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It's probably a safe bet that as medical students most of us
have a good understanding of the concept of "informed consent."
Even if you have not encountered the topic of consent during an
undergraduate ethics class, you have gained a greater appreciation
of this vital element in the practice of medicine during the first
two years of medical school. But what happens as you transition
from merely talking about informed consent to actually obtaining
consent from a patient? Additionally, how do you handle the
awkwardness of obtaining consent for a minor procedure (e.g.,
phlebotomy, pelvic/rectal exam) when it's likely your first
Obtaining consent is especially difficult as a medical student
because we're often explaining the risks and benefits of procedures
that we've only read or talked about during our first two years of
training. "Awkward" is probably a good way to describe your first
attempt at obtaining consent from a patient. You're not sure
exactly what you should be saying, and it probably isn't coming out
as clearly and understandably as you might hope. Like most of the
learning during the clinical years, one of the best ways to learn
how to work through this awkwardness is to learn from the senior
members of your medical team. Learn the risks and benefits
associated with a particular procedure and review them with your
senior residents, fellows, or attendings. Observe these same
individuals obtaining consent from patients and note how their
styles differ. Be cognizant of how the patients react and respond
during the consent process as well. You're likely to observe
mannerisms and other spoken or unspoken elements of patient
interaction used by your residents or attendings that you like
personally and will want to integrate into your own practice.
Lastly, when you finally do obtain consent from a patient for a
procedure, ask your resident or attending for feedback when the
process is complete. By soliciting feedback and other constructive
criticism after each of your patient encounters, you'll quickly
lose the feeling of inexperience.
The second issue at hand when navigating the waters of informed
consent is the fact that you will likely be performing many of the
minor procedures for which you are obtaining consent. It is your
duty to let your patient know that this is your first time
performing a particular procedure1, 2. In my experience,
this has led to a few patients telling me politely that they would
rather have someone more senior perform the procedure. However,
contrary to what you may think, many patients do not mind when you
are honest and frank with them about your inexperience3.
I can attest to this fact first-hand. As you can imagine, once the
inexperience issue is on the table, it's amazing how much more
comfortable you feel and how much more you gain from the procedural
experience! Some of the best feedback I have received has not been
from my seniors, but rather from the patients on whom I have
completed the procedures. I urge all of you to try this next time
you're looking to gain some procedural experience - ask your
patients for constructive criticism! Our patients are and always
will be our greatest teachers.
Becoming comfortable with the processes of informed consent and
minor procedures are important steps in medical education. Once you
strike the balance of competency and comfort, you will be well on
your way to becoming the best physician you can be. Take advantage
of all learning opportunities as they present themselves during
your clinical years - once residency comes you'll be glad you
Vance L. Albaugh
Council of Student Members, North Central Region
Penn State College of Medicine, 2011
1. Draper H, Ives J, Parle J, Ross N. Medical education and
patients' responsibilities: back to the future? J Med Ethics
2. Sokol DK. How to be a "good" medical student. J Med Ethics
3. Santen SA, Hemphill RR, Spanier CM, Fletcher ND. 'Sorry, it's my
first time!' Will patients consent to medical students learning
procedures? Med Educ 2005;39:365-9.
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