1
|
Riad AM, Cambridge WA, Henshall D, McAdam H, Drake TM, Fairfield CJ, Knight SR, Sgrò A, Shaw C, Glasbey JC, Potter MA, Harrison EM, McLean KA. Educational impact and recommendations from implementation of student-led clinical trial recruitment: a mixed-methods study. Postgrad Med J 2023; 99:484-491. [PMID: 37294723 DOI: 10.1136/pmj-2022-142122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/25/2022] [Indexed: 12/15/2022]
Abstract
Medical students have an essential role in medical research, yet often lack opportunities for involvement within randomised trials. This study aimed to understand the educational impact of clinical trial recruitment for medical students. Tracking wound infection with smartphone technology (TWIST) was a randomised controlled trial that included adult patients undergoing emergency abdominal surgery across two university teaching hospitals. All recruiters underwent prerecruitment training based on 'Generating Student Recruiters for Randomised Trials' principles, and completed prerecruitment and postrecruitment surveys. Respondent agreement with statements were assessed using 5-point Likert scales (from 1 ('strongly disagree') to 5 ('strongly agree')). Quantitative data were analysed using paired t-tests to compare differences pre-involvement and post-involvement. Thematic content analysis was performed on free-text data to generate recommendations for future student research involvement. Of 492 patients recruited to TWIST between 26 July 2016 and 4 March 2020, 86.0% (n=423) were recruited by medical students. Following introduction of student co-investigators (n=31), the overall monthly recruitment rate tripled (4.8-15.7 patients). 96.8% of recruiters (n=30/31) completed both surveys, and all respondents reported significant improvement in clinical and academic competencies. Three higher-level thematic domains emerged from the qualitative analysis: (1) engagement, (2) preparation and (3) ongoing support. Student recruitment in clinical trials is feasible and accelerates recruitment to clinical trials. Students demonstrated novel clinical research competencies and increased their likelihood of future involvement. Adequate training, support and selection of suitable trials are essential for future student involvement in randomised trials.
Collapse
Affiliation(s)
- Aya M Riad
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | | | - David Henshall
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Heather McAdam
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Cameron J Fairfield
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
- Center for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Stephen R Knight
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
- Center for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Alessandro Sgrò
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Catherine Shaw
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
- Center for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - James C Glasbey
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham Institute of Translational Medicine, Birmingham, UK
| | - Mark A Potter
- Colorectal Unit, University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Ewen M Harrison
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
- Center for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Kenneth A McLean
- Department of Clinical Surgery, The University of Edinburgh, Edinburgh, UK
- Center for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| |
Collapse
|
2
|
[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]. DER ORTHOPADE 2021; 50:937-945. [PMID: 33666674 PMCID: PMC8571141 DOI: 10.1007/s00132-021-04080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
Abstract
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.
Collapse
|
3
|
Schleicher I, van der Mei SH, Mika J, Kreuder JG. [Teaching medical students informed consent]. Unfallchirurg 2019; 121:216-222. [PMID: 28083630 DOI: 10.1007/s00113-016-0298-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Teaching competencies in communication are important for medical education, but implementation in the surgical curriculum is still deficient. Communication during informed consent is one main issue. The aim of the study was to implement a reproducible teaching module for informed consent, which closely represents reality. MATERIAL AND METHODS In the existing practical surgical course we implemented a module for practising communication during surgical informed consent with the help of standardized patients and feedback rounds. The outcome was assessed during a clinical examination and the students evaluated the module. RESULTS The module was evaluated by the students positively and deemed helpful for their later work as a doctor. The outcome at clinical examination was 63% (mean) for content and structure of the informed consent and 92% for competency in communication. CONCLUSION For improving the quality of informed consent, teaching competencies in communication during informed consent should be implemented in the curriculum of medical studies, but legal and content-based aspects should not be ignored.
