Impact on Outcomes of Participation by Interns/Residents in Surgery — Thinking About Students in Access Services

Fascinating NYT piece about research into whether having doctors in training — interns or residents — participate in surgery impacts outcomes.  This is a big study and the results paint just the kind of complicated picture that gets you thinking.

This month The Journal of the American College of Surgeons published the results of a study on how well patients come through when a surgeon-in-training is involved in the operation. Analyzing the results of more than 600,000 operations at more than 225 hospitals across the country, researchers found that while resident involvement was indeed associated with slightly higher complication rates and longer operating times, those patients who had trainees participating in their operations also experienced decreased mortality rates.

Here is one part of the data.

[F]or every 1,000 people who underwent colon surgery with trainees present, 30 patients experienced complications who wouldn’t have if they had undergone the same operation without residents. But five patients who would have died ended up surviving because trainees were involved in their surgery and care. “The question might then become,” Dr. Raval added, “‘Would you accept the risk of a urinary tract infection that required an antibiotic for several days if you knew it might save your life?’”

The abstract can be accessed here.

I am no doctor, but one possible explanation of the higher complication rate might just be that the trainees bring one more set of potentially dirty hands, and that this study also makes the case for even greater vigilance in this area.

In the legal world, however, it once again sets us thinking about the impact of the use of students, particularly when often the alternative to having supervised student assistance is having no assistance at all.

One point is I am absolutely convinced of is that well trained students performing focused tasks (even if they are not law students) such as form completion, can in many contexts help a lot — although the impact on outcomes is dependent on the responsiveness of judges to information that comes from the form, and their willingness to engage with the litigants to obtain the needed information.

The other is that there are kinds of cases in which the extra time that students can put into a case is determinative.  This is particularly the case in areas like child protection, where a deeply engaged student can know the emerging facts better than any overloaded social worker, and where in the vast majority of cases (at least in many jurisdictions) outcomes are negotiated against a party with no financial stake.

Anyway, as we start to get more and better statistics and research, we will probably be better able to use law student (and indeed college student) resources where they will make the most difference.


About richardzorza

I am deeply involved in access to justice and the patient voice movement.
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1 Response to Impact on Outcomes of Participation by Interns/Residents in Surgery — Thinking About Students in Access Services

  1. Charles Dyer says:

    The use of students who take the time to know a case and know the client would, I think, usually improve outcomes. I am thinking specifically about issues of cultural competency, wherein the student provides a vital link that enables the client to get over barriers created by legal discourse and, in some instances, by ESL issues. In this regard, I think the case can be made that they have more to bring in legal settings than in medical ones. The medical trainees were not, for instance, explaining the use of medicine to the patients, at least during the operation. They weren’t really talking with the patients, except perhaps in follow-up. In a legal clinic setting, the whole point is to increase the “face time” with the client.

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