The evolution of informed consent in gastroenterology.

With medical litigation on the rise, physicians require a nuanced understanding of the legalities of consenting patients to reduce their liability while practising evidence-based medicine. This study aims to a) clarify the legal duties of gastroenterologists in the UK and USA when gaining informed consent and b) provide recommendations at the international and physician level to improve the consent process and reduce liability.A bibliometric analysis of the Web of Science database with the MeSH terms "gastroenterology" and "informed consent" yielded 383 articles, of which 228 were excluded due to not meeting the inclusion criteria. Of the top 50 articles, 48% were from American institutions and 16% were from the UK. Thematic analysis showed 72% of the articles discussed informed consent in relation to diagnostic procedures, 14% regarding treatment, and 14% regarding research participation.Both the USA and the UK have progressed from previously paternalistic Natanson case (1960) and Bolam test (1957), respectively, where physicians were held to the standard of a "reasonable and prudent medical doctor". The American Canterbury case (1972) and the British Montgomery case (2015) radically shifted the standard of disclosure during the consent process by requiring physicians to explain all information pertinent to a "reasonable patient".It is our recommendation that a two-pronged approach be taken; a) creation of international guidelines for consenting patients for invasive procedures in gastroenterology, and b) development of internationally standardised endoscopy consent forms containing all the details pertinent to a "reasonable patient".

Emergency medicine undergraduate simulation training during the COVID-19 pandemic: A course evaluation.

OBJECTIVE: Reduction in patient-facing teaching encounters has limited practical exposure to Emergency Medicine for medical students. Simulation has traditionally provided an alternative to patient-facing learning, with increasing integration in courses. Rapid advancements in technology facilitate simulation of realistic complex simulations encountered in the emergency setting. This study evaluated the efficacy of high-fidelity simulation in undergraduate emergency trauma medicine teaching. METHODS: A consultant trauma expert delivered an introductory lecture, followed by consultant-led small group transoesophageal echocardiogram (TOE) and chest drain simulations, and a splinting station. Participants then responded to a major trauma incident with simulated patients and high-fidelity mannequins. Pre- and post-surveys were administered to assess change in delegates' trauma surgery knowledge and confidence. DESIGN: One-group pretest-posttest research design. SETTING: A higher education institution in the United Kingdom. PARTICIPANTS: A convenience sample of 50 pre-clinical and clinical medical students. RESULTS: Recall of the boundaries of the safe triangle for chest drain insertion improved by 46% (p < 0.01), and knowledge of cardinal signs of a tension pneumothorax improved by 26% (p = 0.02). There was a 22% increase in knowledge of what transoesophageal echocardiograms (TOEs) measure (p = 0.03), and 38% increased knowledge of contraindications for splinting a leg (p < 0.01). The average improvement in knowledge across all procedures when compared to baseline was 35.8% immediately post-simulation and 22.4% at six-weeks post-simulation. Confidence working in an emergency setting increased by 24% (p < 0.001) immediately, and by 27.2% (p < 0.001) at six weeks. CONCLUSIONS: The findings suggest that simulation training within emergency medicine can result in significant increases in both competency and confidence. Benefits were observed over a six-week period. In the context of reduced patient-facing teaching opportunities, emergency medicine simulation training may represent an invaluable mechanism for delivery of teaching.

Validating the Use of Peer-Assisted Learning Laparoscopic Simulation Training for Medical Students.

Medical students are often passive observers in laparoscopic theatres due to their lack of basic laparoscopic skill competence, which negatively impacts their education. This study aims to (1) validate the use of peer-assisted learning (PAL) to teach medical students basic laparoscopic skills on low-cost simulators and (2) compare the efficacy of PAL training between pre-clinical and clinical medical students to ascertain when this training should be introduced. Our results demonstrate significant training efficacy at both levels, suggesting that PAL simulation may be implemented at either stage of training, but may garner better retention of confidence and knowledge in the clinical medical students.

Analysis and recommendations regarding surgeons' liabilities during an acute health crisis.

The SARS-CoV-2 pandemic has highlighted discrepancies between surgeons' professional duties and legal protections when acting outside their specialities during the pandemic. These discrepancies between legal and professional standards leave surgeons and the NHS vulnerable to litigation. In the following article, we explore the liabilities that have arisen for surgeons during this period in the United Kingdom and Canada. We recommend, upon review of the literature, that a two-pronged approach be taken to address these discrepancies; (a) a change in policy at the national level to accurately reflect the constraints and demands placed upon the profession in this acute health crisis and (b) the provision of clearer, more stringent legal protection. In the interim, we suggest that individual surgeons utilise a decision-making framework where they consider their personal and professional obligations in regard to resource stewardship, innovation in practice, patient-specific contexts, and patient advocacy while acting outside of their speciality.