Updated GMC guidance on decision-making and consent: implications for urologists

2020 ◽  
pp. 205141582094553
Author(s):  
Siobhan Duffy ◽  
Catriona Barlow ◽  
Mark Underwood ◽  
Elizabeth Day
Keyword(s):  
Decision Making ◽  
General Medical Council ◽  
Medical Council ◽  
Level Of Evidence ◽  
Consent Forms ◽  
One Stop

We summarise the updated General Medical Council guidance on consent and decision-making. We explore the emphasis on enabling supported decision-making and the implications this has in day to day urological practice. In particular, we address some of the issues encountered in one-stop clinics, on pooled elective lists and with pre-written consent forms. The new guidance will emphasise the importance of sharing information relevant to your patient in light of the Montgomery ruling. Every decision is unique. We must appreciate the importance of the process of decision-making and understand our role as the clinician. Here we suggest some practical considerations to address the updated General Medical Council guidance. Level of evidence: Not applicable.

scholarly journals An audit cycle of consent form completion: A useful tool to improve junior doctor training

2016 ◽  
Vol 49 (01) ◽  
pp. 72-75 ◽  
Author(s):  
Catherine Leng ◽  
Kavita Sharma
Keyword(s):  
Junior Doctor ◽  
General Medical Council ◽  
Consent Form ◽  
Junior Doctors ◽  
Medical Council ◽  
Emergency Setting ◽  
Consent Forms ◽  
Surgical Practice ◽  
Audit Cycle ◽  
Practice Methods

ABSTRACT Background: Consent for surgical procedures is an essential part of the patient's pathway. Junior doctors are often expected to do this, especially in the emergency setting. As a result, the aim of our audit was to assess our practice in consenting and institute changes within our department to maintain best medical practice. Methods: An audit of consent form completion was conducted in March 2013. Standards were taken from Good Surgical Practice (2008) and General Medical Council guidelines. Inclusion of consent teaching at a formal consultant delivered orientation programme was then instituted. A re-audit was completed to reassess compliance. Results: Thirty-seven consent forms were analysed. The re-audit demonstrated an improvement in documentation of benefits (91–100%) and additional procedures (0–7.5%). Additional areas for improvement such as offering a copy of the consent form to the patient and confirmation of consent if a delay occurred between consenting and the procedure were identified. Conclusion: The re-audit demonstrated an improvement in the consent process. It also identified new areas of emphasis that were addressed in formal teaching sessions. The audit cycle can be a useful tool in monitoring, assessing and improving clinical practice to ensure the provision of best patient care.

Changes in surgical consent practices for common otolaryngology procedures: impact of Modernising Medical Careers

2010 ◽  
Vol 124 (8) ◽  
pp. 899-904 ◽  
Author(s):  
P Puwanarajah ◽  
S E McDonald
Keyword(s):  
National Health Service ◽  
Telephone Survey ◽  
Elective Surgery ◽  
General Medical Council ◽  
Medical Council ◽  
Consent Forms ◽  
Department Of Health ◽  
Medical Careers ◽  
Patient Consent ◽  
Selection Of

AbstractObjectives:To assess elective surgery consent practices amongst senior house officers from a selection of UK ENT departments, and to compare results with similar surveys in 2002 and 2005.Methods:A telephone survey of senior house officers in 40 UK ENT departments was conducted to assess departmental consent policies and knowledge of complications of common ENT operations.Results:A total of 77.5 per cent of responding senior house officers were responsible for consenting, reduced from 92.5 per cent in 2002 (p = 0.06). There had been a significant improvement in the use of patient information sheets, from 25 per cent of departments in 2002 to 65 per cent in 2008 (p = 0.0002). There had been no improvement in training or in the use of standard National Health Service consent forms, and the senior house officers' knowledge of specific complications remained poor. Of the senior house officers surveyed, 37.5 per cent were foundation trainees.Conclusions:There has been some improvement in information delivery to patients during the consent process, in accordance with General Medical Council, Department of Health and Modernising Medical Careers guidelines. However, most senior house officers are still required to obtain patient consent without appropriate training.

Mentoring for urologists

2018 ◽  
Vol 12 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Tim Terry ◽  
Nancy Redfern ◽  
Gordon French
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
General Medical Council ◽  
Cross Sectional Study ◽  
Medical Council ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Trained Staff ◽  
The Uk ◽  
Based Medicine

