Possibility that up to a quarter of intimate examinations by trainees are conducted without consent
The ethics of intimate examinations – teaching tomorrow’s doctors BMJ Volume 326, pp 97-9
A survey of medical students in this week's BMJ suggests that as many as a quarter of the intimate examinations, which they performed on anaesthetised patients, are carried out without adequate consent from the patient.
The study was conducted after students at the University of Bristol expressed concerns that ethical guidelines requiring consent for the teaching of vaginal and rectal examinations were not always being followed.
The authors contacted 452 second, third, and fourth year students at an English medical school and asked them how many intimate examinations they had done, when in their training they had taken place, and the level of consent that had been obtained.
In a third of examinations by second-year students and half of those by third-years, students had not obtained consent from the patient and did not know whether it had been obtained by the supervising doctor. Fourth-year students, who are required to do more examinations, were more likely to have obtained consent personally. Almost a quarter of examinations on sedated or anaesthetised patients had apparently been carried out without consent.
The authors argue that this is unlikely to be the only medical school failing to meet ethical standards. "Trust and respect are essential to the doctor-patient relationship, yet this study suggests that these are missing from students' experiences of learning to do intimate examinations," they conclude.
In an accompanying editorial, University of Toronto bioethicist Peter Singer praises the authors for highlighting the problem, describes model guidelines for ethics in clinical teaching, and calls on all medical schools to implement guidelines to address the ethical challenges of medical education. His views are echoed in a commentary by Britt-Ingjerd Nesheim, who stresses that "The patient must be treated as the student's teacher, not as a training tool".