Informed Consent in the OR: The Ethics of Patient Disclosure Regarding Medical Student Involvement in Surgical Procedures

Abstract: During their third year of medical school, U.S. medical students are given the opportunity to gain clinical exposure by rotating through various specialties. While most teaching centers expect medical students to only observe during their general surgery rotation, attending surgeons often permit and encourage medical students to assist in performing invasive procedures. Active participation in some aspects of surgeries can provide invaluable educational benefits to students, but this usually occurs without patient awareness or consent. This project unpacked the dilemma between balancing medical students’ academic needs and maintaining patient trust and agency. Literature searches and real-world accounts from surgeons revealed implicit assumptions and structural barriers to disclosing students’ exact roles to patients, such as assuming patients’ consent extended to students and encountering time constraints to conduct a thorough informed consent process alongside students. This project explored the utilitarian underpinnings of surgeons’ outlooks and contrasted them with relevant moral theories like virtue ethics and Kantian deontology, as well as clinical ethics principles of patient autonomy and voluntary decision-making. From this analysis, it was revealed that ethical principles that discourage manipulating patients, normalizing dishonesty, and exacerbating mistrust in surgeons and the broader healthcare system should be utilized in order to resolve this ongoing challenge. Recommended steps include prioritizing transparency in the clinical interaction to establish trust and validate patient autonomy, building a triadic relationship by incorporating medical students into the preoperative informed consent process, and considering pedagogical reform to organize surgery clerkships with more consistency and emphasis on students’ surgical training opportunities.

Keywords: Informed Consent, Medical Education,