Assessment of Informed Consent and the Impact of Simulation on Anesthesia Trainees

Abstract

Introduction Over the years, the process of obtaining informed consent has evolved and now places an emphasis on the concept that patients should play a major role in medical decision making. Failure to adequately involve patients in making decisions regarding their health can lead to medicolegal consequences. Therefore, taking informed consent is a fundamental component of anaesthesia training. Simulation, for training, is an excellent tool that is being utilised widely in the training of medical professionals. The use of simulated training for teaching the process of informed consent is an innovative initiative that can provide improved results. Material and methods After approval from the institutional review board, a prospective clinical study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from August 2019 to September 2020. Sixteen anaesthesia trainees were randomly selected for the study. The study was divided into pre-interventional, interventional and post interventional phases. For data collection, a predesigned checklist was used. Data collected was analysed using SPSS version 23 (IBM Inc., Armonk, New York). The McNemar test was deployed to assess the difference between the baseline assessment and post-simulated training assessment; p-value < 0.05 was taken to be significant. Results Of the 16 participants, the majority were males (n= 13). A positive impact was observed in terms of improvement of the outcome of the following study components i.e., description of benefits of the procedure (p=0.01), disclosure of associated minor risks (p=0.005), disclosure of major risks (p=0.01), discussion of alternatives (p=0.001), teach back (p=0.001), documentation of patients’ verbal agreement (p=0.01), and communication skills involving utilising the process of connecting, introduction, communication, permission, response, and exit (p = 0.01). Conclusion Simulated training had a positive impact in improving outcomes in the following study components: description of benefits of the procedure, disclosure of associated risks, discussion of alternatives, teach back, documentation of patients’ verbal agreement, and utilisation of the process of connecting, introduction, communication, permission, responding, and exiting.

Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education

“…The study demonstrated that residents who received any type of training whether in the form of a video curriculum or through journal articles performed better on the postintervention objective structured clinical examination (OSCE) [16 & ]. In another study, anesthesiology trainees demonstrated an improvement in obtaining informed consent after simulation-based training [22]. Improvement in post intervention performance was observed in description of the procedure, discussion of alternatives, disclosure of associated procedure risks, teach back, and documentation of patient's verbal consent [22].…”

“…In another study, anesthesiology trainees demonstrated an improvement in obtaining informed consent after simulation-based training [22]. Improvement in post intervention performance was observed in description of the procedure, discussion of alternatives, disclosure of associated procedure risks, teach back, and documentation of patient's verbal consent [22]. These findings underscore the importance of formal training in advance care planning for anesthesiology trainees.…”

Community-engaged training in informed consent

“…Training that incorporates simulated or standardized patients (SPs) is an effective way to provide continuing education training to professionals in a variety of clinical contexts [16][17][18]. Specifically, the use of role-plays with SPs in training can increase clinicians' confidence [19] and performance [20,21] in conducting informed consent discussions for clinical procedures. More recently, researchers have begun to employ role-plays in training programs for staff conducting informed consent for research [22][23][24].…”