Patient Attitudes Toward Resident and Fellow Participation in Orthopedic Surgery

Background: Residents' and fellows’ participation in orthopedic surgery is a potential source of anxiety and concern for patients. The purpose of this study was to determine patients’ attitudes toward trainee involvement in orthopedic surgery, surgeons as educators, and disclosure of trainee involvement. Methods: Three hundred two consecutive patients with preoperative and postoperative appointments at three arthroplasty practices in academic medical centers were surveyed with an anonymous, self-administered questionnaire. The questionnaire was developed in consultation with an expert in survey design. Results: Two hundred thirty-four patients completed the questionnaire (response rate 77.5%). Respondents were 60.5% female, 79.6% white, 66.5% privately insured, and 82.8% had at least some college education. About 65.9% of the respondents felt that surgeons who teach are better surgeons. Nearly all felt residents and fellows should perform surgeries as part of their education (94.1% and 95.3%, respectively). However, 39.7% of the respondents were not satisfactory with a second-year resident assisting in their own surgery. Patients dissatisfied with their most recent orthopedic surgery were more likely to respond that they did not want residents helping with their surgery. Respondents agreed that resident or fellow involvement in surgery should be disclosed (92.2% and 90.1%, respectively). Conclusions: Insured and educated patients in the United States overwhelmingly desire disclosure of trainee involvement in their surgery. To address the need for orthopedic training in the context of a patient population that is not fully comfortable with trainee involvement in their own surgery, an open discussion between patients and surgeons regarding trainees’ roles may be the best course of action.