The six elements in the ready to use consent rubric
The current catalog case uses a six element rubric grounded in AMA Code of Medical Ethics Opinion 2.1.1 and the StatPearls review of informed consent.
Assess decision making capacity
Establish that the patient can understand the options, weigh their implications, and communicate a choice. When a surrogate decides, confirm that role and start from what they understand.
Explain the diagnosis and proposed intervention
State the clinical problem in plain terms, then explain what is proposed and why the team recommends it.
Describe risks, benefits, and expected outcomes
Explain the material risks and expected benefits without minimizing harm or promising an outcome the clinician cannot know.
Discuss alternatives, including no treatment
Present reasonable alternatives as real choices and compare their risks, benefits, and likely outcomes with the proposed intervention.
Protect voluntariness
Make clear that the patient or surrogate can decide without coercion, ask for time, or decline.
Confirm understanding, questions, and the decision
Invite questions, use teach back to check the explanation, correct misunderstandings, and ask for the patient's decision.
What a program gets
Participants get feedback they can use on the next attempt, while programs review agreed individual or cohort views.
Your consent policy, scored as written
The rubric uses your element definitions, in your words, including the disclosure of who performs which parts that CMS addressed in its April 2024 hospital memo.
Feedback for the clinician and a reviewable program record
The clinician receives specific feedback after each simulated consent conversation. Under agreed access rules, a program can review a dated record alongside its other evidence.
On demand, not on schedule
Voice-based AI patient encounters available 24/7 from any device. No standardized patient to recruit, no sim center to book, no faculty observer required to practice.
Scored only where the case asked
An element is scored only where the conversation gave the clinician a chance to show it. A same-day consent that never raised a preference-sensitive alternative does not mark the clinician down for missing one.
The frameworks behind the score
Each AI patient case names the published framework or institution-defined standard used for feedback. The report shows strengths and areas for practice, with the participant's own words behind each score.
Informed consent: Consent discussion
AMA Code of Medical Ethics and StatPearlsThe ready to use rubric above has six scored elements and is attached to the current PICU central line case.
Your own consent policy
YoursSend the approved policy and procedure specific form. We use their element definitions as written.
How scoring against a framework works, including the scope rule
Frequently asked questions
How often do consent conversations actually contain all the elements?
Rarely. Across 1,057 audio-recorded clinical encounters, 9% contained all seven elements of an informed decision, and in a separate sample of 141 orthopedic surgery discussions the figure was zero (Braddock et al., JAMA 1999 and J Bone Joint Surg Am 2008). In 145 major vascular surgery cases, 45% contained all the informed consent elements and in 23% the surgeon did not discuss the basic ones (Etchells et al., Can J Surg 2011).
Which part of the conversation is usually missing?
The end of it. When 90 preoperative conversations before major cardiothoracic, vascular, oncologic and neurosurgical operations were recorded and scored, surgeons reliably described the nature of the illness, the operation, and the potential complications, and were least likely to check whether the patient had understood any of it (Journal of the American College of Surgeons, 2021).
Do patients remember what they were told?
Not for long. Adult spinal deformity patients who received both a verbal and a video risk discussion recalled a median 45% of the risks immediately afterward and 18% at six to eight weeks (Spine, 2015, n=56). That is one reason a check of understanding inside the conversation matters more than the volume of information delivered.
Is this a skill that responds to training?
Yes, with a measured effect. In a randomized trial of 122 senior medical students, consent OSCE scores rose from 61% to 71% in the trained arm against under 1% change in control, an effect size of 0.79, and the number reporting confidence obtaining consent went from 11 to 62 (BMC Medical Education, 2025). Separately, 56% of 402 emergency medicine residents reported never having had formal training on informed consent at all (Academic Emergency Medicine, 2007).
Does ClinicalSim make our consent process compliant?
No, and no vendor can. Compliance is determined by a surveyor against your own policy. What ClinicalSim does is narrower and checkable: your policy defines the elements, and the score reports whether each one appeared in the conversation, with the clinician's words attached.
Is the consent rubric validated?
No. ClinicalSim's consent rubric has not been validated against expert raters. Scores are anchored to published element definitions and verbatim transcript evidence, and agreement with faculty raters remains unmeasured.
What this page does not claim
ClinicalSim is not endorsed by, affiliated with, or approved by the ACGME or the American College of Surgeons. Scores map to published frameworks; they do not establish compliance with any standard, which a surveyor determines against the institution's own policy.
ClinicalSim output is formative. It is evidence that informs program judgment, and it is not intended for employment, credentialing, privileging, licensure, or other high-stakes decisions.
Consistency between model runs is not the same thing as agreement with expert human raters. Faculty-rater validation on a customer's own rubric is the gate before any high-stakes use, and that work has not been done.
ClinicalSim does not predict patient experience scores, readmissions, safety events, claims, or other clinical or business outcomes. Any comparison with institution-held outcome data requires a separate study plan.
Formative scores must not be used for employment decisions, discipline, compensation, credentialing, privileging, or licensure. Institutions should set access, retention, and reporting rules before staff participate.
Practicing consent conversations in simulation has not been shown to reduce claims, reduce survey findings, improve patient recall, or change any accreditation score, and this page does not claim it does. The closest published attempt improved interns' confidence discussing benefits without moving total confidence (Journal of Surgical Education, 2023).