"Sign here. Oh... and this is my first time."

Here's the question of the day. Do patients and their families have an explicit right to know about the experience levels of their providers as a part of every informed consent?

This is the report of an inquest conducted by the government of Manitoba following the deaths of twelve pediatric heart surgery patients in 1994. These cases involved a children's hospital with a newly reopened cardiac surgery program led by a young pediatric heart surgeon who had just completed his fellowship.

The above report details the problems faced by the program in its relatively brief run. There were pure technical errors and there were system issues such as poor planning and communication breakdown. But the report is also surprisingly adamant that the informed consent process was inadequate, stating that families should have been told of the inexperience of the surgeon and surgical team.

I've witnessed many surgical consents involving providers with the full spectrum of experience levels, albeit in a different country than these cases. Surprisingly, parents rarely ask about this sort of thing and I find that providers almost certainly will not volunteer the info. Should they?

And that question just leads to more questions. Who would consent to a major procedure at the hands of a known first-timer? What is the impact if patients refuse these things? Thinking broadly, would it produce physicians who completed training with less hands-on experience? And if we run with this thinking, should these disclosures apply to less invasive procedures? What about the impact on nursing? Should I be telling families that this is my first unsupervised ECMO run as the pump specialist?

What say you?