DECODING THE NAME GAME: THE INFLUENCE OF TITLES ON PATIENT CONFIDENCE IN THEIR EYE SURGEON

A variety of factors influence a patient’s perception of their healthcare professional, including but not limited to, gender, age, ethnicity, and accent. In the UK, postgraduate doctors who are in a training programme to achieve a certificate of completion of training (CCT) in ophthalmology, are frequently referred to as ‘trainees’ or ‘specialty trainees’. Senior 'trainees', especially those who have performed hundreds of independent cataract operations, may negatively impact patient confidence in their skills by using a title that does not reflect their experience. Multiple alternative titles exist, including ‘specialty registrar’ or ‘resident’, which are used in other healthcare systems.

This study aims to investigate how a given title affects patient perception of the level of experience of their cataract surgeon.

Patients attending the Western Eye Hospital, Imperial College NHS Trust, UK.

Patients were invited to fill in an anonymous questionnaire in the clinic and Ophthalmic A&E waiting rooms at the Western Eye Hospital between May and August 2023. The surveys were completed on iPads, and the order of questions was randomised for each respondent. It consisted of a series of doctor’s titles commonly used in the NHS, including Foundation (FY) doctor, Senior House Officer (SHO), Specialty Trainee, Specialty Registrar, Associate Specialist, Fellow, and Consultant. The respondents were asked to score each title from ‘least experienced’ to ‘most experienced’ on a five-point Likert scale. They were then asked how confident they would be for a doctor with the aforementioned titles (excluding SHO and FY doctor) to perform their cataract surgery. Demographic data, including age, ethnicity, gender, and level of education, was also collected.

There were 98 respondents to the questionnaire. Respondents correctly considered ‘Consultants’ to be the most experienced doctor. The title ‘Specialty Trainee’ was associated with the lowest perceived experience, and a ‘Specialty Trainee’ doctor was incorrectly thought to be even less experienced than a ‘Foundation Doctor’, which received the second-lowest rating of perceived experience (p = 0.03). Respondents considered 'Specialty Registrars' to be more experienced than a ‘Specialty Trainee’ and were more confident in the ‘Specialty Registrar’ performing their surgery (p < 0.0001). Patients were least confident with having a ‘Specialty Trainee’ perform their cataract surgery.

This study highlights the widespread misunderstanding of medical titles amongst patients. The title ‘specialty trainee’ may induce unnecessary anxiety amongst patients undergoing cataract surgery. An alternative, simplified, and more intuitive naming system should be adopted, which accurately portrays the level of experience of ophthalmologists in training in the UK.