To reject trainee surgeon?

My child (6) recently had very complex eye surgery under GA, and the surgeon was supporting a ‘trainee’ who did the op (on both eyes!) with constant direct supervision. I completely understand your anxiety around a newbie performing this surgery, and you are well within your rights to decline this, if you feel it necessary.

my child had complications AFTER surgery, nothing to do with the op itself but the GA, so it happens.

The ‘trainee’ will never be performing something they do not know, and would of course stop and let the more experienced surgeon take over. These are very skilled, highly intelligent people who know what they are doing, and would never intentionally put someone’s health at risk for the sake of ‘carrying out an operation’.

The risks will be the same regardless of who is performing it. From a mother’s point of view, I get it, completely. But these people learn and learn as they go along. That highly qualified surgeon that you would like to carry the op out was once a ‘trainee’ and had everyone refused to have them carry out the ops he/she would never become highly qualified.

By all means decline, that is your prerogative, and nobody can judge you on that, but look at the bigger picture here.

I wish you and your child all the luck in the world for op, it is scary, but it is so worth it x

Ask if you have a choice. If you do, don't take it, if you can avoid this. Your husband might not have let it sink in yet, and maybe he was just put on the stop, but otherwise he was bloody foolish to just nod along.

Some students might be very talented, but they will no way have the confidence and skill of an experienced surgeon.

What they're basically asking you is - 'Could we practice on your child in this complex operation that might lead to blindness if done incorrectly'?

There will be a lot of self righteous people on here that will say 'Well you can't choose your surgeon', or that everybody has to learn sometime, but I wouldn't care. It's not their child at the end of the day.

I think the reason why they've asked you, is because they know full well a student surgeon doesn't have the experience and the operation is therefore riskier, and they want to cover their own backs legally by making sure they have your consent before they proceed.

I would have no problem with it. I think you are anxious for your child and looking for an outlet elsewhere.

So why does the NHS website say you have the right to choose? As I said upthread DH has requested a different surgeon as he wasn't happy with the first one he saw.

If it’s an NHS operation you will get who you get

OP , I’ve just had eye surgery myself the consultant who was doing it runs a fellowship training program and it was them who did my op … I was under local anaesthetic ,so I was able to know what was going on .. yes he watched and oversaw everything and yes they were both already ophthalmologist doctors.. but surgery was longer however, I had a better outcome as he was teaching and went the extra mile so to speak .. hope this helps

As the OP says, ignorance is bliss. I think we've perhaps gone too far in "informed consent" because without the knowledge and understanding about how surgical training works, being told that a "trainee" is doing an operation just increases the level of anxiety that patients and their families experience.

Where do we draw the line? Do you want to know about whether the surgeon is about to go on holiday, because there's evidence that this increases the risk? Or whether they had a row with their husband before work and got stuck in traffic and are really stressed about their child's exam results?

There comes a point where you have to trust them or not have the operation.

YANBU at all. I went in for one of my planned c-sections and there was a trainee anaesthetist all set up to do my spinal block. It was extremely disconcerting sitting there waiting for a huge needle to go in my spine while simultaneously hearing the consultant saying to them “yes see on here that’s the bit you want to be going into, no not there, over to the right a bit, no left a bit more, you’ll have to make sure you get the right angle” etc. I said actually, no, I don’t consent to this, sorry I know you need to train new doctors but I’m already extremely anxious about this and literally shaking with fear, I don’t also need to worry about this. The trainee looked crushed but the consultant just shrugged and said of course, no problem, I’ll do it.

And it’s fair enough not to want surgery done by someone who has to be guided with discussion and more “heavy-handed” than a more experienced surgeon.

Massively unreasonable.
What if everyone "insisted on this"? We'd never have any new surgeons.
Your child will be absolutely fine, under the care of a multitude of highly-qualified professionals.

Completely fair point, yes you're trusting the consultant to do a good job of the supervising, to recognize emerging complications sooner than the trainee might do and know when to step in etc (which is a skill in itself and one they have to learn, not just any consultant gets to be a supervisor, they may be a very skillful surgeon themselves but terrible at teaching), but fortunately/ unfortunately either way you have to trust your consultant to do a good job whether they're scalpel in hand themselves or supervising someone else. Just like you have to trust the pilot of your plane whether they're doing the flying themselves or supervising their first officer, your life is just as much in their hands. I wouldn't say (personally) you're much safer either way. That is to say, you're very safe in both scenarios but mistakes, distractions etc can always happen, I wouldn't say overall one is much safer than the other, certainly the consultants I know and work with personally of course take patient safety and outcomes very seriously at all times, but probably particularly so when supervising trainees because there's double consequences if a bad outcome happens, not only the patient and their family but the impact on the trainee too. Selfishly they also don't want their teaching/supervising privileges taken off them.

But ofc I'm not so naive as to say there's not poor practice out there, laziness, downright negligence. Sadly that is not the reality, it's a risk we have to live with whenever we employ humans to do a skilled and difficult job. All I'm saying is if my consultant (that I trusted) felt it was a suitable case for a trainee to do some or all of, I personally would be very happy with that for myself or my child. Mainly because that means they've already judged it to be a lower risk case TBH which is correlation not causation but point stands!

This. You really shouldn’t turn your nose up at a highly qualified medical professional. My baby had his life saved by a registrar who treated me as an emergency in the middle of the night, performing complex surgery that she had only ever read about in textbooks because the complications I/my baby had were so rare.

This is really silly what you've said. Of course doctors expect questions from someone other then the patient, especially as its a child. Of course it will be the parent who of course is probably not qualified. 🤦‍♀️🤦‍♀️🤦‍♀️🤦‍♀️

Isn’t there usually stats on surgeons where you can see how many of each operation they perform each year?

