Scenario Analysis: This scenario is professionally challenging because it requires a breast oncology surgeon to balance the imperative of providing evidence-based care with the practical realities of resource limitations and the need for timely patient intervention. The surgeon must synthesize complex, often conflicting, evidence to make critical decisions about treatment pathways, while also considering the potential impact of delays on patient outcomes and the ethical obligation to provide the best possible care within existing constraints. This necessitates a robust understanding of risk assessment methodologies and their application in clinical decision-making. Correct Approach Analysis: The best professional approach involves a systematic risk assessment that prioritizes evidence synthesis for established treatment pathways while concurrently identifying and evaluating emerging or less established interventions based on their risk-benefit profile and the strength of supporting evidence. This approach begins by thoroughly reviewing high-level evidence (e.g., meta-analyses, systematic reviews, large randomized controlled trials) for standard-of-care treatments. For novel or less common approaches, it involves a critical appraisal of lower-level evidence, considering factors such as study design, sample size, and potential biases. The surgeon then integrates this synthesized evidence with patient-specific factors (stage of disease, comorbidities, patient preferences) to construct a personalized clinical decision pathway. This method aligns with the ethical principle of beneficence by ensuring that treatment decisions are grounded in the most reliable available evidence, while also acknowledging the need for a nuanced approach to rapidly evolving fields like breast oncology. It also implicitly addresses the principle of non-maleficence by carefully considering the risks associated with less proven interventions. Regulatory frameworks in professional credentialing and medical practice emphasize the importance of evidence-based decision-making and the continuous evaluation of treatment efficacy and safety. Incorrect Approaches Analysis: One incorrect approach involves solely relying on the most recent, high-impact publications without a comprehensive synthesis of the broader evidence base. This can lead to the adoption of interventions that appear promising in isolated studies but lack robust validation across multiple trials or in diverse patient populations, potentially exposing patients to unproven risks or suboptimal outcomes. This fails to meet the standard of diligent evidence synthesis and can violate the principle of non-maleficence. Another incorrect approach is to exclusively adhere to established protocols without critically evaluating new evidence that might offer superior outcomes or reduced toxicity. While adherence to guidelines is important, a static approach can lead to the underutilization of beneficial advancements, potentially contravening the principle of beneficence by not offering patients the best available care. This also fails to demonstrate the continuous learning and adaptation expected of a credentialed specialist. A further incorrect approach is to prioritize patient preference or anecdotal evidence over a rigorous assessment of the scientific literature. While patient autonomy is crucial, it must be informed by sound medical evidence. Basing decisions primarily on personal anecdotes or strong patient preferences without a thorough risk-benefit analysis grounded in evidence can lead to the selection of treatments that are not only ineffective but potentially harmful, representing a significant ethical and professional failing. Professional Reasoning: Professionals should adopt a framework that begins with a comprehensive understanding of the existing evidence landscape for breast oncology surgery. This involves actively seeking out and critically appraising systematic reviews, meta-analyses, and high-quality clinical trials. When considering novel or less established interventions, a structured risk assessment should be employed, evaluating the strength of evidence, potential benefits, and known or theoretical risks. This evidence should then be integrated with patient-specific factors through shared decision-making. Professionals should maintain a commitment to continuous learning, regularly updating their knowledge base and critically evaluating new research to refine their clinical decision pathways. This iterative process ensures that patient care remains at the forefront of scientific advancement while upholding ethical obligations and professional standards.

