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    Issue 16

  • A doctor’s life

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    Assessing the consent process

    Adam Golabek

    Adam Golabek

    MBA, MScTech (Risk Mgmt), BPhysio (Hons)

    Head of Avant Foundation

    Avant
     
    Assessing consent main image

    Obtaining patient consent is a fundamental, yet tricky skill and some doctors don’t always get it right. Our data shows consent is a factor in one in 10 claims1. The Avant Foundation was pleased to support members’ research into assessing trainees’ abilities in performing this task.

    “We have found that although consent was taught in medical school, it was not assessed,” Professor Ian Incoll said. “By the time trainees were sitting in front of patients in a real-world setting they had often forgotten key aspects of consent. They didn’t understand the intended procedures well enough or were not effective in communicating with patients and thus failed to elucidate the material risks.”

    With the support of the Avant Foundation and the Australian Orthopaedic Association Research Foundation, a research team led by Professor Incoll and education consultant, Ms Jodie Atkin, have developed a tool to reliably assess the ability of surgical trainees to obtain informed consent.

    The researchers were inspired to create the Informed Consent Observational Tool based on consent issues identified in the literature. Many studies show junior doctors don’t adhere to legal and ethical best practices regarding informed consent and overstate patient literacy2.

    “The tool, which encompasses a systemised checklist covering the key aspects of the consent process, will help further the practice of medicine,” Professor Incoll said. “Until now, the research has relied on patient feedback and we had no reliable means of assessing trainee proficiency on obtaining informed consent from patients.

    “On top of this, the supervisory process of evaluating and teaching trainees was often time consuming and results varied greatly from one supervisor to the next,” he said.

    By the time trainees were sitting in front of patients in a real-world setting they had often forgotten key aspects of consent.


     

    Orthopaedic trainee trial

    The six-item assessment tool is based on recognised elements of legally and ethically valid consent, and NHMRC guidelines on providing information to patients. Following a pilot study, the tool was then assessed in a trial involving 38 introductory orthopaedic trainees who were asked to take informed consent from a simulated patient. The trainees were rated using the form by one of six consultant assessors.

    “For each trainee, one assessment was completed in-person and two additional assessments were completed by the same group of assessors using recorded videos of the live sessions,” Professor Incoll said. “Scores were analysed to determine the inter-rater reliability and internal validity of the informed consent assessment tool.

    “The informed consent assessment tool hopes to improve orthopaedic surgery practice for trainees and enables supervising surgeons to assess proficiency and identify areas for improvement in consent conversations for trainees early in their careers, leading to enhanced professional and ethical practice.”

    Educational program

    In a separate survey, Professor Incoll and Ms Atkin, and co-authors Dr John Owen and Dr Chris Conyard, have looked at trainees’ underlying knowledge of consent. The survey results were recently presented at the Annual Scientific Congress of the Royal Australasian College of Surgeons. They have also developed an educational program which incorporates targeted training on informed consent to help new trainees hone their skills.

    The Avant Foundation was established in 2017 to support initiatives such as this, that improve quality, safety and professionalism in practice, and reduce risk for both doctors and patients. To date, 14 Avant Foundation grants have been awarded totalling $749,000.

    Visit: avantdifference.org.au/avant-foundation for more information.

    Dr Incoll headshot
     
    Professor Ian Incoll

    MBBS, FRACS, FAOrthA, MSurgEd, FFSTEd

    Conjoint Professor, Faculty of Medicine and Public Health, University of Newcastle and District Clinical Director of Surgery, Central Coast Local Health District. As well as Subject Coordinator, Graduate Programs in Surgical Education, University of Melbourne and Past President, Australian Orthopaedic Association.

    References

    • 1. Compensation claims and complaints to regulators finalised between July 2016 to June 2018.
    • 2. Kelly PA, Haidet P. Physician overestimation of patient literacy: a potential source of health care disparities. Patient Education and Counseling. 2007 Apr;66(1):119–22.

     

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    The Avant Foundation (ABN 27 179 743 817) is administered by its trustee, Avant Foundation Limited (ACN 618 393 847). The Avant Foundation is a Public Ancillary Fund, endorsed by the Australian Taxation Office as a Deductible Gift Recipient..

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