Compassionate and Clinical Behavior of Residents in a Simulated Informed Consent Encounter

Compassionate and Clinical Behavior of Residents in a Simulated Informed Consent Encounter
Waisel DB, Ruben MA, Blanch-Hartigan D, Hall JA, Meyer EC, Blum RH
Anesthesiology, 20 November 2019
Abstract 
What We Know About This Topic
Compassionate behavior in clinicians includes understanding patients’ psychosocial, physical, and medical needs; promptly attending to needs; and engaging patients to the extent they wish.
What This Article Will Tell Us That Is New
The investigators evaluated compassionate behavior of anesthesia residents in a simulated preoperative encounter with a patient in pain before urgent surgery. Anesthesia residents had variable and, at times, flawed recognition of patient cues, responsiveness to patient cues, pain management, and patient interactions.
Background
Compassionate behavior in clinicians is described as seeking to understand patients’ psychosocial, physical and medical needs, timely attending to these needs, and involving patients as they desire. The goal of our study was to evaluate compassionate behavior in patient interactions, pain management, and the informed consent process of anesthesia residents in a simulated preoperative evaluation of a patient in pain scheduled for urgent surgery.
Methods
Forty-nine Clinical Anesthesia residents in year 1 and 16 Clinical Anesthesia residents in year 3 from three residency programs individually obtained informed consent for anesthesia for an urgent laparotomy from a standardized patient complaining of pain. Encounters were assessed for ordering pain medication, for patient-resident interactions by using the Empathic Communication Coding System to code responses to pain and nausea cues, and for the content of the informed consent discussion.
Results
Of the 65 residents, 56 (86%) ordered pain medication, at an average of 4.2 min (95% CI, 3.2 to 5.1) into the encounter; 9 (14%) did not order pain medication. Resident responses to the cues averaged between perfunctory recognition and implicit recognition (mean, 1.7 [95% CI, 1.6 to 1.9]) in the 0 (less empathic) to 6 (more empathic) system. Responses were lower for residents who did not order pain medication (mean, 1.2 [95% CI, 0.8 to 1.6]) and similar for those who ordered medication before informed consent signing (mean, 1.9 [95% CI, 1.6 to 2.1]) and after signing (mean, 1.9 [95% CI, 1.6 to 2.0]; F (2, 62) = 4.21; P = 0.019; partial η = 0.120). There were significant differences between residents who ordered pain medication before informed consent and those who did not order pain medication and between residents who ordered pain medication after informed consent signing and those who did not.
Conclusion
In a simulated preoperative evaluation, anesthesia residents have variable and, at times, flawed recognition of patient cues, responsiveness to patient cues, pain management, and patient interactions.

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