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S.J. Lee, R.A. Adelman; Impact of New Written Informed Consent Guidelines on Residency Participation in Ophthalmic Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1955.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To determine the effect of new guidelines for informed consent set by the Center for Medicare and Medicaid Services (CMS) on residency training, residents' participation in surgery and patient decision–making. The new CMS guidelines for consent states: "If someone other than the operating surgeon performs important parts of an operative procedure, even under the operating surgeon's supervision, the informed consent and operative report should contain the name of the person and describe the important tasks the person will complete or has completed. Important surgical tasks include opening and closing, harvesting grafts, dissecting tissue, removing tissue, implanting devices, and altering tissue." Methods: A prospective study of 100 ophthalmic patients was conducted. Demographic data including age, race, gender, and history of previous eye surgery were collected. The patients were asked at the time of their routine scheduled clinic appointments if they would give consent for surgery under the new guidelines for resident participation. Results: Responses were received from 100 patients. 47 (47%) of the respondents were male, 81 (81%) white, 13 (13%) African–American, 6 (6%) Hispanic and 56 (56%) had undergone previous eye surgery. The mean age was 55.5 years with a median of 52 years. In response to the following questions: 1) If your attending physician recommends that eye surgery is needed, would you grant written consent to undergo the surgery performed by the attending physician? 100% answered yes; 2) If a resident is observing and assisting in the surgery under the supervision of the attending physician, would you grant written consent? 87% answered yes; 3) If the resident is performing "important surgical tasks" of the surgery including "opening and closing, harvesting grafts, dissecting tissue, removing tissue, implanting devices, and altering tissue," under the supervision of the attending would you grant written consent? 30% answered yes; 4) If the resident is performing the entire surgery under the supervision of the attending surgeon, would you grant written consent? 15% answered yes. Conclusions: Based on patients' responses made in the survey, it is predicted that residents' participation in ophthalmic surgery under the new CMS guidelines for consent may dramatically decrease to less than half (87% to 30%, p<0.01). The impact on the quality of residents' surgical training and patient care for the next generation may be significant.
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