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Comment & Response
May 14, 2018

Redefining Informed Consent as Part of Consent Training in Pediatrics—Reply

Author Affiliations
  • 1Division of Pediatric Anesthesiology, Department of Anesthesiology, Michigan Medicine, Ann Arbor
  • 2Michigan Institute for Clinical and Health Research, Michigan Medicine, Ann Arbor
  • 3Division of Pediatric Hematology-Oncology, Department of Pediatrics and Communicable Diseases, Michigan Medicine, Ann Arbor
JAMA Pediatr. Published online May 14, 2018. doi:10.1001/jamapediatrics.2018.0925

In Reply We thank Jones et al for their thoughtful comments regarding our Viewpoint1 and appreciate their insight into this important topic. Although we agree with most of their comments and thank them for reaffirming our concern regarding consent obtained by nonparticipant trainees, we do not fully endorse the assertion that “regardless of the extent of formal training, consent needs to be learnt by apprenticeship, much like the procedure itself.” While we agree that learning by apprenticeship for procedures and treatments is the norm, these are typically taught by individuals who have been formally trained and have the requisite expertise. In contrast, in the absence of standardized training programs, consent is often “taught” through observation of others, many of whom do not have the requisite understanding and/or appreciation of the consent process. In this regard, we agree with pediatrician and bioethicist Steven Joffe, who tweeted in response to our article that “we don't do enough to train physicians in the art & science of seeking informed consent. See one, do one, teach one isn’t good enough.”2 Thus, while we do not dismiss the value of apprenticeship learning for obtaining informed consent, we respectfully submit that standardized formative training for all trainees should be the first step in the process. A solid grounding in informed consent is not only important for the individual practitioner but will also increase the likelihood that good practices are passed on to others.

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