Collapse
Affiliation(s)
- I Schleicher
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Agaplesion Evangelisches Krankenhaus Mittelhessen in Gießen, Gießen, Deutschland.
| | - S H van der Mei
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland
| | - J Mika
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, operative Notaufnahme, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen, Gießen, Deutschland
| | - J G Kreuder
- Studiendekanat des Fachbereichs Humanmedizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| |
Collapse
|
4
|
AlMahmoud T, Hashim MJ, Almahmoud R, Branicki F, Elzubeir M. Informed consent learning: Needs and preferences in medical clerkship environments. PLoS One 2018; 13:e0202466. [PMID: 30281603 PMCID: PMC6169846 DOI: 10.1371/journal.pone.0202466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/03/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Limited information exists regarding students’ routine educational needs in support of ethics and professionalism practices faced in real clinical practice. As such the authors aimed to explore medical students learning needs and preferences for informed consent and relevant ethical issues in the clerkship environments. Materials and methods A cross-sectional study using a self-administered, printed survey distributed to final year clinical clerks. Results 84% completed the survey. Students indicated the need for more attention to all topics related to informed consent (mean = 7.1 on a scale of 0 to 9; ±1.2). Most additional instructional attention was requested for topics raised in discussions with patients concerning the risks, benefits and alternatives to recommended treatments (7.3 ±1.4). The cohort expressed the need for education in the care of vulnerable patients (7.2 ±1.2) with a maximum score for the care of abused children. Women perceived greater need for education concerning informed consent than male respondents (p>0.05). There were significant differences between students who scored high or low on the item “being treated in professional manner” and “endorsement of educational needs for care of adolescents” (p = 0.05). Conclusion There was heightened perception among final year medical students of the need for greater attention to be paid to informed consent education.
Collapse
Affiliation(s)
- Tahra AlMahmoud
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
- * E-mail:
| | - M. Jawad Hashim
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Rabah Almahmoud
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Frank Branicki
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Margaret Elzubeir
- Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| |
Collapse
|
5
|
Heaney RM, Murray M, Heaney AM, Doherty EM. ‘All by myself’: interns’ reports of their experiences taking consent in Irish hospitals. Ir J Med Sci 2018. [DOI: 10.1007/s11845-018-1782-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
6
|
Ashraf B, Tasnim N, Saaiq M, Zaman KU. An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC). Int J Health Policy Manag 2014; 3:315-21. [PMID: 25396207 DOI: 10.15171/ijhpm.2014.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/26/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The Surgical Informed Consent (SIC) is a comprehensive process that establishes an information-based agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. METHODS This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. RESULTS Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. CONCLUSION The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.
Collapse
Affiliation(s)
- Bushra Ashraf
- Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Nasira Tasnim
- Department of Obstetrics and Gynecology, Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Muhammad Saaiq
- Department of Plastic Surgery and Burns, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Khaleeq-Uz- Zaman
- Departments of Neurosurgery and Medical Education, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| |
Collapse
|
7
|
Leclercq WK, Keulers BJ, Houterman S, Veerman M, Legemaate J, Scheltinga MR. A survey of the current practice of the informed consent process in general surgery in the Netherlands. Patient Saf Surg 2013; 7:4. [PMID: 23336609 PMCID: PMC3804026 DOI: 10.1186/1754-9493-7-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/15/2013] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Additional non-English language abstract (in Dutch) BACKGROUND A properly conducted surgical informed consent process (SIC) allows patients to authorize an invasive procedure with full comprehension of relevant information including involved risks. Current practice of SIC may differ from the ideal situation. The aim of this study is to evaluate whether SIC practiced by Dutch general surgeons and residents is adequate with involvement of all required elements. METHODS All members of the Dutch Society of Surgery received an online multiple choice questionnaire evaluating various aspects of SIC. RESULTS A total of 453 questionnaires obtained from surgeons and residents representing >95% of all Dutch hospitals were eligible for analysis (response rate 30%). Knowledge on SIC was limited as only 55% was familiar with all three basic elements ('assessment of preconditions', 'provision of information' and 'stage of consent'). Residents performance was inferior compared to surgeons regarding most aspects of daily practice of SIC. One in 6 surgeons (17%) had faced a SIC-related complaint in the previous five years possibly illustrating suboptimal