This scenario is professionally challenging because it requires a nuanced understanding of the purpose and eligibility criteria for Applied Breast Oncology Surgery Consultant Credentialing, balancing the need for rigorous standards with the practicalities of ensuring qualified professionals can obtain necessary credentials. Misinterpreting these criteria can lead to either the exclusion of deserving candidates or the credentialing of individuals who may not meet the required expertise, potentially impacting patient care and institutional reputation. Careful judgment is required to apply the credentialing framework consistently and fairly. The correct approach involves a thorough review of the applicant’s documented surgical experience, peer evaluations, and evidence of specialized training directly relevant to applied breast oncology surgery. This aligns with the fundamental purpose of credentialing, which is to verify that an individual possesses the necessary knowledge, skills, and experience to provide safe and effective patient care within a specific specialty. Eligibility is determined by meeting predefined standards that reflect current best practices and the complexity of the procedures involved. This systematic evaluation ensures that only those who have demonstrated proficiency and commitment to the field are granted consultant status, thereby upholding the quality of care and patient safety. An incorrect approach would be to grant credentialing based solely on the applicant’s general surgical board certification without specific verification of their applied breast oncology surgery experience and outcomes. This fails to acknowledge that applied breast oncology surgery is a subspecialty requiring distinct expertise beyond general surgical competence. It overlooks the purpose of specialized credentialing, which is to identify individuals with advanced skills and a focused practice in this area, potentially leading to suboptimal patient management. Another incorrect approach would be to prioritize the applicant’s seniority or years in practice over demonstrable competency in applied breast oncology surgery. While experience is valuable, it is not a substitute for specific, verifiable expertise in the subspecialty. Credentialing is about current competence and specialized skill, not merely longevity in the profession. This approach risks credentialing individuals who may not have kept pace with the evolving techniques and knowledge in applied breast oncology surgery. A further incorrect approach would be to rely on informal recommendations or anecdotal evidence of surgical skill without requiring objective documentation and peer review. Credentialing processes are designed to be systematic and evidence-based. Informal endorsements lack the rigor necessary to objectively assess an applicant’s qualifications and can be influenced by personal relationships rather than professional merit, undermining the integrity of the credentialing process and potentially compromising patient safety. Professionals should employ a decision-making framework that prioritizes adherence to established credentialing policies and guidelines. This involves a systematic review of all submitted documentation, objective assessment of qualifications against defined criteria, and a commitment to transparency and fairness throughout the process. When in doubt, seeking clarification from credentialing bodies or experienced colleagues is advisable, always with the ultimate goal of ensuring patient safety and the highest standards of care.

Scenario Analysis: This scenario is professionally challenging because it requires the surgeon to balance the immediate need for effective hemostasis and tissue dissection with the long-term implications of energy device usage on patient outcomes and the potential for unintended thermal injury. The selection of an energy device is not merely a technical choice but one that carries significant responsibility for patient safety and the quality of surgical care. Careful judgment is required to align the device’s capabilities with the specific operative field characteristics and the surgeon’s expertise. Correct Approach Analysis: The best professional practice involves a comprehensive pre-operative assessment of the operative field, considering tissue type, vascularity, and the specific surgical goal (e.g., dissection, coagulation, sealing). This assessment informs the selection of an energy device whose parameters (e.g., energy type, power setting, waveform) are most appropriate for the task, minimizing collateral thermal spread and optimizing efficacy. This approach is correct because it prioritizes patient safety by proactively mitigating risks associated with energy device use, aligning with the fundamental ethical principle of non-maleficence and the regulatory expectation for evidence-based, patient-centered care. It also reflects a commitment to utilizing technology judiciously and effectively. Incorrect Approaches Analysis: Selecting an energy device based solely on surgeon preference or familiarity without a thorough assessment of the operative field risks suboptimal performance and increased potential for complications. This approach fails to consider the specific needs of the patient and the nuances of the surgical site, potentially leading to excessive thermal damage or inadequate hemostasis, which are regulatory and ethical failures. Choosing an energy device based on the perceived speed of operation, without regard for its safety profile or suitability for the tissue type, disregards the principle of patient