26 January 2011

Consent still an issue for intimate medical examinations

Medical students need to learn how to perform intimate examinations and procedures in order to conduct them competently and safely for the benefit of future patients. However, medical students are still being asked by senior clinicians to conduct or observe intimate examinations without valid patient consent, new research from the Universities of Dundee and Cardiff suggests.

In 2003 the British Medical Journal published the results of a survey at one UK medical school which showed 24% of intimate examinations of anaesthetised patients recalled by students had been undertaken without valid consent.

The new research, published in the journal Medical Education and funded by the British Academy, is based on group and individual interviews with hundreds of students at three medical schools - two in the UK and one in Australia.

It shows that despite the medical schools having developed comprehensive policies, students are still being placed in the same situation. It also shows that most students still feel unable to refuse such requests.

'We suspect that this problem is common across the clinical workplace, affecting medical schools across the UK and elsewhere,' said Professor Charlotte Rees, of the Centre for Medical Education at the University of Dundee.

'There are many factors playing into this, but among them, our data suggests that there is a cultural acceptability of students learning intimate examinations without valid consent within the clinical workplace that ultimately serves to legitimise and reinforce these unethical practices.

'We know from our findings that policy alone is insufficient to prevent ethical breaches involving intimate examinations in workplace learning. There is a gap between policy and practice which needs to be understood and tackled more effectively.

'Policy developers have to ensure that all clinical teachers with responsibilities for helping students learn intimate examinations know what the policy is and put that policy into practice.'

Although considerable cultural variation exists in terms of which parts of the body are considered `intimate’, the researchers focused on three main body regions for what they regarded as 'intimate examinations' - the female breasts; the genital and groin regions of males and females including the female pelvic organs; and the rectum of males and females including the prostate of males.

The researchers are currently conducting an online survey of UK medical students to explore their dilemma experiences in terms of learning with patients, including the learning of intimate examinations to establish the prevalence of this type of dilemma across the UK and its emotional impact on medical students.

Students can access this online survey at: Questionnaire. Medical students can also join their Facebook Group.

NOTES TO EDITORS

A copy of the full research paper is available on request.

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