals in several aspects, including the environment, infrastructure, and complexity of the healthcare system, all of which may contribute to improved outcomes. Furthermore, recent studies indicate that, in certain surgical procedures, the involvement of trainees may have an adverse effect on outcomes, underscoring the need for a nuanced interpretation of this relationship2,3.
Additionally, in our opinion, one of the most important elements lacking in the process, that needs immediate attention is the lack of communication and explanation to the patient. Currently, most NHS hospitals, use a standard consent template and the patient agrees to the statement: “I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person will however have appropriate experience.”4. This doesn’t explain the grade, training or competence of the person performing the procedure apart from the fact having an “appropriate experience” which is quite a general nonspecific phrase. We should not assume that patients, being treated in a teaching hospital, do consent to allow trainees to operate on them. In a study on contract surgery consent5, 86% of patients consented for trainees to participate in surgery when they were explained the role of trainees and adequate supervision, as opposed to 21% when only given written statement to ask for consent.
This highlights the importance of open dialogue and transparency when discussing trainee participation, emphasizing the crucial role of surgeons as advocates for trainee involvement in patient care. However, in practice, communication regarding trainee involvement in surgery remains insufficient. It is imperative for stakeholders to address and improve this aspect to ensure informed patient consent and foster trust in surgical training environments.
We believe that carefully selecting procedures that are deemed appropriate for trainee involvement, coupled with effective communication with patients, will lead to a more balanced approach, ultimately benefiting both current and future patients.
References
1Houghton N, Prionas A, Kneebone R, Papalois V. Ethics of training surgeons. BJS 2024;111, doi: https://doi.org/10.1093/bjs/znae252
2Fajardo OM, Grebenyuk E, Chaves KF, Zhao Z, Ding T, Curlin HL, Harvey LF. Impact of trainees involvement on surgical outcomes of abdominal and laparoscopic myomectomy. J Obstet Gynaecol 2024;44:2330697.
3Aggarwal S, Wisely CE, Pepin MJ, Bryan W, Raghunathan K, Challa P. Resident involvement in cataract surgery at the Veterans Health Administration: complications, case complexity, and the role of experience. J Cataract Refract Surg 2023;49:259-65.
5Sharda 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;47:113-7.
.png)
.jpg){kind=logo}
