Is consent "informed" when patients receive care from medical trainees?

Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of "informed" on "consent," by assessing willingness to be seen by trainees before and after information about trainee's credentials.

A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar's test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information.

The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of "medical student," and 35%"intern" and "resident." In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower-ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029).

Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees' credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non-English speakers and should address these issues in other medical settings.