• Vol. 36 No. 12, 995–1002
  • 15 December 2007

Surgical Training in Singapore: Will Patients Consent to Trainee Surgeons Performing Their Operations?



Introduction: Little is known about the attitudes of Singaporean patients towards the intraoperative involvement of trainee surgeons. We aimed to discover if patients would consent to having a trainee surgeon perform their surgery under the supervision of a consultant and if patients would agree to having their photographs or X-rays used for education or research. We sought to discover if patients’ decisions were related to demographic factors such as ethnicity, gender, age, socioeconomic status and previous hospitalisation. Materials and Methods: A questionnaire was administered to 104 patients immediately after their consent was obtained at the Orthopaedic Surgery Clinic and Hand and Reconstructive Microsurgery Clinic at the National University Hospital, Singapore or after admission at the Day Surgery Centre. Only patients undergoing elective orthopaedic or hand surgery were recruited. Results: Sixty-eight per cent of the patients refused to have a trainee surgeon perform their surgery. However, 96% of the patients consented to the use of their photographs or X-rays for teaching. Demographic factors found to be statistically significant were education level and age of the patients. Patients with higher educational levels were more likely to refuse trainee surgeons compared to the group with little or no education [odds ratio (OR), 4.57] but they were more likely to consent to the use of their photographs or X-rays (OR, 0.13). Conclusions: Most patients are reluctant to have a trainee surgeon operate on them. This was strongly related to the level of education attained by the patient and the age of the patient.

Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future.1 In most hospitals, trainee surgeons play a substantial role in providing healthcare and surgical services, under the supervision of a consultant. The Departments of Hand Surgery and Orthopaedic Surgery of the National University Hospital (NUH) attract 6 to10 Basic Surgery trainees, 4 to 5 Advanced Orthopaedic Surgery trainees2 and 4 Advanced Hand Surgery trainees each year. Since 1993, a structured postgraduate training and assessment format has been put in place. Trainees have to undergo 3 years of basic surgical training, followed by another 3 years of advanced orthopaedic training before taking an exit assessment.3,4

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