Simulation and Consent

I wanted to blog briefly on two very separate topics, simulation and consent in pediatrics. We have a few educational simulations in pediatric anesthesia to play out rare situations such as cardiac arrest or local anesthetic toxicity. The way these simulations are done is interesting because we keep repeating the same scenario over and over again (with each resident playing a different role). The purpose is for us to assimilate the algorithms of treatment into our muscle memory so that if the rare situation arises, we won't be completely off guard. At first, I wasn't sure this was the best way of using simulation - after all, wouldn't it be more educational to do lots of different cases? But after doing the same thing over and over, the actions ("Resume chest compressions, give 10mcg/mg epinephrine IV, what are the possible H's and T's?") become boring because we're so familiar with them, and that's what you want in an emergency.

On a completely different note, being in pediatrics reminds me how complex consent can be. For adult procedures, consent is (fairly) simple; for the most part, patients can understand what to expect with anesthesia and decide whether to have it. But for kids, surrogate decision makers have to determine the best course of action. What do you do when a child refuses something the parents want (pretty much any surgery for a toddler)? What if it's a teenager? What do you do if one parent desires something that the other declines? Is a phone consent as good as an in-person consent (and is the fact that the parent isn't present for their child's surgery an indication of anything?). There are the legal black-and-white answers and then there are practical ones. For example, one child undergoes a procedure requiring blood transfusions and his father is a Jehovah's witness - how do we approach that situation? Legally, we can (and should) transfuse if medically indicated, but how do we broach the topic with the parents? There are many nuances I'm learning as I work with kids.