Improving the preoperative assessment of older adults considering surgery: The need for a structured curriculum during surgery residency

Abstract

Background

Over half of surgeries in the United States are performed on older adults. The aims of this study were to quantify geriatric-relevant discussion topics and assessments during the consent process and to assess the need for a structured approach to consent older patients.

Methods

General surgery residents at a single institution answered questions about content of the informed consent process and preoperative assessment in adult and geriatric (> 65) patients. Questions addressed frequency of geriatric- relevant discussions, assessments and consultations for the two patient groups.

Results

Part 1 was completed by 66/75 residents (88.0%). Most residents received training in informed consent during medical school or residency (95%). Common avenues for training were direct observation of attending surgeons or senior residents (85%), followed by didactic teaching (47%) and independent reading (30%). Only three residents (two PGY1s and one PGY2) reported receiving specific training in how to achieve informed consent in older patients. Part 2 was completed by 47/56 eligible residents (83.9%). Postoperative expectations (85.1%), living situation (53.2%), postoperative goals (53.2%), and advanced directives (42.6%) were most commonly discussed. Cognitive testing (19.1%), geriatrics consults (14.9%), and frailty scores (4.3%) were rarely addressed. There were no correlations between discussion of this information with resident age, level in residency, self-identified gender, or self-identification as a member of a racial or ethnic minority.

Conclusions

Geriatric-relevant topics and assessments occurred sporadically during the resident-led informed consent process and were more common with senior residents. Training in geriatric relevant informed consent rarely occurs during residency. These results, if generalizable across surgical training sites, highlight the need for a structured curriculum to address geriatric-relevant perioperative concerns.