safety. Rapid tissue transection or coagulation achieved through excessive energy can lead to deeper thermal injury, nerve damage, or delayed wound healing, violating the duty of care. Utilizing an energy device without confirming its proper functioning or understanding its specific settings for the current procedure introduces an unacceptable level of risk. This oversight can result in unpredictable energy delivery, leading to unintended burns, bleeding, or damage to adjacent structures, which constitutes a significant breach of professional responsibility and regulatory compliance. Professional Reasoning: Professionals should employ a systematic decision-making process that begins with a thorough pre-operative evaluation of the patient and the surgical site. This includes understanding the characteristics of the tissue to be manipulated, the presence of critical structures, and the desired surgical outcome. This information should then be used to select the most appropriate surgical technique and instrumentation, including energy devices. A critical component of this process is staying abreast of current evidence regarding the efficacy and safety of different energy devices and their application in specific surgical contexts. When in doubt, consulting with colleagues or seeking further training is a responsible course of action.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for rigorous credentialing to ensure patient safety with the potential for bias or arbitrary application of policies. The consultant’s career progression and the institution’s commitment to quality care are at stake. Navigating the nuances of blueprint weighting, scoring, and retake policies demands a thorough understanding of the credentialing body’s framework and ethical obligations. Correct Approach Analysis: The best professional practice involves a meticulous review of the candidate’s application against the established credentialing blueprint, paying close attention to how each component is weighted and scored. This approach ensures that the evaluation is objective, fair, and directly aligned with the defined requirements for the Applied Breast Oncology Surgery Consultant credential. Adherence to the documented weighting and scoring mechanisms prevents subjective interpretation and upholds the integrity of the credentialing process, which is a fundamental ethical and regulatory expectation for professional bodies. This systematic evaluation minimizes the risk of bias and ensures that decisions are based on merit and documented criteria, aligning with principles of due process and fairness inherent in professional credentialing. Incorrect Approaches Analysis: One incorrect approach involves prioritizing the candidate’s extensive experience and reputation over the specific scoring criteria outlined in the credentialing blueprint. While experience is valuable, it does not negate the requirement to meet the defined benchmarks for knowledge, skills, and competency as stipulated by the blueprint. Failing to adhere to the established weighting and scoring can lead to an inconsistent and potentially unfair assessment, undermining the credibility of the credentialing process and potentially exposing patients to inadequately vetted practitioners. This approach risks introducing subjective bias and deviates from the regulatory framework that mandates objective evaluation against defined standards. Another incorrect approach is to grant an automatic waiver of certain blueprint components due to the candidate’s perceived seniority or previous accomplishments. Credentialing policies, including those related to blueprint weighting and scoring, are designed to ensure a consistent level of competence across all applicants. Circumventing these established procedures without a clear, documented, and justifiable rationale (e.g., a specific policy exception clearly defined within the regulations) introduces arbitrariness and can be seen as a failure to uphold the regulatory framework governing credentialing. This can create a perception of favoritism and erode trust in the fairness of the process. A further incorrect approach is to apply a more lenient scoring threshold for this specific candidate without a documented policy change or a clear, objective justification that aligns with the credentialing body’s guidelines. Retake policies are typically established to provide a structured pathway for candidates who may not initially meet the required standards, ensuring they have opportunities to demonstrate competence. Deviating from these policies for an individual applicant, without a transparent and equitable basis, violates the principle of consistent application of rules and can be interpreted as a breach of ethical conduct and regulatory compliance. Professional Reasoning: Professionals should approach credentialing decisions by first thoroughly understanding the specific credentialing blueprint, including its weighting and scoring mechanisms, and any associated retake policies. This involves a commitment to objective evaluation based on documented criteria. When faced with a candidate who may not meet all criteria, the decision-making process should involve consulting the established policies for any provisions for appeals, re-evaluation, or retakes. If a deviation from standard procedure is contemplated, it must be supported by a clear, documented rationale that is consistent with the overarching regulatory framework and ethical principles of fairness and due process. Transparency and consistency are paramount in maintaining the integrity of the credentialing process.

