Patient Trust Is Predictive of Comfort Level with Overlapping Surgery and Trainee Independence

by Linda Kossoff •

How do trust, past experiences, and demographics interact with patient comfort level with overlapping surgery and trainee independence?

BOTTOM LINE: Efforts to increase patient comfort with overlapping surgery and surgical training should include strategies to address past negative experiences and foster trust in trainees and the delegation process.

BACKGROUND: Much attention is paid to attending surgeon absence during overlapping surgery, although during training settings, attending absence during noncritical portions is permitted. This practice is essential to helping trainees develop independence. In either scenario, however, patient comfort varies widely, with no established informed consent process to address their concerns.

STUDY DESIGN: Mixed methods.

SETTING: Vanderbilt University School of Medicine, Nashville, Tenn.

SYNOPSIS: Researchers developed an online survey to examine patient opinion on trainee independence and attending surgeon presence among the general adult population and to explore potential predictors for these opinions. Surveys from 255 adult respondents were analyzed. Survey components included trust-related items requiring a 5-point Likert response; comfort level assessment with three surgical scenarios (using a visual analogue scale); and prompts for open-text responses to items regarding demographics and previous positive/negative healthcare experiences. Results showed a range of comfort levels among respondents regarding trainees performing portions of procedures, attending surgeons leaving the operating room, and overlapping surgery. Subjects who were more comfortable with overlapping surgery were more trusting of trainees and delegation by the attending surgeon. Past experiences in healthcare (positive and negative) were associated with multiple domains of trust (in trainees, surgeons, and the healthcare system). Demographics were not predictive of trust responses or comfort ratings. Study limitations included a subject pool source not representative of the larger U.S. population and a not-yet-validated process of adapting previously validated scales.

CITATION: Langerman A, Brelsford KM, Diehl CJ, et al. Trust as a predictor of patient perceptions regarding overlapping surgery and trainee independence [published online ahead of print February 17, 2020]. Laryngoscope. doi:10.1002/lary.28557.