Understand the importance of informed consent
Learner Task: You decide with the patient to treat her abnormal uterine bleeding with a levonorgestrel intrauterine device. Consent the patient for an IUD placement.
Educator Checklist: IUD Informed Consent
Mark the appropriate column to indicate whether the learner included each element in his or her response. When completed, tally the “Included” column to calculate the learner’s score.
| Included =1 | Not Included =0 | |
| Clearly states the procedure for which consent is requested | ||
| Correctly discusses the indication for the procedure | ||
| Correctly states the benefits of the procedure | ||
| Reviews the potential risks of the procedure | ||
| Offers alternatives for the procedure, including no intervention | ||
| Discusses post-procedure expectations | ||
| Clearly introduces self, including role on team | ||
| Establishes rapport with patient | ||
| Uses accessible language and explains medical terminology where appropriate | ||
| Invites patient questions | ||
| Avoids responses implying judgment | ||
| Avoids false reassurances | ||
| Listens without interrupting | ||
| Verifies patient understanding |