A new informed consent statement for medical students in clinical placements will provide clarity and further protection for patients, students and supervisors, its authors say.
Developed by the University of Otago and the University of Auckland, with input from Chief Medical Officers, the Health and Disability Commissioner, Medical Council of New Zealand, New Zealand Medical Students' Association, and Council of Medical Colleges, the document will replace the current one introduced in 2015.
The statement affirms proper consent processes as essential to culturally safe and Tiriti-informed care, describes responsibilities of institutions and individuals, clarifies the level of information that should be provided and the processes that should be followed across the range of contexts in which students learn.
Professor Warwick Bagg, of the Faculty of Medical and Health Sciences at Waipapa Taumata Rau, University of Auckland, led the writing of the first consensus statement and along with Dr Simon Walker, of the University of Otago’s Bioethics Centre, co-led this review and rewrite.
“The 2015 statement was a substantial step forward in reaffirming the links between informed consent and medical teaching and describing what this means for specific areas of practice. Anecdotally, students find this consensus statement helpful and empowering,” Professor Bagg says.
However since 2020, feedback suggested that at times patient consent to student involvement in care was substandard and updating of the document was needed.
“Senior leaders of Aotearoa New Zealand’s two medical schools met to discuss these challenges and reflect on ways they could be addressed. The updated consensus statement – which importantly incorporates a Te Ao Māori worldview – is the result.”
Enabling patients to consent or decline involvement of medical students in their care is not just a requirement of law, he says.
“It is an essential aspect of ethically sound patient-centred, mana enhancing healthcare.
“Consent is not a tick box exercise or one off signing of a bit of paper – it is an on-going conversation with the patient, which will enhance patient health outcomes and student learning.”
Dr Walker, of the University of Otago’s Bioethics Centre, says the new statement does not introduce major changes to policy, but builds clarity around what the standards are in respect of specific applications.
“It will provide pragmatic guidance for busy clinical settings which upholds the rights and safety of patients. We have clarified the levels of responsibilities, from the institution to the clinical teacher to the student.”
The level of specified consent required for particular kinds of student involvement – an area which had caused confusion – has also been addressed.
“In some cases supervisors or teachers appeared to believe consent to student involvement can be covered entirely by a single broad consent. In other cases, there may be over-correction, when students have been excluded from some procedures when broad consent should be enough.
“There is a list of key principles and considerations, including responsibilities for obtaining consent, the consent process and disclosure of information, documenting consent, sensitive examinations and procedures, patients who may not be able to consent, health information, care at home and remote care,” Dr Walker says.
The consensus statement provides guidance on how the Code of Health and Disability Services Consumers' Rights might be interpreted where students are involved in teaching. Both universities will include it in their teaching and policies as soon as possible.
“Ongoing attention, training and review is required to ensure Aotearoa New Zealand’s legal and professional standards and societal expectations are met. Everyone in healthcare needs to work together to address the practical challenges in obtaining such consent for the betterment of patient care and medical training,” he says.
An article on the document is published in this week’s New Zealand Medical Journal.
Informed Consent for Medical Student Involvement in Patient Care: An updated consensus statement
Simon Walker (University of Otago), Papaarangi Reid (University of Auckland), Lynley Anderson (University of Otago), Susan Bull (University of Auckland, University of Oxford), Monique Jonas (University of Auckland), Joanna Manning (University of Auckland), Alan Merry (University of Auckland, Te Whatu Ora Te Toka Tumai Auckland), Suzanne Pitama (University of Otago), Sarah Rennie (University of Otago), Jeanne Snelling (University of Otago), Tim Wilkinson (University of Otago), Warwick Bagg (University of Auckland).
New Zealand Medical Journal
For more information please contact
Dr Simon Walker
University of Otago
Professor Warwick Bagg
Faculty of Medical and Health Sciences
Waipapa Taumata Rau, University of Auckland