Can any med students shed some light on this article?

I came across this on reddit and was shocked to read that Doctors have supposedly allowed med students to perform pelvic exams on women while under anesthetics. Not sure how valid her argument is or what standard practice is but found it interesting. Any thoughts?


http://www.theunnecesarean.c om/blo...etized-pa.html

Originally Posted by trainspotter

Can any med students shed some light on this article?

I came across this on reddit and was shocked to read that Doctors have supposedly allowed med students to perform pelvic exams on women while under anesthetics. Not sure how valid her argument is or what standard practice is but found it interesting. Any thoughts?


http://www.theunnecesarean.c om/blo...etized-pa.html

Non-consented medical procedures... Completely against it. On one hand it allows students to have practice, but without consent it should be illegal.

Originally Posted by trainspotter

Can any med students shed some light on this article?

I came across this on reddit and was shocked to read that Doctors have supposedly allowed med students to perform pelvic exams on women while under anesthetics. Not sure how valid her argument is or what standard practice is but found it interesting. Any thoughts?


http://www.theunnecesarean.c om/blo...etized-pa.html

http://premed101.com/forums/showthread.php?t=3934 7 Same topic discussed in a Canadian context.

Apparently it used to be common practice, now it's not the case (according to one poster). Also, the original article was from someone in the states ... the practices are likely different in Canada.

Typically when students are in their 3rd year for their clerkship, we are asked to perform pelvic exams on patients who are awake during our obs/gyn rotation. In the link that you posted, they did say that the woman consented to a pelvic exam and often it's the surgeons role to determine who is assisting in the OR (in this case the med student, not sure what year she was in). Since she's undergoing a D & C she had to be under anesthetic during this time.

In my opinion, they should have been more clear about obtaining consent in this context "Would it be okay if X, a Y year medical student, performs a pelvic exam on you?". But often, they ask for consent for a procedure but not who is going to perform each task.

If you’re anesthetized and you’re in the OB/GYN department, you probably have had students practice pelvic exams on you regardless of what you’re in the hospital for - even if the procedure you need doesn’t require a pelvic exam! Additionally, while doctors don’t go to other departments — such as general surgery patients, neurosurgery patients or cardiac surgery patients — if your surgeon is an OB/GYN, odds are there’s going to be a team of hungry medical students waiting for you to fall asleep.

This sounds like BS to me. If you're going in for nose surgery or cardiac surgery, the doctor isn't going to wait for students to practice pelvic exams on the patients. If they did they'd be losing out financially as many physicians are paid partially by fee-for-service. Maybe it's different in the states.

I can probably provide more insight after this year.

Originally Posted by Lij

http://premed101.com/forums/showthread.php?t=3934 7 Same topic discussed in a Canadian context.

Apparently it used to be common practice, now it's not the case (according to one poster). Also, the original article was from someone in the states ... the practices are likely different in Canada.

Typically when students are in their 3rd year for their clerkship, we are asked to perform pelvic exams on patients who are awake during our obs/gyn rotation. In the link that you posted, they did say that the woman consented to a pelvic exam and often it's the surgeons role to determine who is assisting in the OR (in this case the med student, not sure what year she was in). Since she's undergoing a D & C she had to be under anesthetic during this time.

In my opinion, they should have been more clear about obtaining consent in this context "Would it be okay if X, a Y year medical student, performs a pelvic exam on you?". But often, they ask for consent for a procedure but not who is going to perform each task.

This sounds like BS to me. If you're going in for nose surgery or cardiac surgery, the doctor isn't going to wait for students to practice pelvic exams on the patients. If they did they'd be losing out financially as many physicians are paid partially by fee-for-service. Maybe it's different in the states.

I can probably provide more insight after this year.

But isn't the patient consenting for a doctor to perform the procedure? A medical student isn't a doctor yet and shouldn't be part of this consent. Of course I've never seen a consent form before so I don't know what words are on it.

Well one of the problems is they make you sign it do fast. I would be like I just wanna quickly read it, they get annoyed etc( Well this has happened several times in different dentist offices and one time in a hospital for a simpler procedure)

Originally Posted by jhan523

But isn't the patient consenting for a doctor to perform the procedure? A medical student isn't a doctor yet and shouldn't be part of this consent. Of course I've never seen a consent form before so I don't know what words are on it.

That seems to be the main issue. The patient did consent to a pelvic exam since it was required to make sure that everything is okay after the procedure.

I know at most centers this is included in the fine print of consent. It also commonly says that the surgeon has final decision over who will be in the OR/assisting, and the Anes has final call over anesthetic choices.

Edit:
It would be useful to know what year of medical school she was in. During clerkship you are asked to assist with procedures under the supervision of a physician.

Originally Posted by Lij

That seems to be the main issue. The patient did consent to a pelvic exam since it was required to make sure that everything is okay after the procedure.

