EPA 11: Informed Consent

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Please provide your email address (@vcuhealth.org preferred). These results will be sent to you, and can then be optionally forwarded to the student by you.

Email *

Evaluator Name *

Evaluator Level *

Student Name *

Observation Context *

Describe the complexity of the case you observed. *

0 = Not Complex: One problem, no challenging interpersonal issues on behalf of patient

1 = Somewhat Complex: More than one problem, mildly challenging interpersonal issues

2 = Complex: Several (or one complex) problems, significant interpersonal issues

EPA11: Key Functions

Key functions provide details to the specific work associated with the observed activity. Select the option that describes the student's performance of meeting each function.

E11K1: Explain informed consent, including indications, risks, benefits, alternatives, and complications *

0 – Lacks basic knowledge; provides inaccurate or misleading information; treats consent as a formality

1 – Minimally engages in consent; allows personal biases to influence discussion; only obtains consent when directed

2 – Provides general but incomplete information; requires prompting for specifics

3 – Clearly explains all key elements; ensures accuracy; views informed consent as essential to good practice

E11K2: Ensure patient and family understand the intervention
*

0 – Uses insensitive language; disregards emotional cues; dismisses need for interpreters

1 – Relies on medical jargon; communicates unidirectionally; misses emotional cues; overlooks interpreter use

2 – Self-corrects jargon; asks about patient preferences; recognizes emotional cues; enlists interpreters

3 – Avoids jargon; engages in shared decision-making; responds to emotions in real time; uses interpreters effectively

E11K3: Balance confidence and skill to reassure patients and seek help when needed
*

0 – Overconfident, does not recognize limitations, risking negative outcomes

1 – Lacks confidence, increasing patient stress, or is overconfident and erodes trust; asks questions and accepts help

2 – Struggles to convey personal limitations, requiring reassurance from supervisor; asks for help

3 – Displays confidence appropriate to skill level, reassuring patients; seeks timely help

Could this student perform EPA 11 without direct supervision now? *

Overall, is this student performing at the level of an intern?

Describe how this student can progress to the next level performing this activity.

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