Bashir Muhammad Adeel, Khan Asma A, Khan Sanaa A
Anesthesia and Critical Care, University Hospital of Derby, Derby, GBR.
Anesthesia and Pain Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.
Cureus. 2021 Nov 21;13(11):e19787. doi: 10.7759/cureus.19787. eCollection 2021 Nov.
Introduction Over the years, the process of obtaining informed consent has evolved and now places an emphasis on the concept that patients should play a major role in medical decision making. Failure to adequately involve patients in making decisions regarding their health can lead to medicolegal consequences. Therefore, taking informed consent is a fundamental component of anaesthesia training. Simulation, for training, is an excellent tool that is being utilised widely in the training of medical professionals. The use of simulated training for teaching the process of informed consent is an innovative initiative that can provide improved results. Material and methods After approval from the institutional review board, a prospective clinical study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from August 2019 to September 2020. Sixteen anaesthesia trainees were randomly selected for the study. The study was divided into pre-interventional, interventional and post interventional phases. For data collection, a predesigned checklist was used. Data collected was analysed using SPSS version 23 (IBM Inc., Armonk, New York). The McNemar test was deployed to assess the difference between the baseline assessment and post-simulated training assessment; p-value < 0.05 was taken to be significant. Results Of the 16 participants, the majority were males (n= 13). A positive impact was observed in terms of improvement of the outcome of the following study components i.e., description of benefits of the procedure (p=0.01), disclosure of associated minor risks (p=0.005), disclosure of major risks (p=0.01), discussion of alternatives (p=0.001), teach back (p=0.001), documentation of patients' verbal agreement (p=0.01), and communication skills involving utilising the process of connecting, introduction, communication, permission, response, and exit (p = 0.01). Conclusion Simulated training had a positive impact in improving outcomes in the following study components: description of benefits of the procedure, disclosure of associated risks, discussion of alternatives, teach back, documentation of patients' verbal agreement, and utilisation of the process of connecting, introduction, communication, permission, responding, and exiting.
引言 多年来,获取知情同意的过程不断演变,如今强调患者应在医疗决策中发挥主要作用这一理念。未能让患者充分参与其健康相关决策可能会导致法医学后果。因此,获取知情同意是麻醉培训的一个基本组成部分。模拟作为一种培训工具,在医学专业人员培训中得到广泛应用。将模拟培训用于教授知情同意过程是一项创新举措,能够产生更好的效果。
材料与方法 经机构审查委员会批准,于2019年8月至2020年9月在拉合尔的绍卡特·汗姆纪念癌症医院及研究中心开展了一项前瞻性临床研究。随机挑选了16名麻醉学员参与该研究。该研究分为干预前、干预和干预后阶段。数据收集采用预先设计的检查表。收集到的数据使用SPSS 23版(IBM公司,纽约州阿蒙克)进行分析。采用McNemar检验评估基线评估与模拟培训后评估之间的差异;p值<0.05被视为具有显著性。
结果 16名参与者中,大多数为男性(n = 13)。在以下研究内容的结果改善方面观察到了积极影响,即手术益处的描述(p = 0.01)、相关轻微风险的披露(p = 0.005)、重大风险的披露(p = 0.01)、替代方案的讨论(p = 0.001)、反馈(p = 0.001)、患者口头同意的记录(p = 0.01)以及涉及连接、介绍、沟通、许可、回应和结束过程的沟通技巧(p = 0.01)。
结论 模拟培训对改善以下研究内容的结果产生了积极影响:手术益处的描述、相关风险的披露、替代方案的讨论、反馈、患者口头同意的记录以及连接、介绍、沟通、许可、回应和结束过程的运用。