Journal of surgical education · 2026
A Procedure-Specific Consent Sticker as an Educational Tool to Improve Informed Consent Documentation by Junior Surgical Trainees: A Before-and-After Interventional Study.
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Agrawal Kapil, Kaur Jaspreet Singh, Varghese Merene, Tanveer Shumaila, Bhanuda Paashupat, Pereira Gordon, Ranger Deepak Singh, Elgaddal Sanaa
Аннотация
OBJECTIVE: To assess baseline consent documentation for laparoscopic appendicectomy against national standards and evaluate the educational impact of a procedure-specific consent sticker and targeted training programme on documentation completeness among junior surgical clinicians.
DESIGN: Before-and-after interventional educational study with two sequential study periods separated by a three-month multicomponent intervention phase comprising a procedure-specific consent sticker, targeted education sessions, and a ward reminder poster.
SETTING: A single NHS general surgical unit at a large UK district general teaching hospital (The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom), with consent obtained by foundation year doctors and core surgical trainees.
PARTICIPANTS: Consecutive adult patients (aged ≥18 years) undergoing emergency laparoscopic appendicectomy: baseline period (n = 68) and post-intervention period (n = 55). All consent was obtained by junior surgical trainees.
RESULTS: Common risks were well-documented at baseline (bleeding 98.5%, infection 95.6%). Critical deficiencies were identified for death (13.2%), adhesions (23.5%), reintervention (23.5%), and Meckel's diverticulectomy (1.5%). Following the educational intervention, adopted in 54.5% of cases via sticker use, documentation improved substantially: Meckel's 1.5%-90.9% (+89.4 percentage points), death 13.2%-58.2% (+45.0 pp), adhesions 23.5%-60.0% (+36.5 pp), and anaesthetic risk 42.6%-78.2% (+35.6 pp). Subgroup analysis showed complete documentation across all assessed domains when the sticker was used. In non-sticker cases, documentation remained high for some common risks, but important gaps persisted, including absent gynaecological risk documentation in female patients.
CONCLUSIONS: A procedure-specific consent sticker combined with targeted education substantially improved consent documentation completeness among junior surgical trainees, with the greatest gains in previously deficient medico-legally critical domains. This structured educational tool addresses a recognised training gap and offers a scalable, low-cost model for improving consent competency in surgical training programmes.
DESIGN: Before-and-after interventional educational study with two sequential study periods separated by a three-month multicomponent intervention phase comprising a procedure-specific consent sticker, targeted education sessions, and a ward reminder poster.
SETTING: A single NHS general surgical unit at a large UK district general teaching hospital (The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom), with consent obtained by foundation year doctors and core surgical trainees.
PARTICIPANTS: Consecutive adult patients (aged ≥18 years) undergoing emergency laparoscopic appendicectomy: baseline period (n = 68) and post-intervention period (n = 55). All consent was obtained by junior surgical trainees.
RESULTS: Common risks were well-documented at baseline (bleeding 98.5%, infection 95.6%). Critical deficiencies were identified for death (13.2%), adhesions (23.5%), reintervention (23.5%), and Meckel's diverticulectomy (1.5%). Following the educational intervention, adopted in 54.5% of cases via sticker use, documentation improved substantially: Meckel's 1.5%-90.9% (+89.4 percentage points), death 13.2%-58.2% (+45.0 pp), adhesions 23.5%-60.0% (+36.5 pp), and anaesthetic risk 42.6%-78.2% (+35.6 pp). Subgroup analysis showed complete documentation across all assessed domains when the sticker was used. In non-sticker cases, documentation remained high for some common risks, but important gaps persisted, including absent gynaecological risk documentation in female patients.
CONCLUSIONS: A procedure-specific consent sticker combined with targeted education substantially improved consent documentation completeness among junior surgical trainees, with the greatest gains in previously deficient medico-legally critical domains. This structured educational tool addresses a recognised training gap and offers a scalable, low-cost model for improving consent competency in surgical training programmes.