I know, but the consent form should say who is doing the procedure even if it's as general as "a doctor"... shouldn't it? Because if you consent to have a doctor do the procedure, medical students can't do the procedure since they aren't doctors.

Originally Posted by jhan523

I know, but the consent form should say who is doing the procedure even if it's as general as "a doctor"... shouldn't it? Because if you consent to have a doctor do the procedure, medical students can't do the procedure since they aren't doctors.

Under the quoted statement before, it says that the surgeon has the final say in who is assisting with the procedure (nurses, medical students, PAs, etc) technically this would be covered. Clerks often end up doing a lot of insertions that would need consent (intubations, oral temperatures, suturing) in the OR.

As a technical note, the consent form that the patients read and sign before the procedure, it states that medical students and residents are involved in the operation and that they are signing consent for this to happen.

I still think it's best if they go over it with the patients to ensure that they understand what they're consenting to. "This is X, a 3rd year clerk, they will be assisting with your procedure".

edit:

Another comment from the G & M article

As a Staff gynecologist in one of the named institutions, I can CLEARLY indicate that the Globe article does NOT reflect accurately on the state of affairs in Canadian ORs and teaching hospitals.

Canadian women sign written consents for surgery in our institution, granting consent not only for their surgery but consent is given (or withheld) for the involvement of students in their procedures. Each OR starts (while the patient is still conscious) with a review by name of all of the persons present and their role(s) in the procedure. This extends from anesthesia to nursing to surgeons to postgraduate physician-learners and yes , to medical students.

If the patient does not meet and acknowledge the presence of a student before anesthesia, then the student is not present or performing any part of the exam or surgery.

The consent for student involvement begins with consent PRIOR to any surgical booking and is repeated in the OR prior to anesthesia. In my more than 35 years practicing medicine it has not been my experience to see an unconsented pelvic exam in the OR or clinic, and the description of a "troop of students" marching in to exam an unconscious patient is inaccurate hyperbole that does disservice to conscientious Canadian Physicians and Surgeons and medical students alike !

Many Canadian medical models for teaching pelvic exams to students have included CONSCIOUS volunteer 'teaching assistants' or 'programmed patients' who help students to learn appropriate manner and technique to aide them in learning these sensitive physical examination skills while having a dialogue with their role modelling 'patient'.

As a medical student in my clerkship at a Canadian university, I have performed many pelvic exams under anaesthesia while on my obs/gyne rotation and I would like to help make a few things as clear as possible:
- There are very rarely 2 medical students in the OR at once, usually ONE.
- It is common policy that medical students should NEVER (except in certain emergencies) participate in any operation where they have not met the patient pre-op (and explained that they will be involved). In fact, usually NO ONE is allowed into the OR who is not directly involved in the patient's care.
- Once medical students enter their clerkship (usually 3-4th year), they are still learners, but they are also expected to take on certain responsibilities. In fact, on my Obs/Gyne rotation, it was not uncommon for me to be called from less urgent duties to the OR for procedures. Procedures that could not have been performed without a student there as an assist.
- Pelvic exams under anaesthesia are an important part of most gynecologic surgeries (as are limb exams in orthopedics, and yes prostate exams for prostate surgery). A pelvic exam would never be performed for an unrelated surgery (ie. rectal surgery etc.)
- finally, it is very clearly stated, in each of our pre-op consents that medical students and residents will be involved. If patients are unaware of this that is an indication that they were poorly informed in general (although the fact they signed the consent indicates that this is not legally assault as some readers have suggested).
- The widespread lack of properly informed consent is what should be taken from the SCIENTIFIC article. This is, in itself, very troubling (yet not directly related to medical education or limited to the practice of Obs/Gyne). And this is what Mr. Picard should have focussed on.

I am a resident (doctor in training) at one of the six teaching centres in Ontario, and I completed my medical school training here as well. I have *never* performed a gynecological exam on any woman under any circumstances without having obtained consent beforehand.

In a gynecological O.R., physicians will often perform pelvic exams after induction of anaesthesia to aid in planning the surgery (eg. to help guide positioning). Occasionally, medical students will perform this exam too under the guidance of a staff physician or a more senior resident.

When I was a medical student, the staff physician always advised me, before going into the O.R., that a pelvic exam would be performed prior to the surgery. With this information, I would approach the patient before she was brought into the O.R., in order to introduce myself and explain that the staff physician would perform a pelvic exam after induction of anaesthesia. I would then ask the patient if it would be okay if I, the medical student, performed the pelvic exam as well, in order to help me learn how to do this important exam properly. Usually the staff physician was present for, or even would lead, this conversation. Most patients had no problem with this, but, of course if the patient was uncomfortable with this, I would not proceed. Of course, I can only speak to my own experience, but this is the way it is done in all gynecological O.R.s at my training centre.

Finally, I have never heard of medical students being "paraded in" to perform any medical exam without explicit consent from patients beforehand, and certainly this would never be done for pelvic exams. This was a provocative, misleading and ultimately disappointing choice of language coming from a journalist.