How Should Trainee Autonomy and Oversight Be Managed in the Setting of Overlapping Surgery?

Abstract

This case highlights an attending surgeon's conflicts between duty to care for individual patients, train independent surgeons, and serve a patient population in an efficient manner. Although oversight of surgical residents and multiple operating room scenarios can be conducted in an ethical manner, patients might not understand the realities of surgical training and clinical logistics without explicit disclosure. Central to the ethical concerns of the case are the attending surgeon's obfuscation of resident involvement and her insufficient oversight of two concurrent procedures. Full and proper informed consent, increased transparency, better planning, and improved communication could have prevented this difficult situation.

Double trouble with double-booking: limitations and dangers of overlapping surgery

“…These challenges are even more important in vulnerable patient groups, such as children 7 . Issues related to training have also been discussed elsewhere 8 ; overlapping surgery requires trainees of sufficient seniority to commence non-critical portions of surgery as well as not being adversely affected by missing out on being present for critical parts. Understandably, safety concerns have been raised, with some studies reporting adverse outcomes 9 , but others not 10 .…”