[Teaching medical students informed consent]

Psychotropic Medication Informed Consent: A Cross-Specialty Role-Playing Skill Builder

INTRODUCTION

Obtaining informed consent (IC) is an essential medical practice. Utilization of IC role-playing training with medication study cards and self-peer-supervisor review should improve student fund of knowledge and strengthen IC skills for clerkship-level medical students.

METHODS

Between 2017 and 2020, approximately 555 clerkship medical students used our formative role-playing exercise tools. Students independently prepared psychotropic medication study cards and role-played IC during group didactics. Peer and supervisor reviews were not recorded but were discussed as a group. Students completed routine anonymous postclerkship surveys regarding the IC exercise. An enhanced IC curriculum was deployed in 2020, adding a training video and peer/supervisor feedback form. Student feedback and specialty shelf exam scores were reviewed to assess the exercise's effectiveness.

RESULTS

Surveys indicated satisfaction with the exercise and increased confidence in obtaining IC. Interestingly, the student group that received enhanced IC training had fewer shelf exam failures than those without, perhaps indicating improved fund of psychotropic medication knowledge.

DISCUSSION

Peer role-playing IC training is well accepted by students, allows practice of essential elements of IC and shared decision-making, and provides an engaging way to improve medication fund of knowledge. Our clerkship has initiated development of an IC objective structured clinical examination station and is adapting the exercise across specialties for longitudinal learning in response to the positive feedback and ease of use. Structured review of psychotropics and peer IC role-playing can be tailored for other specialties, medications, and procedures and further developed for use in pre- and postclerkship education.

[Informed consent for surgery: clearly regulated by the patient rights law-significant uncertainty among medical students : Legal analysis and inventory of over 2500 medical students in Berlin as part of the Progress Test Medicine]

Hintergrund

Das chirurgische Aufklärungsgespräch stellt eine komplexe Herausforderung dar und ist als Lernziel im Nationalen Kompetenzbasierter Lernzielkatalog Medizin verankert. Die wenigen bestehenden Lehrformate sind uneinheitlich und aufwändig; insbesondere juristische Implikationen nehmen im Studium wenig Raum ein, obwohl sie mit Inkrafttreten des Patientenrechtegesetzes vermehrt in den Fokus gerückt sind und u. a. bei Regressverfahren eine wichtige Rolle spielen.

Ziel der Arbeit

Ziel war eine Ermittlung des Wissensstandes von Medizinstudierenden zu den rechtlichen Aspekten des chirurgischen Aufklärungsgespräches auf Basis einer juristischen Analyse des Patientenrechtegesetzes. Dieses wurde auf Implikationen für die Lehre im Medizinstudium überprüft.

Material und Methoden

Nach Analyse von Gesetz und Rechtsprechung wurden Multiple-Choice-Fragen zu den rechtlichen Aspekten des chirurgischen Aufklärungsgespräches erstellt und im Sinne einer Querschnittsanalyse im Progress Test Medizin platziert. Es erfolgte die deskriptive statistische Auswertung der Ergebnisse bei Berliner Medizinstudierenden.

Ergebnisse

Es wurden die Antworten von 2625 (Wintersemester 2018/19) und 2409 (Sommersemester 2019) Berliner Studierenden ausgewertet. Bei den Fragen zur Art aufzuklärender Prozeduren sowie der Bedenkzeit nahm die Anzahl Studierender, die die Frage korrekt beantwortete, über die Zeit zu, erreichte jedoch nicht den Vergleichswert aller Fragen des Progress Test Medizin. Bei den Fragen zu den notwendigen Inhalten wählten, unabhängig vom Ausbildungsstand, zwischen 30 und 60 % die korrekte Antwort, eine Zunahme korrekter Antworten über die Zeit war nicht zu sehen.

Diskussion

In der vorliegenden Arbeit konnte gezeigt werden, dass bei Medizinstudierenden über alle Semester hinweg Unsicherheiten bezüglich der juristischen Aspekte des Aufklärungsgespräches bestehen. Der gesetzliche Rahmen lässt allerdings Raum für neue Lehrformate wie der hier erstmals vorgestellten „Co-Aktion“: der Studierende führt die Aufklärung eines Patienten selbstständig, unter Aufsicht und Verantwortung des behandelnden Arztes, durch.

Promoting informed consent in a children's hospital in Tabriz, Iran: a best practice implementation project

INTRODUCTION

Informed consent is a continuous and dynamic process. It is a crucial part of healthcare procedures that becomes more complex in a pediatric clinical practice, where parents must make decisions for their children.

OBJECTIVES

The aim of this implementation project was to evaluate the current practice and implement the best practice related to obtaining informed consent in a children's hospital in Tabriz, Iran.

METHODS

A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool. Five audit criteria representing the best-practice recommendations for informed consent were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to determine change in practice.

RESULTS

The compliance rate of all criteria improved from baseline to follow-up audit. Criteria 1 (obtaining informed consent prior to all nursing procedures) and 5 (provision of information related to the necessity of the treatment) reached 97% compliance in the follow-up cycle. Criterion 4 (provision of information related to the nature and effect of the treatment) achieved 74% compliance. Both criteria 2 and 3 (provision of information related to alternative treatments and consequences of refusing treatment) reached 57% in the follow-up cycle. To improve compliance, meetings were organized with the heads of departments, nurses and residents regarding informed consent. Also, staff were encouraged to report cases where informed consent was not obtained.

CONCLUSION

The audit results indicated an improvement in obtaining informed consent in the included departments. The interventions that were employed can facilitate the implementation of evidence into clinical practice.