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I welcome many of the ideas set out by Professor Rowley in his editorial (August 2004 JRSM1). Clearly, assessment in the workplace is the way forward. But where does the patient come in all this? Will patients be told that a junior surgeon will be performing their operation and that a more senior one will be assessing them as they do it? Surely these assessments should not be done until the patient has given explicit and informed consent. In one study only 38% of teaching hospitals in the United States informed patients that students would be involved in their care.2 Do we do any better when junior surgeons are involved?
Some people may argue that society as a whole will benefit as a result of better assessment of surgical skills. But it should be up to the patient as an individual to decide whether or not to contribute to society in this way. How would we feel if it was a member of our own family? A study by Diekema et al.3 showed that children of doctors were less likely to see trainees than other children attending an emergency department.