Purpose: Surgical training is shifting toward competency-based models that promote earlier supervised autonomy. We assessed caregiver knowledge, willingness to consent, and opinions regarding trainee autonomy in their child's operation. Methods: At two academic children's hospitals, 100 caregivers of children aged 0–17 years completed an electronic survey in the pediatric surgery clinic (1/2018–4/2018). Knowledge, willingness to consent, and opinions of trainee involvement in their child's operation in standard and competency-based training models were assessed. McNemar's test compared willingness to consent with standard and competency-based training (p < 0.05). Results: Caregivers were 75% female, 41% age 30–39 years old, and 78% white. All provider roles were correctly identified by 14% of caregivers. For routine procedures, caregivers would consent to a fellow assisting (95%) or independently operating with the attending present (78%). They would less likely consent if the attending was not in the operating room (39%) or the hospital (25%). Competency-based training improved willingness to consent, but was significant only for independence with the attending present. Most caregivers wanted to know about (81%) and be asked permission for (82%) trainee involvement in their child's operation. Conclusions: This study suggests that surgeons in academic settings must balance transparency with trainee autonomy when obtaining caregiver consent. Level of evidence: Level III. © 2019 Elsevier Inc.
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