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.
Month: January 2020
Informed about Informed Consent: A Qualitative Study of Ethics Education
Informed about Informed Consent: A Qualitative Study of Ethics Education
Rocksheng Zhong, John K. Northrop, Puneet K.C. Sahota, Anthony L. Rostain
Online Journal of Health Ethics, January 2019 ;15(2)
Open Access
Abstract
Iformed consent is a foundational concept in modern medicine. Despite physicians’ ethical and legal obligations to obtain informed consent, no standard curriculum exists to teach residents relevant knowledge and skills. This paper presents a qualitative study of residents at one academic medical center. The authors conducted focus groups with trainees in the Departments of Internal Medicine, Emergency Medicine, and Ob/Gyn and analyzed their responses using rigorous qualitative methods. Four themes emerged: First, participants agreed that informed consent and decision-making capacity were relevant in many clinical situations. Second, participants varied widely in their understandings of consent. Third, current resident training was insufficient. Fourth, more training was needed. These results add to the growing literature that ethics education in residency is desired and useful. The findings will help educators craft instruments assessing the prevalence and degree of deficiencies related to informed consent competencies and aid in the development of a model curriculum.
Informed consent within a learning health system: A scoping review
Informed consent within a learning health system: A scoping review
Research Report
Annabelle Cumyn, Adrien Barton, Roxanne Dault, Anne‐Marie Cloutier, Rosalie Jalbert, Jean‐François Ethier
Learning Health Systems, 4 December 2019
Open Access
Abstract
Introduction
A major consideration for the implementation of a learning health system (LHS) is consent from participants to the use of their data for research purposes. The main objective of this paper was to identify in the literature which types of consent have been proposed for participation in research observational activities in a LHS. We were particularly interested in understanding which approaches were seen as most feasible and acceptable and in which context, in order to inform the development of a Quebec‐based LHS.
Methods
Using a scoping review methodology, we searched scientific and legal databases as well as the gray literature using specific terms. Full‐text articles were reviewed independently by two authors on the basis of the following concepts: (a) LHS and (b) approach to consent. The selected papers were imported in NVivo software for analysis in the light of a conceptual framework that distinguishes various, largely independent dimensions of consent.
Results
A total of 93 publications were analysed for this review. Several studies reach opposing conclusions concerning the best approach to consent within a LHS. However, in the light of the conceptual framework we developed, we found that many of these results are distorted by the conflation between various characteristics of consent. Thus, when these characteristics are distinguished, the results mainly suggest the prime importance of the communication process, by contrast to the scope of consent or the kind of action required by participants (opt‐in/opt‐out). We identified two models of consent that were especially relevant for our purpose: metaconsent and dynamic consent.
Conclusions
Our review shows the importance of distinguishing carefully the various features of the consent process. It also suggests that the metaconsent model is a valuable model within a LHS, as it addresses many of the issues raised with regards to feasibility and acceptability. We propose to complement this model by adding the modalities of the information process to the dimensions relevant in the metaconsent process.
Center for Informed Consent Integrity 