Emily S Binstadt1,2, Nathaniel D Curl3,4, Jessie G Nelson1,2, Gail L Johnson5, Cullen B Hegarty1,2, Robert K Knopp1,2. 1. Emergency Department Regions Hospital St. Paul MN. 2. Department of Emergency Medicine University of Minnesota Minneapolis MN. 3. Regions Hospital Emergency Medicine Residency St. Paul MN. 4. Trinity Medical Center Rock Island IL. 5. Health Partners Clinical Simulation St. Paul MN.
Abstract
BACKGROUND: Informed consent (IC) is an essential component of shared medical decision making between patients and providers in emergency medicine (EM). The basic components required for adequate consent are well described, yet little is published investigating whether EM residents demonstrate adequate IC skills. OBJECTIVE: The objectives were to assess the ability of EM residents to obtain IC for an invasive emergency procedure using a novel assessment tool and to assess reliability and validity of the tool. METHODS: This was an observational study in which participants were initially blinded to the primary objectives of the study. Each participant conducted a video-recorded history and physical examination with a standardized patient, requiring tube thoracostomy due to spontaneous pneumothorax. Two faculty EM physicians independently reviewed the videos and evaluated the participants' IC skills. First, they gave an overall impression of whether IC was obtained; they then evaluated the participants using a 30-point scoring tool based on the five elements of IC (decision-making capacity, disclosure, voluntariness, understanding, and physician recommendation). Upon all participants' case completion, we revealed the primary objectives and gave participants the option to withdraw from the study. Descriptive statistics and kappa coefficient were generated from the data collected. RESULTS: Twenty-two residents completed the study. None withdrew from the study after the primary objectives were revealed. Twenty residents (91%) obtained adequate IC based on both reviewers' overall impression. One disagreement occurred between reviewers (κ = 0.64). The mean IC score on a 30-point scale was 18.5 ± 0.5. CONCLUSIONS: In a simulated setting, most EM residents at this training program possess the knowledge and skills necessary to obtain IC prior to an invasive procedure. The assessment tool appears reliable and demonstrates construct validity.
BACKGROUND: Informed consent (IC) is an essential component of shared medical decision making between patients and providers in emergency medicine (EM). The basic components required for adequate consent are well described, yet little is published investigating whether EM residents demonstrate adequate IC skills. OBJECTIVE: The objectives were to assess the ability of EM residents to obtain IC for an invasive emergency procedure using a novel assessment tool and to assess reliability and validity of the tool. METHODS: This was an observational study in which participants were initially blinded to the primary objectives of the study. Each participant conducted a video-recorded history and physical examination with a standardized patient, requiring tube thoracostomy due to spontaneous pneumothorax. Two faculty EM physicians independently reviewed the videos and evaluated the participants' IC skills. First, they gave an overall impression of whether IC was obtained; they then evaluated the participants using a 30-point scoring tool based on the five elements of IC (decision-making capacity, disclosure, voluntariness, understanding, and physician recommendation). Upon all participants' case completion, we revealed the primary objectives and gave participants the option to withdraw from the study. Descriptive statistics and kappa coefficient were generated from the data collected. RESULTS: Twenty-two residents completed the study. None withdrew from the study after the primary objectives were revealed. Twenty residents (91%) obtained adequate IC based on both reviewers' overall impression. One disagreement occurred between reviewers (κ = 0.64). The mean IC score on a 30-point scale was 18.5 ± 0.5. CONCLUSIONS: In a simulated setting, most EM residents at this training program possess the knowledge and skills necessary to obtain IC prior to an invasive procedure. The assessment tool appears reliable and demonstrates construct validity.
Authors: Sara Kim; Sinan Jabori; Jessica O'Connell; Shanna Freeman; Cha Chi Fung; Sahrish Ekram; Amruta Unawame; Gail Van Norman Journal: Patient Educ Couns Date: 2013-08-27
Authors: Michael A Gisondi; Rebecca Smith-Coggins; Phillip M Harter; Robert C Soltysik; Paul R Yarnold Journal: Acad Emerg Med Date: 2004-09 Impact factor: 3.451
Authors: Emily S Binstadt; Nathaniel D Curl; Jessie G Nelson; Gail L Johnson; Cullen B Hegarty; Robert K Knopp Journal: AEM Educ Train Date: 2017-05-12
Authors: Emily S Binstadt; Nathaniel D Curl; Jessie G Nelson; Gail L Johnson; Cullen B Hegarty; Robert K Knopp Journal: AEM Educ Train Date: 2017-05-12