Emergency Medicine: Evaluation of knowledge of emergency doctors about capacity and consent

Evaluation of Knowledge of Emergency Doctors About Capacity and Consent
1. Introduction
Importance of Capacity & Consent in Emergency Medicine: Legal and ethical obligations.
Challenges in the Emergency Department (ED): High-stress environment, time-sensitive decisions, unconscious or confused patients.
Legal Framework: National laws and ethical guidelines governing medical decision-making.
2. Objectives of the Evaluation
Assess emergency doctors' understanding of patient capacity.
Evaluate knowledge of informed consent principles.
Identify gaps in knowledge and training needs.
Recommend strategies to improve compliance and patient care.
3. Methodology
Study Design: Cross-sectional survey or knowledge assessment test.
Participants: Emergency doctors at a selected hospital or group of hospitals.
Assessment Tools:
Multiple-choice questions (MCQs) on legal and ethical principles.
Case vignettes testing real-world application.
Self-assessment questionnaire on confidence in handling capacity/consent issues.
Data Collection: Online survey, interviews, or direct observation.
Scoring & Analysis: Percentage of correct responses, identification of key deficiencies.
4. Key Areas of Assessment
A. Understanding of Capacity
Definition of decision-making capacity.
Four key components of assessing capacity:
Understanding information.
Retaining information.
Weighing information to make a decision.
Communicating the decision.
Temporary vs. permanent lack of capacity.
Common causes of impaired capacity in ED patients (e.g., head trauma, intoxication, psychiatric illness).
B. Knowledge of Consent
Definition of informed consent.
Elements required for valid consent:
Voluntariness.
Competency.
Adequate information.
Implied vs. explicit consent in emergency situations.
Special circumstances:
Consent in unconscious patients.
Parental consent for minors.
Patients refusing life-saving treatment.
Role of advanced directives.
C. Legal & Ethical Aspects
National laws & guidelines regarding medical decision-making.
Emergency exceptions (e.g., treatment under the doctrine of necessity).
Mental health considerations (e.g., involuntary admission laws).
Documentation standards for capacity assessments and consent.
5. Results & Interpretation
Percentage of doctors demonstrating satisfactory knowledge.
Common misconceptions and areas of weakness.
Differences in knowledge by experience level (junior vs. senior doctors).
6. Recommendations
Training Programs: Regular workshops or online courses on capacity and consent.
Clinical Decision Tools: Algorithms and flowcharts for bedside decision-making.
Legal Consultation Access: Hospital-based medico-legal support for complex cases.
Simulation-Based Learning: Role-playing capacity assessments with standardized patients.
7. Conclusion
Summary of findings.
Importance of continuous education on medical ethics and legal principles.
Need for hospital policies ensuring proper consent practices.

1. EVALUATION OF KNOWLEDGE OF EMERGENCY DOCTORS ABOUT CAPACITY AND CONSENT

2. INTRODUCTION N Since the introduction of the Consumer protection Act in India, there has been increasing public awareness of individuals' rights and increase in litigations. The element of consent is one of the critical issues in the area of medical treatment today. It is well known that the patient must give valid consent to medical treatment; and it is his prerogative to refuse treatment even if the said treatment will save his or her life. 2

3. Consent means an agreement, compliance or permission given voluntarily without any compulsion. Voluntaryness suggests willingness of patient to undergo treatment. Capacity means a degree of ability of the patient to understand the nature and consequences of the treatment offered. Knowledge means that sufficient amount of information about the nature and consequence of the treatment has been disclosed to the patient. Decision-making means the ability to take decisions regarding consent.

4. Consent can be implied, expressed or presumed. An expressed consent can be written or oral. informed consent involves telling the patients about the nature of their condition, the nature of the proposed treatment, benefits of the proposed treatment, risks of the proposed treatment

5. Presumed consent is important in cases of emergency when consent cannot be taken. Tacit consent describes consent that is expressed silently or passively by omission. The element of consent is one of the critical issues in the area of medical treatment today.

