Medical Student Perspectives: Informed Consent: Managing the Awkwardness of Inexperience
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 time?
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 did!
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 2008;34:116-9.
2. Sokol DK. How to be a "good" medical student. J Med Ethics 2004;30:612.
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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