SIC implementation in daily surgical practice. CONCLUSIONS The quality of the current SIC process is far from optimal in the Netherlands. Surgical residents require training aimed at improving awareness and skills. The SIC process is ideally supported using modern tools including web-based interactive programs. Improvement of the SIC process may enhance patient satisfaction and may possibly reduce the number of complaints. ACHTERGROND Het doel van het preoperatieve informed consent proces (surgical informed consent, SIC) is om patiënten een weloverwogen en welgeïnformeerde keuze te laten maken over hun operatieve ingreep. De hedendaagse praktijk betreffende SIC staat mogelijk ver van de ideale situatie af. Doel van deze studie is om de dagelijkse praktijk van chirurgen en chirurgen in opleiding betreffende SIC te evalueren en te zien of deze voldoet aan de daarvoor gestelde eisen. METHODE: Alle chirurgen en andere leden van de Nederlandse Vereniging voor Heelkunde ontvingen een online multiple-choice vragenlijst betreffende de belangrijkste aspecten van SIC. RESULTATEN: In totaal waren er 453 bruikbare reacties uit meer dan 95% van alle Nederlandse ziekenhuizen (respons 30%). De kennis over SIC blijkt zeer beperkt. Slechts 55% van de chirurgen bleek bekend met de drie basiselementen van SIC ('beoordelen van de competentie van een patiënt', 'verstrekken van informatie' and 'adequaat vastleggen van de toestemming van de patiënt'). De dagelijkse praktijk liet behoorlijke verschillen tussen alle respondenten zien, maar chirurgen in opleiding scoorden significant slechter vergeleken met chirurgen. 17% van alle chirurgen kreeg de afgelopen vijf jaar te maken met een klacht betreffende SIC, wat zou kunnen wijzen op een suboptimale implementatie van SIC in de dagelijkse praktijk. CONCLUSIE De kwaliteit van het preoperatieve informed consent proces is in Nederland verre van goed. Chirurgen in opleiding scoorden minder goed dan chirurgen en dienen beter geschoold te worden. Het hele SIC proces zou geformaliseerd moeten worden in protocollen. Moderne hulpmiddelen zoals interactieve softwareprogramma's kunnen hierbij mogelijk helpen. Door het verbeteren van het SIC proces kan de patiëntentevredenheid verhoogd worden terwijl het aantal klachten mogelijk wordt verminderd.
Collapse
Affiliation(s)
- Wouter Kg Leclercq
- Department of Surgery, Máxima Medical Centre, de run 4600, Veldhoven, 5504 DB, the Netherlands.
| | | | | | | | | | | |
Collapse
|
8
|
Humayun A, Fatima N, Naqqash S, Hussain S, Rasheed A, Imtiaz H, Imam SZ. Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore. BMC Med Ethics 2008; 9:14. [PMID: 18816413 PMCID: PMC2564960 DOI: 10.1186/1472-6939-9-14] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 09/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The principles of informed consent, confidentiality and privacy are often neglected during patient care in developing countries. We assessed the degree to which doctors in Lahore adhere to these principles during outpatient consultations. MATERIAL & METHOD The study was conducted at medical out-patient departments (OPDs) of two tertiary care hospitals (one public and one private hospital) of Lahore, selected using multi-stage sampling. 93 patients were selected from each hospital. Doctors' adherence to the principles of informed consent, privacy and confidentiality was observed through client flow analysis performed by trained personnel. Overall patient perception was also assessed regarding these practices and was compared with the assessment made by our data collectors. RESULTS Some degree of informed consent was obtained from only 9.7% patients in the public hospital and 47.8% in the private hospital. 81.4% of patients in the public hospital and 88.4% in the private hospital were accorded at least some degree of privacy. Complete informational confidentiality was maintained only in 10.8% and 35.5% of cases in public & private hospitals respectively. Informed consent and confidentiality were better practiced in the private compared to the public hospital (two-sample t-test > 2, p value < 0.05). There was marked disparity between the patients' perspective of these ethical practices and the assessment of our trained data collectors. CONCLUSION Observance of medical ethics is inadequate in hospitals of Lahore. Doctors should be imparted formal training in medical ethics and national legislation on medical ethics is needed. Patients should be made aware of their rights to medical ethics.
Collapse
Affiliation(s)
- Ayesha Humayun
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Noor Fatima
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Shahid Naqqash
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Salwa Hussain
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Almas Rasheed
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Huma Imtiaz
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Sardar Zakariya Imam
- Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan
| |
Collapse
|
9
|
Abstract
This article briefly describes the background and status of medical education in the areas of ethics and professionalism. Methods of teaching and assessment are described for medical students, residents, and practitioners within the core competency framework of medical education. Key areas of content for child and adolescent psychiatrists are described.
Collapse
Affiliation(s)
- Arden D Dingle
- Child and Adolescent Psychiatry, Emory University School of Medicine, 1256 Briarcliff Road #317 South, Atlanta, GA 30306, USA.
| | | |
Collapse
|