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Montgomery in, Bolam out: are trainee surgeons 'material risks' when taking consent for cataract surgery in the UK?

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First Author: Y.Abdallah UK

Co Author(s):    O. Qadir   H. Mulholland   I. Masood   S. Vernon   S. Madge        

Abstract Details


Montgomery v Lanarkshire Health Board [2015] UKSC 11 confirmed that clinicians have a duty to warn their patients of ‘material risks’ of surgical procedures. This paper considers whether - in light of Montgomery and current law on consent- clinicians are duty-bound to discuss with patients the involvement of trainee surgeons in cataract surgery, given that there is a proven higher complication rate when trainees perform such surgery.


Ophthalmology trainees working in the West Midlands region of the UK under the national health service, of varying grades, were invited to participate in an online survey (SurveyMonkey software).


Data from the online survey were prospectively collected over a six-month period (September 2018 to January 2019). Trainees were asked to respond anonymously to ten questions concerning their discussions with patients about trainee involvement in cataract surgery. We aimed to investigate whether trainee participation was disclosed to patients and if so, who discloses it and how. Trainees’ opinions regarding other aspects of the surgery such as two-tier waiting lists and unsupervised surgery were explored. Free text comments were also included. Medicolegal counsel was then involved in analysis of the Law.


Of the 54 trainees who were polled, 30 responded to the questionnaire. All questions were answered by the 30 respondents. Only 33% of trainees taking consent discussed trainee involvement in the procedure. Only 23% of trainees’ consultants discussed this topic with the patient. 93% of trainees opted not to discuss the increased risk associated with their involvement in cataract surgery. 40% of the eye units do not outline trainee involvement or the increased risk in the information leaflet provided and only 10% mention both. 50% of the units’ leaflets mention trainee involvement in passing, without exploring the additional risk.


Trainee involvement in surgery and how to take this consent is undoubtedly a sensitive issue for both patients and trainees. Trainee involvement is indeed a material risk, which must be disclosed to the patient and should not be disregarded in fear of patient rejection, but rather be something that we aspire to discuss openly with patients. This will lead to more informed consent, as well as potentially further opportunities for training surgeons, if approached sensibly.

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