Consent and provision of information — structured oral station (12 minutes)

Opening: “What are the elements of valid consent?”

Model: “I would establish capacity, voluntariness and adequate information. Capacity is decision-specific: she must understand, appreciate, reason about the options and communicate a choice. Voluntariness means free choice without pressure from me, her husband or the institution. Adequate information means the procedure, intended benefits, material risks, alternatives including no treatment, and consequences important to her. A signature is evidence, not the consent itself.” ^[3]

Probe 1: “What is the material-risk test?”

Model: “Under Rogers v Whitaker, I disclose a risk that a reasonable person in the patient's position would attach significance to, and any risk I know or should reasonably know this particular patient would attach significance to. Her fertility concern is therefore material even if the operation is already planned. I would explain consequences for ovarian function, sexual function, alternatives and the possibility of changed findings or conversion, using absolute frequencies where available.” ^[1]

Probe 2: “Her husband answers every question and she has limited English.”

Model: “I would arrange a qualified interpreter, not rely on her husband. I would speak to her directly, offer a private conversation, ask who she wants involved, and check for coercion. I would use plain language, written or visual aids, adequate time and teach-back. If she cannot explain the choice, I would adapt the discussion and defer; I would not label her incapable because of language or anxiety.” ^[3]

Probe 3: “She withdraws consent at theatre reception.”

Model: “I would stop the procedure. Withdrawal is effective at any time. I would speak with her privately, clarify the new concern without pressure, answer questions and offer postponement. If she does not freely re-consent, surgery is cancelled or deferred. I would document her words, who was present, the discussion and the plan, and notify the consultant and anaesthetist.” ^[1][3]

Probe 4: “How would you assess a patient who may lack capacity?”

Model: “Presume capacity and provide support first: interpreter, easy-read information, time, hearing aids and a trusted support person if the patient wants. Assess understanding, appreciation, reasoning and communication for this decision. If capacity remains absent, identify an applicable advance care directive, then the legally recognised substitute decision-maker or tribunal pathway; do not simply ask next-of-kin to consent.” ^[14]

Probe 5: “What about adolescents?”

Model: “A young person 16 or older in New Zealand may generally consent independently, subject to the applicable law. In Australia, an under-16 patient may be Gillick competent if sufficiently mature and understands the treatment, risks, alternatives and consequences of refusal. I would assess and document the individual adolescent's understanding, preserve confidentiality where appropriate, and involve parents supportively without replacing the adolescent's decision.” ^[15]

Probe 6: “How do advance care directives affect an incapable adult?”

Model: “I would locate and verify the directive, assess whether it applies to the present treatment and follow it where valid and applicable. If it does not resolve the decision, use the relevant state or territory substitute-decision-maker hierarchy or tribunal. In an immediate life-threatening emergency without an available decision-maker, provide necessary treatment under the doctrine of necessity and document urgency, attempts to contact a decision-maker, treatment and review.” ^[14]

Probe 7: “What must be documented?”

Model: “The record should identify indication, procedure, benefits, alternatives including no treatment, the specific material risks and the patient's particular concerns, questions and own words, capacity and voluntariness assessment, interpreter and support used, written information, teach-back, date/time, who was present, the signed form and the plan to revisit. I would record withdrawal and postponement clearly.” ^[3]