Informed consent and haptic actions in interdisciplinary simulation training

Introduction: According to the American College of Emergency Physicians (ACEP), doctors should communicate truthfully with their patients and obtain informed consent for treatment, unless it is a dire situation. Clinicians are responsible for giving information and seeking approval from their patients to maintain an effective, positive relationship. We analyzed five simulations from Ysbyty Gwynedd Hospital in Wales where medical and nursing students treated a high-fidelity patient mannequin. We analyzed these simulations to determine if trainees followed recommended guidelines of seeking approval and/or giving information prior to performing an action on the patient.

Methods: The students' task was to accurately identify the patient's condition and treat it accordingly. We studied both verbal and nonverbal behavior; for the latter we examined haptic actions, which are instances where a clinician touches the patient. We coded four types of haptic actions: performing interventions, rearranging the gown, checking vitals, and assessing physiological changes. For each haptic action, we noted how clinicians verbally communicated with the patient; in particular, if they sought approval before acting, gave information but did not seek approval, or just acted without speaking. We then averaged these instances across all five simulations.

Results: There were 155 total haptic actions: 47 intervention-related, 38 gown-related, 29 vitals-related, and 41 diagnostics-related. During interventions, clinicians sought approval before acting 16% of the time, gave information but did not seek approval 37% of the time, and just acted 47% of the time. When rearranging the gown, clinicians never sought approval, gave information 9% of the time, and just acted 91% of the time. When checking vitals, clinicians sought approval 22% of the time, gave information 33% of the time, and just acted 45% of the time. During diagnostic testing, clinicians sought approval 9% of the time, gave information 5% of the time times, and just acted 86% of the time.

Discussion: For our data, our results suggest that at the training level clinicians rarely seek approval or give information to patients before performing a haptic action upon them. This trend is particularly apparent for gown and diagnostic related haptic actions. This suggest that clinicians at the training level my not be following the ACEP guidelines, which may be inculcating bad practices. We are currently collecting additional simulation data from other clinical training contexts to determine the frequency of this practice. We aim to use these findings to develop best practice guidelines for medical education.