Trainee and established urologists are familiar with ‘generic mentoring’ as a potpourri of helping aids that include supervision, coaching, buddying, career advice, counselling and patronage to enable mentees to develop professionally. However, most are unfamiliar with ‘developmental mentoring’ as a highly specific learnt technique through which mentors help mentees, by interactive dialogue, to choose their own agendas and arrive at their own solutions to career/professional/personal opportunities or difficulties as distinct from the paternalistic mentor approach typified by the downward flow of information generated by ‘generic mentoring’. This paper is a systematic review of developmental mentoring as pertains to urologists in the UK, and reports outcomes of 1-hour taster sessions between Egan-trained mentors and urologists offered at British Association of Urological Surgeons (BAUS) annual general meetings since 2013. Both the General Medical Council and the Royal College of Surgeons of England imply that ‘mentoring’ is mandatory for both trainees and trained urologists, but fail to clarify what they mean by a ‘mentor’, which potentially creates a void in providing ‘developmental mentoring’ since the later requires specific training and is costly to provide. Currently, most ‘developmental mentoring’ is performed by trained staff in Local Education and Training Boards or National Health Service Trusts. BAUS has an opportunity to offer ‘developmental mentoring’ through a portal on its website to manage opportunities and difficulties experienced by its members. Level of evidence: This paper is a systematic review as pertains to the place of mentoring in current urological practice. By its nature, it has reviewed previous narrative reviews and its highest level of evidence is a contemporary paper from 2016, which was a comparative cross-sectional study; other case series were reviewed. Overall, this amounts to level 4 with a recommendation of C as per the Oxford Centre for Evidence-based Medicine Levels of Evidence.

The good, the bad and the dishonest doctor: the General Medical Council and the ‘redemption model’ of fitness to practise

Legal Studies ◽  
2011 ◽  
Vol 31 (4) ◽  
pp. 591-614 ◽  
Author(s):  
Paula Case
Keyword(s):  
Decision Making ◽  
Patient Population ◽  
General Medical Council ◽  
Medical Council ◽  
Professional Integrity ◽  
Professional Discipline ◽  
Elusive Concept

The ‘elusive’ concept of ‘impairment’ was introduced into the General Medical Council's Fitness to Practise Procedures in 2002. Its function was ostensibly to bring all forms of fitness to practise allegations against doctors under a unifying concept and thereby reduce procedural complexity. This paper strives to illuminate the application of ‘impairment’ of fitness to practise with reference to a year of fitness to practise decision making by the General Medical Council (GMC). It concludes that impairment has brought with it a redemptive style of resolving matters of professional discipline which brings significant benefits to doctors, the patient population and society as a whole, but which can also encourage a contrived exchange of remorse, insight and remediation with further implications for professional integrity and truth.

scholarly journals 108 Neck of Femur Fractures: Streamlined Approach to Improve Consenting Practices

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Brown ◽  
A Gaukroger ◽  
M Raza ◽  
R Sturley ◽  
M Arnander
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
General Medical Council ◽  
Mean Value ◽  
Medical Council ◽  
The Novel ◽  
Neck Of Femur ◽  
Consent Forms ◽  
Femur Fractures ◽  
Operative Fixation

Abstract Aim Neck of femur fractures (NOFs) are synonymous with frailty, and successful outcomes are achieved with operative fixation. The United Kingdom’s General Medical Council guidance governing consent highlights the importance of thorough pre-operative discussion of risk with the patient. We aimed to audit consenting practices in NOF patients within our unit against the British Orthopaedic Association’s (BOA) criteria, with the addition of delirium as a risk factor. Method In cycle one all operatively managed NOFs over a two-month period in October-November 2019 were retrospectively reviewed. Consent forms 1 (CF1) and 4 (CF4) were assessed against BOA-endorsed criteria. Our intervention included a standardised sticker detailing 14 important risks was introduced and a departmental seminar on delirium. A second cycle was undertaken from August-October 2020 to close the audit loop Results No consent form documented all BOA-approved risk factors in cycle one (N = 35). Of cycle two’s 35 patients, 70.8% CF1 were completed using the novel sticker. All of these had 100% BOA-approved risk documentation. Consent forms without the sticker in cycle two documented 9/14 risks (mean value). No CF4 had any risks documented in either cycle. Delirium was documented in 51% in total and in 75% patients with CF1. Delirium documentation improved from 2.9% in cycle one to 51.4% in cycle two. Conclusions Clear lapses in operative consenting processes were identified, especially regarding delirium and CF4 documentation. The introduction of a novel consent sticker drastically improved compliance with BOA guidance for CF1. Recognition and departmental education regarding delirium significantly reduced incidence between cycles.

Permission without Direction: Gross Negligence Manslaughter and Erasure following Bawa-Garba

2019 ◽  
Vol 26 (3) ◽  
pp. 183-203
Author(s):  
Nathan Hodson
Keyword(s):  
Decision Making ◽  
General Medical Council ◽  
Medical Council ◽  
Medical Practitioners ◽  
High Court ◽  
Harm To Others ◽  
Court Of Appeal

Abstract This article explores when a doctor convicted of gross negligence manslaughter would be erased from the medical register. The General Medical Council (GMC) sanctions guidance avoids directing the Medical Practitioners Tribunal (MPT) about erasure following gross negligence manslaughter and rulings at the High Court and Court of Appeal argue against any presumption of erasure after a doctor is convicted of gross negligence manslaughter. The Court of Appeal in Bawa-Garba ruled that the sanctions guidance should not be taken to guide the MPT towards erasure after “serious harm to others either deliberately or through incompetence”, but merely permits erasure in those circumstances. This approach is consistent with the rest of the sanctions guidance which allows the MPT wide discretion and defends that MPT’s case-by- case approach. This promotes decision-making behind closed doors, diminishes the Sanctions Guidance, and makes it difficult to predict when a doctor will be erased after gross negligence manslaughter.

