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How Do Anesthesia Residents Respond to Patient Concerns about Young Age and Inexperience during Informed Consent? (1090-004219) (Research Abstract Professor Rounds: Group 1)
Start time: Tuesday, January 26, 2021, 2:00 PM End time: Tuesday, January 26, 2021, 3:00 PM Session Type: Research Abstracts (Completed Studies) Cost: $0.00
Content Category: Researcher
Hypothesis:
Patients’ concerns about resident physicians’ inexperience may interfere with forming a trusting patient-doctor relationship and may limit patients’ ability to fully participate and ensure the integrity of the informed consent process. A patient’s perception of youth and/or inexperience may lead to concern about their qualification to provide care. This relational dynamic is central to patient-centered care, patient satisfaction and optimal clinical care. The aim of this observational study was to examine anesthesia residents’ responses to standardized patients’ apprehensions about the residents’ inexperience and to develop a highly realistic model for characterizing physician-patient interactions. Specifically, findings from this study can serve to inform the field about the range of responses to such concerns and inquiries, and to develop simulation-based educational tools and approaches to address these issues.
Methods:
After IRB approval, 67 1st and 3rd year anesthesia residents from 3 Harvard programs obtained informed consent from a standardized patient (SP), a 52-year-old male awaiting surgery for a perforated gastric ulcer; we present preliminary data on 24 residents. Residents were instructed to review clinical data and obtain informed consent. The SP expressed concern about the resident’s young age and inexperience, e.g. “You look awfully young to be a doctor.” Encounters were recorded for coding behaviors and analysis by 2 trained coders. Data included verbal interactions between the SP and resident about these concerns, and coded according to physician status, age and/or inexperience. Resident responses were coded by category e.g. thanks/compliment; denies/dismisses concern; acknowledges concern; provides information about care/role; provides evidence of experience; mentions supervision; and redirects concern. Descriptive analyses were conducted. Analyses of all 67 residents is ongoing.
Results:
Of the 24 1st and 3rd year residents, 14 (58%) were male and 10 (42%) were female. Of the concern prompts expressed by the SPs, 24 (100%) expressed concern about age, 13 (54%) about experience; and 7 (29%) about status as doctor. The SP may have expressed more than one concern, e.g. “you look terribly young, are you a medical student?” Across the sample of 24 residents, there were 75 responses to the initial concerns expressed, with a range of 1-6 responses per resident, a mean of 2.88 responses per resident. Of the cumulative number of responses provided by the 24 residents, 18 (24%) provided information about care/role; 13 (17%) described clinical experience; 13 (17%) denied/dismissed the concern; 8 (11%) mentioned supervision; 6 (8%) acknowledged concern; 6 (8%) invoked formal/polite language; 5 (7%) laughed; 2 (3%) offered thanks/compliment; and 1 (1%) redirected focus to patient. Ongoing analysis will examine differences in responses by resident attributes such as gender.
Conclusions:
We created a reproducible high-fidelity simulated environment to study physician-patient interactions. This has the potential to create a greater understanding of interactions and design methods to improve performance. All of the SP’s expressed concerns related to age, experience and/or status as a physician. The residents had a variety of responses: 62% (information about role, described clinical experience and/or medical supervision) of the residents provided responses that attempted to alleviate the specific concerns of the SP. These responses could be considered patient-centered. 38% of the responses did not address the SP’s concerns, e.g. denied/dismissed the concern. There is room for improvement with respect to resident responses to patient concerns about youth and inexperience. Residents may benefit from training interventions including deliberate practice opportunities to incorporate specific verbal and non-verbal responses to this frequently encountered situation in trainees.