Do Interns Learn On-The-Job How to Obtain Proper Informed Consent for Surgical Procedures?
Original Reports
Michael Lamb, John M. Woodward, Brian Quaranto, Bobbie Ann Adair White, Linda M. Harris, James K. Lukan, Jeffrey Brewer, Steven D. Schwaitzberg, Clairice A. Cooper
Journal of Surgical Education, 17 July 2024
Abstract
Objective
Obtaining surgical informed consent (SIC) is a critical skill most residents are expected to learn “on-the-job.” This study sought to quantify the effect of 1 year of clinical experience on performance obtaining SIC in the absence of formal informed consent education.
Design
In this case-control cohort study, PGY1 and PGY2 surgical residents in an academic program were surveyed regarding their experiences and confidence in obtaining SIC; then assessed obtaining informed consent for a right hemicolectomy from a standardized patient.
Setting
Single academic general surgery residency program in Buffalo, NY.
Participants
Ten PGY1 and eight PGY2 general surgery residents were included in the study, after excluding residents with additional years of training.
Results
PGY2 residents had significantly more experience obtaining SIC compared to PGY1 residents (median response: “>50” vs “between 6 and 15,” p = 0.001), however there was no difference in self-reported confidence in ability obtaining SIC (mean 3.2/5 in PGY1 vs 3.4/5 in PGY2, p = 0.61), self-reported knowledge of SIC (mean 3.1/5 in PGY1 vs 3.6/5 in PGY2, p = 0.15), performance on a test regarding SIC (mean score 9.0/20, SD 3.9 for PGY1 vs mean score 9.6/20, SD 3.5, t = 0.387, p = 0.739) or performance during a standardized patient interview (mean 11.2/20, SD 2.78 for PGY1 vs mean 11.4/20, SD 1.51 for PGY2, p = 0.87). In the interviews all residents addressed general risks (bleeding/infection), however both groups performed worse in addressing procedure-specific risks including anastomotic leak as risk for hemicolectomy.
Conclusions
A year of clinical training between PGY1 to PGY2 did not improve performance in obtaining surgical informed consent when lacking formal education, despite self-confidence in their ability. A curriculum covering the content, delivery and assessment of informed consent should be initiated for residents upon arrival to surgical training.

Improving Clinical Communication: a qualitative study on the Informed Consent
Isabel García-Izquierdo, Begoña Bellés-Fortuño
Revista De Lingüística Y Lenguas Aplicadas, 8 July 2024
Abstract
In the context of the Patient-Centred Care paradigm (Epstein et al., 2005; Suojanen et al., 2012) and the shift toward the psychobiological model (Dean & Street, 2015; Muñoz & García-Izquierdo, 2020), there is a growing demand for the patient to be an active agent in the management of their health. Clinical communication should be conveyed accurately and empathetically (Bellés Fortuño & García-Izquierdo, forthcoming), especially in complex legal genres such as the Informed Consent (IC). The research carried out by the Gentt research group up-to-date has revealed that there is no specific monitoring with the use of IC protocols in clinical practice. In this paper, we present the results of a qualitative pilot study with a group of practitioners from the Valencian Community (Spain). A focus group was conducted where the articulation of communication with patients was analyzed. The study tries to define the practical insights of using the IC to draw conclusions that can improve clinical communication. Results show that MPs generally consider that the IC process needs improvement, especially when considering closeness with patients to enhance communication.

Reviewing past and present consent practices in unplanned obstetric interventions: an eye towards the future
Original Research
Morganne Wilbourne, Hand, Sophie McAllister, Louise Print-Lyons, Meena Bhatia
Journal of Medical Ethics, 26 June 2024
Abstract
Many first-time mothers (primiparous) within UK National Health Service (NHS) settings require an obstetric intervention to deliver their babies safely. While the antepartum period allows time for conversations about consent for planned interventions, such as elective caesarean section, current practice is that, in emergencies, consent is addressed in the moments before the intervention takes place. This paper explores whether there are limitations on the validity of consent offered in time-pressured and emotionally charged circumstances, specifically concerning emergency obstetric interventions. Using the legal framework of the Mental Capacity Act, Montgomery v. Lanarkshire Health Board (2015) and McCulloch v Forth Valley Health Board (2023), we argue that while women have the capacity to consent during labour, their autonomy is best supported by providing more information about instrumental delivery (ID) during the antepartum period. This conclusion is supported by some national guidelines, including those developed by the Royal College of Obstetricians and Gynaecologists, but not all. Further, we examine the extent to which these principles are upheld in modern-day practice. Data suggest there is relatively little antepartum information provision regarding ID within NHS settings, and that primiparous women do not report a thorough understanding of ID before labour. Based on these results, and bearing in mind the pressures under which NHS obstetric services currently operate, we recommend further research into patient and clinician perceptions of the consent process for ID. Pending these results, we discuss possible modes of information delivery in future practice.

Antenatal reproductive screening for pregnant people including preconception: Provides the best reproductive opportunity for informed consent, quality, and safety
Douglas Wilson
Best Practice & Research Clinical Obstetrics & Gynaecology, 25 June 2024
Abstract
Introduction
This antenatal screening review will include reproductive screening evidence and approaches for pre-conception and post-conception, using first to third trimester screening opportunities.
Methods
Focused antenatal screening peer-reviewed publications were evaluated and summarized.
Results
Evidenced-based reproductive antenatal screening elements should be offered and discussed, with the pregnancy planning or pregnant person, during Preconception (genetic carrier screening for reproductive partners, personal and family (including reproductive partner) history review for increased genetic and pregnancy morbidity risks); First Trimester (fetal dating with ultrasound; fetal aneuploidy screening plus consideration for expanded fetal morbidity criteria, if appropriate; pregnant person preeclampsia screening; early fetal anatomy screening; early fetal cardiac screening); Second Trimester for standard fetal anatomy screening (18–22 weeks) including cardiac; pregnant person placental and cord pathology screening; pregnant person preterm birth screening with cervical length measurement); Third Trimester (fetal growth surveillance; continued preterm birth risk surveillance).
Conclusion
Antenatal reproductive screening has multiple elements, is complex, is time-consuming, and requires the use of pre- and post-testing counselling for most screening elements. The use of preconception and trimesters ‘one to three’ requires clear patient understanding and buy-in. Informed consent and knowledge transfer is a main goal for antenatal reproductive screening approaches.