scholarly journals Assessing the current state of quality improvement training in urology in the UK: Findings from the General Medical Council 2018 trainee survey

2020 ◽  
pp. 205141582092052 ◽  
Author(s):  
Elena Pallari ◽  
Archie Hughes-Hallett ◽  
Silia Vitoratou ◽  
Zarnie Khadjesari ◽  
Phil Cornford ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Significant Variation ◽  
General Medical Council ◽  
Cross Sectional Study ◽  
Medical Council ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Training Requirements ◽  
Current State ◽  
The Uk

Objective: The General Medical Council (GMC) of the UK has identified the need to support doctors through education in safety and quality improvement (QI) methods. This study reports findings from the GMC annual survey of 2018 from urology trainees regarding the state of QI training and their training needs. Material and methods: We designed a set of four questions to assess how QI methods are being taught nationally, and inserted them in the 2018 annual GMC trainee survey for urology. This is a cross-sectional study assessing the current state of QI training and mentoring received by trainees, and their self-assessed ability and confidence in completing a QI project as part of training requirements. Data were statistically analysed in Stata 15 stratified by Local Education Training Boards (LETBs)/Deanery and by specialty trainee level (ST3–7). Results: In total, 270 responses were received from urology trainees. Data showed significant variation across the country. Responses from ST3–7 trainees ranged from 5–20% on completing more than three QI projects, while 7–58% replied that they had done none. Across all ST grades, 40% of trainees stated they had not undertaken QI, whereas 0–27% reported they had not received any mentoring on QI to date. There was significant variation across training regions too: 11–74% of trainees answered that they have received training in QI methods, and 58–100% responded that they were confident in undertaking QI projects. Across all LETBs, 1–3% responded that they uploaded projects on national websites for dissemination; finally, a range of 0–18% stated they had completed more than three projects. Conclusion: This is the first national snapshot of QI training for the entire urology specialty in the UK. The study demonstrates wide variation in QI training and activity undertaken by trainees, and shows a lack of systematic implementation of QI education across training regions. Level of evidence: 2c

scholarly journals Review of e-portfolio requirements and methodology

2015 ◽  
Vol 5 (2) ◽  
pp. 29 ◽  
Author(s):  
Joseph Wan ◽  
Neil H Metcalfe
Keyword(s):  
Clinical Practice ◽  
Medical Practice ◽  
General Medical Council ◽  
Reflective Learning ◽  
Medical Council ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Mandatory Requirement ◽  
Writing Portfolio ◽  
The Uk

Background: Portfolios are used in medical practice as a means of instilling “reflective learning” in doctors and accumulating evidence of the doctor’s competence. It is a mandatory requirement by the General Medical Council (GMC), as a form of public accountability, for licensed clinicians to maintain an e-portfolio of daily clinical practice, which is subjected to annual appraisals and ultimately influences their ability to renew their license to practise in the UK. This article reviews the reflective learning process for which the e-portfolio is intended to instil in doctors and the level of evidence required to demonstrate competency and continuing professional development.Methods: A literature review was conducted on Medline and Google Scholar for any available guidance on writing e-portfolio entries and guidelines from the GMC, Royal Colleges and various training boards were reviewed to determine the type of evidence required to be demonstrated.Results: Fifteen articles had met the inclusion criteria on guiding e-portfolio writing. Guidelines reviewed constantly echoed the theme of “reflecting doctors” and “linking evidence to curriculum outcomes”. This article has also proposed a “Do, Reflect, Plan, Act” framework in writing portfolio entries.Conclusions: Creating and maintaining an e-portfolio throughout a lifelong career is no mean feat. We have reviewed the key components that clinicians ought to demonstrate in their e-portfolios, and introduced the “Do, Reflect, Plan, Act” framework, to enhance understanding of the e-portfolio as a learning tool to improve medical practice.

scholarly journals Cystic fibrosis newborn screening

2007 ◽  
Vol 5 (6) ◽  
pp. 158-161
Author(s):  
Emma Farrar
Keyword(s):  
Cystic Fibrosis ◽  
Decision Making ◽  
Ethical Issues ◽  
General Medical Council ◽  
Service Development ◽  
Medical Council ◽  
Local Service ◽  
North West ◽  
The North ◽  
The Right

CYSTIC FIBROSIS - Ethical issues at two extremes Emma Farrar and Jemma Smith worked as medical students with consultant paediatrician Clare Peckham at a time when services for cystic fibrosis were undergoing a transformation. Clare herself is leading the local service development. Neonatal screening for cystic fibrosis started in the North West on 1 October 2007. The right of a child to be involved in decision making concerning his or her future has recently been affirmed by the General Medical Council. These events provide the backdrop to two timely articles on the ethical issues involved in the management of a difficult illness.

Sign in / Sign up

Export Citation Format

Share Document