Scenario Analysis: The scenario presents a common challenge in credentialing for specialized medical fields like applied breast oncology surgery. The core difficulty lies in balancing the need for rigorous evaluation of a candidate’s preparedness with the practicalities of their current professional commitments and the dynamic nature of medical knowledge. Ensuring that a candidate has adequately prepared for the credentialing process, particularly concerning resources and timelines, is crucial for patient safety and the integrity of the credentialing body. A rushed or inadequate preparation can lead to a candidate failing to demonstrate the required competencies, while an overly rigid timeline might unfairly disadvantage a deserving candidate. Correct Approach Analysis: The best approach involves a proactive and personalized consultation with the credentialing body’s administrative or credentialing committee. This approach is correct because it directly addresses the candidate’s specific situation and seeks guidance from the authoritative source on the credentialing requirements. It allows for a clear understanding of the expected resources (e.g., specific literature reviews, case study preparation, simulation requirements) and recommended timelines tailored to the applied breast oncology surgery specialty. This aligns with ethical principles of transparency and fairness in the credentialing process, ensuring the candidate is fully informed and has a reasonable opportunity to meet the standards. It also demonstrates a commitment to due diligence and a professional attitude towards the credentialing requirements. Incorrect Approaches Analysis: Relying solely on general online forums or anecdotal advice from colleagues is professionally unacceptable. This approach fails to acknowledge the specific and potentially evolving requirements of the credentialing body for applied breast oncology surgery. Online forums may provide outdated or inaccurate information, and colleague advice, while well-intentioned, may not reflect the precise standards or expectations of the credentialing committee. This can lead to misinformed preparation, wasted effort, and ultimately, a failure to meet credentialing criteria, potentially jeopardizing patient care by allowing an inadequately prepared individual to practice. Assuming that prior surgical fellowship training automatically covers all credentialing requirements without specific verification is also professionally unsound. While fellowship training is foundational, credentialing bodies often have specific modules or assessments designed to evaluate competencies directly relevant to applied breast oncology surgery, which may go beyond the general scope of a fellowship. This assumption can lead to a candidate being unprepared for specific aspects of the credentialing assessment, risking failure and undermining the credentialing body’s mandate to ensure specialized expertise. Waiting until the last possible moment to begin preparation, assuming that the credentialing process is a formality that can be completed quickly, is a significant professional failing. Applied breast oncology surgery is a complex and rapidly advancing field. Adequate preparation requires dedicated time for reviewing current literature, understanding evolving surgical techniques, and potentially engaging in simulation or case review. A last-minute approach suggests a lack of seriousness and respect for the credentialing process and the responsibilities associated with specialized surgical practice, potentially compromising patient safety. Professional Reasoning: Professionals facing credentialing should adopt a systematic and proactive approach. The first step is always to consult the official guidelines and requirements provided by the credentialing body. If any ambiguity exists, direct communication with the credentialing committee or administrative staff is paramount. This ensures clarity on expectations regarding resources and timelines. Subsequently, a realistic preparation plan should be developed, allocating sufficient time for each component of the assessment. Regular self-assessment and seeking feedback from mentors or supervisors can further refine preparation. This structured decision-making process prioritizes accuracy, thoroughness, and ethical conduct, ultimately safeguarding both the professional’s career and the well-being of patients.

This scenario presents a professional challenge due to the inherent complexities of assessing a surgeon’s competency in a specialized field like breast oncology surgery. Credentialing requires a rigorous, objective evaluation that balances patient safety with the need to allow qualified professionals to practice. The challenge lies in moving beyond superficial metrics to a comprehensive understanding of a surgeon’s actual clinical performance and judgment, particularly in high-stakes situations. Careful judgment is required to ensure that the credentialing process is fair, thorough, and aligned with established professional standards and regulatory expectations for patient care. The best approach involves a multi-faceted review that prioritizes direct evidence of clinical performance and peer assessment. This includes a thorough examination of operative logs, focusing on the complexity and outcomes of breast oncology procedures, alongside a detailed review of anonymized case studies and morbidity/mortality conferences. Crucially, this approach incorporates direct peer review by experienced breast oncology surgeons who can critically evaluate surgical technique, decision-making, and adherence to best practices. This method is correct because it directly addresses the core competencies required for breast oncology surgery, aligns with the principles of evidence-based medicine, and fulfills the ethical obligation to ensure that credentialed surgeons possess the necessary skills and judgment to provide safe and effective patient care. Regulatory frameworks for credentialing typically emphasize the need for objective, verifiable data and peer evaluation to support decisions, thereby protecting the public. An approach that relies solely on the number of procedures performed