6. Purpose of the study The aim of our study is to assess the knowledge about capacity and consent among doctors in India in the following areas: The age at which valid consent can be given in India. Different types of consent in India. Relative importance of written and verbal consent. When and how the consent should be taken. Who should sign the forms? Circumstances in which full disclosure of medical facts can be dispensed with. Role of proxy consent. Consent in Medical Emergencies

7. Study methodology study design ⎼ The study will be a prospective, cross-sectional, multi-centric, observational, questionnaire-based study. For the purpose of this thesis, a descriptive correlational analytical survey will be used, in which a qualitative approach will be undertaken to determine the answers of above mentioned research questions. Study population ⎼ For the purpose of this thesis, the data will be collected from randomly selected doctors meeting all the inclusion & exclusion criteria working all over India. The actual number total population of doctors in India meeting all the inclusion & exclusion criteria is relatively unknown. For the purpose of this proposal, the study population will be arbitrarily taken as 5 00 .

8. Inclusion Criteria: All doctors who deals with patients and tests regularly IN EMERGENCY. Should possess MBBS and medical council registration number Should possess at least 1 year of experience in emergency Exclusion Criteria: Doctors who practice non allopathic medicine. Doctors who do not possess any medical council registration number. Doctors not practicing in emergency or casualty Doctors with less than 1 year of experience in emergency

9. Study Sample: According to Polit & Hunger (2001) in quantitative research the larger the sample the more representative of the population it is likely to be. For the purpose of this proposal, data will be collected, from all participants fulfilling the inclusion criteria. The expected sample size that will be recruited for this study is calculated with the help of Raosoft sample size calculator . The following data were entered: Population size: 5 00 Confidence level: 95% Margin of error: 5% Response Distribution: 50% The sample size required for this survey was calculated as 118 , rounded to 120 , with the following formula: Sample size n and margin of error E are given by Where N is the population size, r is the fraction of responses that you are interested in, and Z ( c /100) is the critical value for the confidence level c . x = Z( c / 100 ) 2 r(100-r) n = N x / ((N-1)E 2 + x) E = Sqrt[ (N - n)x / n(N-1) ]

10. STUDY LIMITATIONS: The study population are being tested upon a confined set of questionnaire and it may not cover the entire range of questions. EMERGENCY Physicians will be selected randomly around the country, which may not represent ideal demographic scenario of physicians in our country. As the questionnaires are being distributed by e-mails, there is a high possibility of low response.

11. Appendix 2

12. Which State/Union Territory you presently work in? ____________________________________ Which category of employment sectors represents best your employment for your main job?  Private  Public/ Governmental sector  Don’t know Do you work?  Full-time  Part-time  Temporary/Casual What is your field of work __________________________________ What are your qualifications?  MBBS  MD  MCEM  MEM  DNB/FNB Other, please specify:_________________________

13. KNOWLEDGE ABOUT CAPACITY AND CONSENT:   Questions Yes No Don’t know 1. Is the consent valid if it is given by a person above 12 years of age?       2. Should the doctor warn the patient of any likely harm in the course of treatment?       3. Can medical treatment be given without consent to a disoriented patient?       4. Can a 16 year old person give consent for operation of organ transplant?       5. Is the consent taken from the local guardian of a mentally unsound person valid?       6. Should a written consent be obtained for medico legal examination for determining age, potency, virginity etc where the person examined is not in police custody?       7. For contraception sterilization consent of both husband and wife should be obtained?      

14. SELF ASSESSMENT: On a scale of 0 to 10 if 0 is no knowledge 10 being complete knowledge, RATE YOURSELF ON A SCALE OF 0 TO 10 on the following Are you comfortable with your current knowledge on capacity and consent? YES NO Rate yourself: Are you comfortable with your current way of consent practices? YES NO Rate yourself Are you aware of any guidelines you follow? YES NO Rate yourself Do you know the different types of consent? YES NO How many? Are you sure when to take which type of consent? YES NO   Your overall confidence  

15. OPINION AND SUGGESTION FOR IMPROVEMENT: Putting up protocol based posters in the ED strongly disagree disagree agree strongly agree Do you think regular updates on will help? strongly disagree disagree agree strongly agree Do you think we need medical law incorporated in MBBS course? strongly disagree disagree agree strongly agree Do you think all doctors should learn / do courses in medical law? strongly disagree disagree agree strongly agree COMMENTS                  

16. Thank you