2024 FSA Podium and Poster Abstracts
P008: CREATING AND PROVIDING A FORMAL ANESTHESIA CONSENT TRAINING PROGRAM
Alicia A McLeod, MD; Tyler Ray, MD; Amanda Frantz, MD; UF Health Shands
Background: Gathering informed consent is a baseline requirement of resident physicians in the United States and requires the residents understanding of the procedure, benefits, risks, and alternatives being consented for by the patient or patient representative. Anesthesiology residents face ethical, practical and relational challenges when obtaining informed anesthesia consent, especially when early on in their anesthesiology residencies. The acquiring of informed consent is an area which receives little formal training (PMID 19225393) despite being a daily requirement in the field of anesthesia. It is also a formally tested topic recently instituted by the ABA advanced OSCE exam and found to have a 5.5% failure rate (PMID 33079864). This project allows the program to identify gaps in knowledge/skills that can allow tailored education to residents.
Aim: The aim of this study is to garner confidence and improve the anesthesia residents’ skills at acquiring informed consent by tracking improvement in several subjective and objective variables as measured by standardized mock OSCEs and self-assessment surveys performed prior to categorical Anesthesiology training.
Methods: Participants filled out self-evaluations on their comfort level and confidence regarding acquiring informed anesthesia consent before participating in a mock OSCE where they did just that. Afterwards, a lecture was provided on gathering informed consent including specific teaching on risks, benefits, alternatives, and methods to reduce risks as related to various anesthetic techniques (i.e. regional, general anesthesia). They participated in both immediate and 6 month post-training mock OSCE’s scored by the senior residents who provided formal training. The scoring of obtaining consent was done according to 7 objectives described in the ABA OSCE clinical outline. Repeat self-evaluations on comfort and confidence level on obtaining informed anesthesia consent was done.
Results: As predicted, there was an overall low level of comfort amongst incoming interns regarding obtaining informed consent; the average report comfort level in obtaining consent was 2.0 pre-training. With <4 hours of overall training, confidence scores increased to an average score of 3.76. A qualitative review of scores on mock OSCE evaluations show a clear improvement after training, even 6 months later. The incidence of only rarely or occasionally achieving a tested objective immediately post training was down to only 3.6% from 42.8% and the incidence of consistently achieving objectives more than doubled from 35.7 to 76.8%.
Future Planning: Formal Anesthesia consent training has demonstrated advantages in the trained physicians comfort level and ability to provide informed consent as shown via self-assessment and performance evaluations. It is proposed that this training become a standard for incoming classes. The training can continue to be faculty overseen and resident lead by anesthesia residents interested in teaching incoming interns. Measured progress of intern performance will be continued in a longitudinal study to ensure continued effectiveness and provide basis for future improvements in the training course.