without qualitative assessment is professionally unacceptable. This fails to account for the complexity of cases, the surgeon’s decision-making process, or the actual outcomes achieved. It is a superficial metric that does not guarantee competency and could lead to the credentialing of a surgeon who may be technically proficient in simple cases but lacks the judgment for complex oncological challenges, posing a risk to patients. Such an approach would violate the spirit and often the letter of credentialing regulations that mandate a thorough evaluation of a practitioner’s ability to provide care. An approach that solely considers positive patient feedback without objective clinical data is also professionally flawed. While patient satisfaction is important, it is not a direct measure of surgical skill or clinical judgment in oncology. A surgeon might receive positive feedback for bedside manner but lack the necessary technical expertise or oncological knowledge. This approach neglects the critical need for clinical validation and peer assessment, which are fundamental to ensuring surgical competence and patient safety, and would fall short of regulatory requirements for objective evaluation. Finally, an approach that defers entirely to the surgeon’s self-assessment without independent verification is inadequate. Self-assessment can be a useful component of professional development, but it is inherently subjective and cannot replace objective evaluation by peers and review of clinical data. Relying solely on self-reporting would bypass the essential oversight mechanisms designed to protect patients and uphold professional standards, representing a significant ethical and regulatory failure. Professionals should employ a decision-making process that begins with understanding the specific credentialing requirements for the specialty. This involves identifying the key clinical and professional competencies, gathering objective evidence of performance (operative logs, outcomes data, peer reviews), and critically evaluating this evidence against established standards. When faced with ambiguous information or potential gaps, professionals should seek further clarification, engage in deeper peer review, and consider a probationary period or additional training if necessary, always prioritizing patient safety and adherence to regulatory and ethical guidelines.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexities of assessing surgical risk in the context of credentialing. Balancing the need for thorough evaluation with the efficient processing of applications requires a nuanced approach. The consultant’s surgical history, while informative, must be interpreted within the broader framework of patient safety, evidence-based practice, and the specific requirements of the credentialing body. Misjudging risk can lead to either the unnecessary exclusion of a qualified surgeon or, more critically, the credentialing of an individual who may pose an undue risk to patients. This necessitates a systematic and objective risk assessment process. Correct Approach Analysis: The best professional practice involves a comprehensive review of the applicant’s surgical outcomes data, benchmarked against established national or institutional quality metrics for similar procedures. This approach is correct because it directly addresses the core of surgical credentialing: ensuring competence and patient safety. By comparing the applicant’s performance to peer averages and established benchmarks, one can identify statistically significant deviations that warrant further investigation. This aligns with regulatory requirements for credentialing bodies to establish objective criteria for assessing physician competence and to ensure that only qualified individuals are granted privileges. Ethically, this method prioritizes patient well-being by relying on objective data to inform decisions, rather than subjective impressions or isolated incidents. Incorrect Approaches Analysis: Focusing solely on the number of complications, irrespective of their severity, type, or the complexity of the cases treated, is an insufficient approach. This fails to account for the inherent risks associated with certain procedures or patient populations, and it does not provide context for the complications. Regulatory frameworks typically require a more sophisticated analysis than a simple count. Excluding an applicant based on a single adverse event without a thorough investigation into the circumstances surrounding that event is also professionally unacceptable. Credentialing processes must allow for due process and a comprehensive review of all contributing factors, including patient comorbidities, surgical complexity, and adherence to established protocols. This approach risks penalizing a surgeon for an isolated incident that may have been unavoidable or due to factors beyond their control, failing to meet ethical standards of fairness and due process. Relying primarily on anecdotal feedback from colleagues without corroborating objective data is another professionally unsound approach. While peer review is a component of credentialing, it should supplement, not supplant, objective outcome measures. Anecdotal feedback can be subjective and prone to bias, and it does not provide the rigorous, data-driven evidence required by most regulatory bodies for credentialing decisions. Professional Reasoning: Professionals involved in credentialing should adopt a systematic, data-driven approach to risk assessment. This involves: 1. Defining clear, objective criteria for evaluation, aligned with regulatory requirements and best practices. 2. Gathering comprehensive data, including surgical outcomes, complication rates, and peer review feedback. 3. Benchmarking performance against relevant national or institutional standards. 4. Conducting thorough investigations into any identified outliers or adverse events, considering all contributing factors. 5. Documenting the entire assessment process and the rationale for the final decision. This structured approach ensures fairness, objectivity, and a primary focus on patient safety, thereby meeting both regulatory and ethical obligations.

