K. C. Cates1, T. Miner1 1Brown University School Of Medicine,General Surgery,Providence, RI, USA
Introduction: The conversation held between a physician and patient when obtaining informed consent is both complex and important. In the inpatient setting, consent often obtained by a junior resident. The purpose of this study was to prepare interns to obtain informed consent. We hypothesized that an educational session outlining elements of consent would augment an intern’s ability to consent his/her patients.
Methods: Surgery interns were given a pre-test in which their ability to give informed consent was assessed. They were graded based off a rubric earning one point was given for addressing each of the following: identification of self, explanation of the situation and indication for the procedure, nature of the procedure, description of the steps involved, providing expectations, explanation of risks, benefits or alternatives, asking for questions and asking for consent. A didactic session was then held reviewing the grading rubric. Thereafter, a post-test was taken. The interns were retested for retention at 3 and 6 month intervals. Those who were not present for the initial information session were also tested throughout the year, serving a control group.
Results: Thirteen interns participated in the study; 9 were involved in the study group and 4 were controls. Statistical significance was calculated using student’s paired t test to compare pre and post-test results and unpaired t tests to compare the intervention and control groups at 3 and 6 month intervals. In the study group, post-test average score increased as compared to pre-test but not to a degree that was statistically significant (pre-test avg 6.6/7, post 6.9/7 p= 0.39). The study group's performed was higher than the control group, but these findings were not statistically significant (study group 3 month avg 6.1/7 vs. control 5.5/7, p= 0.51; study group 6 month avg 6.0/7 vs. control 5.0/7 p=0.21). The most frequent omission was discussion of risks, benefits and alternatives, addressed in 70% of test.
Discussion: An educational session providing guidelines for obtaining informed consent yielded a trend of improved performance; these findings were not statistically significant. We hypothesize that if this experiment were to be repeated with a larger group results might reach a level of statistical significance. This suggests a benefit in providing informed consent educational sessions at the onset of training. Overall, all groups showed regression over time. This may be reflect a sense of confidence that is built by repeated iterations of task and concomitant reflexive approach rather that active thinking about the task at hand. The most frequently omitted element of consent was a core topic in informed consent; discussion of risks, benefits or alternatives. Knowledge of this trend will ideally provide motivation to maintain attention to detail throughout the course of one’s practice in obtaining consent.
