BackgroundVirtual reality technology is an exciting and emerging field with vast applications. Our study sets out the viewpoint that virtual reality software could be a new focus of direction in the development of training tools in medical education. We carried out a panel discussion at the Center for Behavior Change 3rd Annual Conference, prompted by the study, “The Responses of Medical General Practitioners to Unreasonable Patient Demand for Antibiotics––A Study of Medical Ethics Using Immersive Virtual Reality” (1).MethodsIn Pan et al.’s study, 21 general practitioners (GPs) and GP trainees took part in a videoed, 15-min virtual reality scenario involving unnecessary patient demands for antibiotics. This paper was discussed in-depth at the Center for Behavior Change 3rd Annual Conference; the content of this paper is a culmination of findings and feedback from the panel discussion. The experts involved have backgrounds in virtual reality, general practice, medicines management, medical education and training, ethics, and philosophy.ViewpointVirtual reality is an unexplored methodology to instigate positive behavioral change among clinicians where other methods have been unsuccessful, such as antimicrobial stewardship. There are several arguments in favor of use of virtual reality in medical education: it can be used for “difficult to simulate” scenarios and to standardize a scenario, for example, for use in exams. However, there are limitations to its usefulness because of the cost implications and the lack of evidence that it results in demonstrable behavior change.
Despite its invasive nature, specific consent for general anaesthesia is rarely sought—rather consent processes for associated procedures include explanation of risk/benefits. In adult intensive care, because no one can consent to treatments provided to incapacitated adults, standardised consent processes have not developed. In paediatric intensive care, despite the ready availability of those who can provide consent, no tradition of seeking it exists, arguably due to the specialty’s evolution from anaesthesia and adult intensive care. With the current Montgomery-related focus on consent, this seems untenable. We undertook a qualitative study in a specialist children’s hospital colocated paediatric/neonatal intensive care (same medical team) in which parental acceptance of admission and entailed procedures is considered implied by virtue of that admission. Semistructured interviews were carried out with both staff and parents to investigate their views about consent, the current system and a proposed blanket consent system, in which parents actively consent at admission to routine procedures. Divergent views emerged: staff were worried that requiring consent at admission might prove a further emotional burden, whereas parents found providing consent a way of coping, feeling empowered and maintaining control. Inconsistencies were found in the way consent is obtained for your routine procedures. Practice does seem inconsistent with contemporary consent standards for medical intervention. Our findings support the introduction of a blanket consent system at admission together with ongoing bedside dialogue to ensure continuing consent. Both parents and staff expressed concern about avoiding possible harmful delays to children due to parental emotional overload and language difficulties.
BackgroundThere is no established tradition of seeking consent in intensive care units (ICU), probably reflecting the specialist life-saving therapies involved and the usual incapacity of the ICU-patient. With critically ill children, someone with capacity to consent is usually present, but rarely does so. The study aimed to investigate staff and parents’ views about consent to assess whether there was a need for a more formal consent system and to identify local good practice to share with other units.MethodsThis qualitative project was based at Great Ormond Street Hospital. Semi-structured interviews were completed with nine members of ICU staff and fifteen parents of children recently admitted to ICU. A phenomenological approach was used during analysis with themes emerging until saturation.ResultsThemes from staff included inconsistency and protecting parents from the burden of consent. Themes from ICU-parents included maintaining control and feeling empowered. Overall, mutual trust between families and ICU teams underpins satisfaction with the current system and neither group expressed a strong desire to introduce written consent for ICU-care. However, some conflicting views emerged between staff and parents: whilst staff judged consent to be an emotional burden for families, parents found decision-making processes a means of coping, empowerment and maintaining control. Staff were divided about which ICU-interventions it was deemed necessary to obtain written consent for, and for which ideally this should be the case.ConclusionsParents want to be updated regularly on ICU and share decision-making but do not want to explicitly consent.
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