An inexperienced trainee without adequate supervision or working beyond their competence would be higher risk, as would a variety of other circumstances, but there's been nothing to suggest this would be the case here

I wonder if OP's worried that the supervision might not be as close as hoped, @NoctuaAthene, or even that the more senior surgeon might go AWOL because of pressures elsewhere?

I'm not suggesting for an instant it would happen this time, but it could be another reason to discuss it with them herself. As mentioned such worries will be nothing new to the medics, and if they're halfway decent I'm sure they'll be happy to offer reassurance

Oh loads. Like, the vast majority of cases involving operative or peri-operative m&m are the consultant's "fault" (not that we use that language as such), maybe 95% or even more? And of the ones where a registrar/fellow was primary operator and there was an issue, the vast majority will be emergency cases or non elective, not routine elective cases. Sorry not to have specific numbers but like I say I honestly can't remember a recent case from my caseload where a trainee doctor doing a routine elective case under consultant supervision made a negligent mistake. I'm sure it does happen but few and far between for sure. The consultant doing the supervision/teaching sometimes does a bad job of it mind you, and the residents mess up plenty outside the immediate theatre environment, and no-one of any grade is immune to the sorts of nasty behaviour that ultimately gets you struck off like lying, thiefing, bullying, harassing, assaulting people etc but all that's cold comfort to OP (sorry OP!).

Just goes to show though that opting for consultant-led care or going private for a named consultant as was suggested earlier on the thread is really not a total guarantee of safety (personally and my biased /anecdotal opinion only is that I'd never go to a purely private hospital for any operation, private wing of an NHS hospital and with a mainly NHS consultant maybe but you won't catch me in a pure private hospital anytime soon).

I understand your concern OP, but, as others have said, someone who has been given the green light by their supervisor to carry out this kind of surgery will have a wealth of experience, otherwise, they wouldn't be given the opportunity in the first place.
They're not "practicing" on your child, they're doing the real thing and they're being supervised by someone with even more experience.

Given your concerns and anxiety about it, I'd speak to the surgeon and even ask to meet the student/trainee to find out about their background etc. Ask how much of the operation they would be involved in (you said it could be part of or the whole of the operation).

Good luck with your little ones surgery, I hope it goes well and they have a speedy recovery. xx

I think these are questions for your surgeon- not mumsnet.

while pps are correct that this ‘student’ will be highly qualified, it doesn’t sound like the medical professionals you’ve been speaking to are great at communication. Im sure your son is in very safe and qualified hands, but they need to explain why.

you need to ask them what they mean by a ‘trainee’. that will give you a far better idea.

but also ask them to talk you through the differences between this ‘trainee’ operating and a more experienced person.

say you are worried that it’s a high risk operation with significant side effects so you’d like to know how that might affect outcomes for your son.

it sounds like they haven’t really allowed you to give informed consent if your husband just nodded along to what he was told.

ask them to spell it out to you.

( I’m sure it will be fine, but you are not unreasonable to ask them to talk through the risks)

I had eye surgery in May this year by someone not fully qualified - this surgery was to prevent further sight loss in eye already very bad. She was guided all the time by the head of that department at Western Eye Hospital - where I have been going for many years. The surgeon stood right beside her all the time discussing what was going on etc.(local anaesthetic.) The person doing the surgery was probably a bit more heavy handed than the surgeon would have been - but apart from that was OK. I most likely would not have had a choice or would have a long wait - which was not a good idea with deteriorating vison. I have had other eye surgeries there too - this was only one by trainee.

I completely understand how you feel about this, @MsTamborineMan - my own DS is partially sighted and still has to have work done on his "remaining" eye so I know what a worry it is for us parents

PPs are quite right about the care that'll almost certainly be taken, but I wonder if it would help to talk to the senior surgeon yourself? I've been very lucky in building up a brilliant relationship with ours - though I wish I hadn't had to - and believe me they'll have heard this before and will probably be very happy to put your mind at rest

Just to add, my 3 year old is having open heart surgery in a few weeks. We did not get to pick our surgeon. We got who we were given.

You don’t have the “right” to choose your medical
professional. If you want this then go private.

The person doing the surgery will not be a student. This is not possible and has somehow been misinterpreted.

But it isn't higher risk with a trainee, that's what people are trying to say (more or less kindly). It's understandable that as a parent/patient you'd feel as though it is risky, but this isn't actually the case. An inexperienced trainee without adequate supervision or working beyond their competence would be higher risk, as would a variety of other circumstances, but there's been nothing to suggest this would be the case here. There are lots and lots of rules and protections in place around what procedures and surgeries trainees are allowed to do at various levels and with what amount of independence/supervision. If there was evidence to show patients had significantly worse outcomes when trainees are operating then there would be serious consequences, ultimately the hospital would be stopped from having trainees at all, as clearly they are not educating them properly aside from the ethical and patient safety implications.

OP's fears are understandable but not actually justified here, it's not nice to just dismiss her out of hand but nor is it dim to say she's also fine to consent to the trainee doing the operation under supervision, in the conditions and context she's been given. I totally understand everyone wants the best for their child but how are we supposed to have qualified surgeons at all if they're never allowed to operate as a trainee?

It's always been made perfectly clear to me if I'm being offered an appointment with a PA or nurse; usually the option is given "PA this week, or an actual GP next month".

In fact at my current GPs I would always prefer to be seen by one particular PA if the problem relates to my back issues, as he has done extra studies in that area and grasped my issues more quickly the first time I saw him than any GP. And the last person I'd want to see for a blood test or injection is a GP, PAs/nurses or (ideally) a phlebotomist are always better whereas I end up like a black & blue pin cushion with a GP!