Clinical Decision-Making Case: Pediatric Sexually Transmitted Infections and Consent
Correspondence should be addressed to Emily Drone, MD at EDrone@ies.healthcare
DOI: https://doi.org/10.21980/J8.52335
ABSTRACT:
Audience: This clinical decision-making case for the Certifying Board Exam is designed for emergency medicine residents at all training levels (PGY1 through PGY4).
Introduction: Navigating consent for pediatric patients in the emergency department (ED) presents unique ethical and legal challenges. Physicians must understand parental consent requirements and the relevant exceptions that apply in the ED. Studies indicate that residents may lack confidence or knowledge in handling complex or nuanced consent scenarios, particularly regarding adolescents.1 We aimed to develop a structured educational intervention to address this gap. This clinical decision-making case aims to improve resident competency and comfort in managing these situations.
Educational Objectives: By the end of this case the learner will be able to: 1) demonstrate competency with the new ABEM Certifying Exam Clinical Decision-Making Case format, 2) manage a simulated pediatric care encounter that requires navigating the details of pediatric consent, 3) explain common exceptions to requiring parental consent in emergency situations according to established guidelines as well as state and local laws, 4) report increased comfort managing ethical dilemmas related to pediatric consent in the ED.
Educational Methods: This educational activity utilizes the new Clinical Decision-Making Case format for the American Board of Emergency Medicine Certifying Board Exam. This method simulates realistic ED encounters where residents must gather information, apply ethical and legal principles, and make decisions regarding pediatric consent under time constraints, similar to the new structure used in the board certification process for emergency medicine physicians. Additionally, a short presentation accompanied the debrief of this session to highlight the relevant clinical learning points.
Research Methods: We administered pre- and post-intervention surveys assessing self-perceived comfort (using Likert scales) and objective knowledge (using multiple-choice questions) regarding pediatric consent, as well as comparing audience vs. participants experience. This study was approved by the Baylor Research Institute Institutional Review Board, approval number 025-322. Informed consent was obtained from all participants electronically.
Results: Thirteen EM residents (PGY1-PGY3) participated in this activity. In the presurvey, only 30.8% of residents reported to be somewhat or very comfortable, while in the post survey, 100% reported to be somewhat or very comfortable with pediatric consenting. When asked to evaluate the learning value of the case, 76.9% selected very valuable and 15.4% selected valuable.
Discussion: This clinical decision-making case provides a standardized, active learning method to address emergency medicine residency training regarding pediatric consent, which has previously been identified as an area of difficulty for EM trainees. 1 The format allows for assessment of not just knowledge, but also application, communication, and ethical reasoning. Providing specific, constructive feedback immediately following the session is crucial for maximizing educational benefit.
Topics: Clinical decision-making case, board certification, pediatrics, ethics, legal.