This scenario is professionally challenging because it requires balancing the surgeon’s experience and judgment with the need for comprehensive, documented patient safety measures. The core tension lies in ensuring that operative planning is robust enough to mitigate risks without becoming overly rigid or dismissive of emergent intraoperative findings. Careful judgment is required to anticipate potential complications and develop strategies to address them, while also maintaining flexibility to adapt to the realities of the surgical field. The best approach involves a structured operative plan that explicitly identifies potential risks and outlines specific mitigation strategies. This plan should be developed collaboratively with the surgical team and communicated clearly. It should include contingency plans for common or significant anticipated complications, such as specific techniques for managing unexpected bleeding, anatomical variations, or tumor extension. This approach is correct because it aligns with the ethical principles of beneficence (acting in the patient’s best interest by proactively addressing risks) and non-maleficence (avoiding harm by preparing for potential adverse events). Furthermore, it supports professional accountability and transparency, as a documented plan serves as evidence of due diligence and adherence to best practices in patient care. This structured planning is a cornerstone of modern surgical credentialing and quality improvement initiatives, emphasizing a proactive rather than reactive stance on patient safety. An approach that relies solely on the surgeon’s extensive experience without detailed, documented planning for specific risks is professionally unacceptable. While experience is invaluable, it does not negate the need for a systematic, team-based approach to risk assessment and mitigation. This failure to document specific risk mitigation strategies can lead to inconsistencies in care, particularly if different team members have varying interpretations of how to manage a complication. It also hinders post-operative review and learning, making it difficult to identify systemic issues or areas for improvement. Another unacceptable approach is to create an overly detailed and inflexible plan that does not allow for intraoperative adaptation. While thoroughness is important, a plan that rigidly dictates every step without considering the dynamic nature of surgery can be detrimental. If the plan is so prescriptive that it discourages or prevents the surgical team from responding appropriately to unexpected findings, it can lead to suboptimal outcomes or even harm. This approach fails to acknowledge the inherent uncertainties in surgery and the critical need for experienced judgment in real-time decision-making. Finally, an approach that delegates risk assessment and mitigation solely to junior members of the surgical team without direct senior surgeon oversight is also professionally unacceptable. While fostering learning is important, the ultimate responsibility for patient safety and operative planning rests with the credentialed surgeon. Insufficient oversight can lead to the omission of critical risks or the development of inadequate mitigation strategies, jeopardizing patient well-being. Professionals should employ a decision-making framework that prioritizes a comprehensive, collaborative, and documented operative plan. This involves a thorough pre-operative assessment, identification of potential risks specific to the patient and the procedure, development of clear mitigation strategies, and open communication with the entire surgical team. The plan should be a living document, allowing for informed adjustments based on intraoperative findings, but always guided by the principles of patient safety and evidence-based practice.

This scenario presents a significant professional challenge due to the inherent unpredictability of intraoperative findings during breast oncology surgery. The surgeon must balance the immediate need for decisive action with the ethical and regulatory imperative to obtain informed consent and ensure patient safety. The complexity arises from the potential for unexpected pathology that may necessitate a deviation from the pre-operative plan, requiring rapid assessment and communication. Careful judgment is paramount to avoid compromising patient care or violating established professional standards. The best professional practice involves a structured approach to intraoperative decision-making that prioritizes patient safety and adherence to ethical principles. This includes a clear protocol for managing unexpected findings, which involves pausing to reassess the situation, consulting with the surgical team, and, if feasible and necessary, communicating with the patient or their designated representative to obtain consent for any significant deviation from the original surgical plan. This approach aligns with the fundamental ethical principle of patient autonomy and the regulatory requirement for informed consent, ensuring that the patient is aware of and agrees to the course of treatment, even when it evolves during surgery. It also reflects best practices in crisis resource management, emphasizing clear communication and systematic problem-solving under pressure. An approach that proceeds with a significant deviation from the pre-operative plan without attempting to inform the patient or their representative, assuming the patient would consent, represents a failure to uphold the principle of informed consent. This bypasses the patient’s right to make decisions about their own body and treatment, potentially leading to ethical breaches and regulatory non-compliance. Similarly, delaying necessary surgical intervention due to an inability to reach the patient or representative, when the patient’s well-being is clearly at risk and a reasonable course of action is evident, could be considered a failure to act in the patient’s best interest, potentially violating the duty of care. Proceeding with a radical procedure that was not discussed or contemplated pre-operatively, even if technically feasible, without any attempt at further consent, disregards the patient’s right to understand and agree to the extent of surgical intervention. Professionals should employ a decision-making framework that includes: 1) Pre-operative preparation and risk assessment, including discussing potential intraoperative scenarios and obtaining broad consent for anticipated variations. 2) Intraoperative vigilance and team communication, fostering an environment where concerns can be raised and discussed openly. 3) A clear protocol for managing unexpected findings, which may involve pausing, reassessing, consulting, and, crucially, attempting to obtain further informed consent if the deviation is significant and time/patient condition permits. 4) Documentation of all decisions and communications.