Consent for Examinations Under Anesthesia With Learners at the Time of Abortion: Physician Perspectives

Abstract

Introduction: Although obtaining specific consent for examinations under anesthesia with learners is recommended by major professional organizations and mandated by many state laws and institutions, it is not practiced universally. We sought to investigate physicians' experiences using a formalized process to obtain consent from patients presenting for surgical abortions under anesthesia for pelvic examinations with learners.

Methods: Semistructured qualitative interviews were conducted with residents, fellows, and faculty who work or have rotated in a single family planning clinic after the clinic introduced this consent process. Participants were asked about their experiences obtaining informed consent from patients for examinations under anesthesia with learners. Interviews were audiorecorded, transcribed, and analyzed using modified grounded theory. All study procedures were institutional review board approved.

Results: Twenty interviews were performed, achieving thematic saturation, with 14 residents, 4 fellows, and 2 faculty members. Participants described initial discomfort with the consent process and their wording choices, which improved with increased familiarity and almost universal patient acceptance. Some participants felt that an informal training or practice before obtaining informed consent may have been helpful. Participants stressed the importance of this consent process to foster patient autonomy and choice. Participants reported that the fact that patients were presenting for abortion care did not influence their overall process or comfort level obtaining consent for pelvic examinations under anesthesia with learners; however, some noted that they gave patients more time to process the consent or used more intentional language during these encounters.

Conclusions: Physicians desire and accept the integration of a formal consent process for examinations under anesthesia with learners at the time of abortion.