Council on Medical Student Education in Pediatrics

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COMSEP Meeting in Ottawa, ON

Poster Presentation:


Are incoming pediatric interns ready to provide informed consent?

Authors:
Emma A. Omoruyi,University of Texas Health Science Center at Houston,Houston,TX,Amalia Guardiola,University of Texas Health Science Center at Houston,Houston,TX,Michelle S. Barratt,University of Texas Health Science Center at Houston,Houston,TX

Background: Lumbar Puncture is one of the most common procedures consented for in general pediatrics. In 2013, the Association of American Medical Colleges created the “Core Entrustable Professional Activities (EPAs) for Entering Residency” as a way to more clearly define the set of activities that entering residents should be expected to perform when starting residency, without direct supervision. One of the EPAs is obtaining informed consent for tests and/or procedures.  This EPAs acknowledges that an entrustable learner should be able to complete a “comprehensive” and accurate informed consent.

Objective: To explore if incoming pediatric interns demonstrate the behaviors of an “entrustable learner” as defined by the AAMC in the domain of obtaining informed consent for a common pediatric procedure.  

Methods: All incoming interns completed an observed clinical encounter during orientation. The scenario involved obtaining parental consent for an infant lumbar puncture (LP). Using a standardized checklist based on literature review and consensus panel, the researchers analyzed the consents for completeness and accuracy.  

 

Results:

 

Checklist for Completeness

Percentage INCORRECT (n=72)

Is the name complete in the top?

13%

Did they correctly name the condition?

31%

Did they correctly identify the procedure?

17%

Did they consent for blood products?

38%

Did they consent for having photograph or video taken of the procedure?

58%

Did they write the risk of: BLEEDING?

56%

Did they write the risk of: INFECTION?

59%

Did they write the risk of: INJURY TO NERVES

81%

Did they write the risk of: DEATH

96%

Did they completely DATE the consent?

28%

Did they completely fill out the TIME the consent was obtained?

41%

Did the standardized patient/parent SIGN the consent?

7%

  

Discussion: Incoming residents struggled to document all risk involved with a LP. They may not think of injury to spinal cord or death as “real” risks or they may not be comfortable verbalizing these potential risks. Of the 72 consents reviewed only 4 were comprehensive and accurately completed. Inform consent is a skill that should be taught and reviewed in medical education, especially throughout the clinical years.