Blog Post about Med Students doing Exams

[MarissaNicole]

on unconcious patients....

http://www.theunnecesarean.com/blog/...etized-pa.html

This entry rubs me the wrong way because it implies that this is a common practice - I would doubt that it is.

Do I think med student exam unconscious patients... I'd say its more likely that the med student is in the room for the procedure and then if something is remarkable the doctor shows the student. I'd hate to think its a common practice to perform exams on unconscious patients.

[MissCrabette]

I think I remember reading that this used to be pretty common, especially in Canada, but I think they've wizened up since. Of course, I could be very wrong and they're probably still doing it.

[medpedspouse]

IT was practiced as recently as the late 70s. However, no reputable teaching hospital would ever allow this. In addition, there are so many other ways to learn how to do a pelvic exam that IF hospital staff are still utilizing this method, it is not only unethical but an antiquated form of education.

[SoonerTexan]

There was another post on here about this sometime in the past year. That freaks me out, though.

[MissCrabette]

Here's another article from 2010 that talks about this. http://www.theglobeandmail.com/life/...rticle1447337/

And here's a comment supposedly from one of the authors of the study mentioned in the article:

I'm one of the authors of this study, and I want to thank you all for your comments. I agree with much of what was said here.

To clarify a few things:

I've never seen a group of med students enter the OR to practice a pelvic exam. Generally it's one student, who has met the patient, been involved with the case, and is assisting with the surgery. This doesn't make it right, but it's perhaps a bit less horrifying than the article made it sound.

Most medical schools do use highly-paid female models, as well as anatomical manniquins, to initially teach students how to do a pelvic exam. We did the study at the University of Calgary, where such a program has been in existence for years. However, once a student has done the skill several times on a manniquin and once or twice on a paid model, they do need to practice it on many real women to become skilled. So this is not a practice that just occurs in a few unenlightened places without proper teaching programs- it is widespread. Dr Wainberg and I trained at two different schools in two different provinces (Ontario and Alberta), and both had this experience. Her brother, who sparked the idea for the study, had the same experience in Newfoundland. And when we polled our Calgary Family Medicine residents, who come from med schools across Canada as well as in other countries, the majority had been asked to do a pelvic exam on an anaesthetized patient at some point in their training.

To those who advise simply avoiding teaching hospitals: here in Calgary, all four of our hospitals are teaching sites. Patients don't always have a choice.

We are delighted that the Globe has brought our paper to the attention of the general public- informed patients who ask pointed questions will help put an end to this practice. We hope that the publication of the article in Canada's leading gynecological journal will help as well- if we can reassure gynecologists that most patients would give consent if asked, they may start asking.

[GrayMatterWife]

Performing an unnecessary, unauthorized medical procedure involving the touching of a patient is assault, at least under state law in the US. It is both civilly actionable and criminally prosecutable. I seriously doubt the patient pre-authorized the nurse to allow a med student to perform an unnecessary OB/Gyn exam while she was unconscious.

Unrelatedly, half the medical students I've been exposed to during OB/Gyn exams are the ones who are unconscious. Very unimpressed, with the exception of one guy.

[scrub-jay]

DH told me that his school does all practice exams on standardized (actor) patients. If they have an OB/GYN preceptor, they may do the exam under the guidance of the Dr. with permission from the patient. He says that performing a completely unnecessary procedure without consent is not only unethical, but also illegal. There are cases where it is legal to perform procedures without consent (ie: when a patient arrives in the ER unconscious) but the example in the article would never be condoned. I don't have any experience at other med schools, but DH's school takes ethics and bedside manner very seriously.

[Deebs]

Where DH went to med school, it was ABSOLUTELY on standardized patients. These people actually kind of guided the students a bit as they were doing the exam. Any of the institutions where I have work would have thought it grossly unethical to do this on unconscious patients. There is a ton of regulation involved with medical education in the US, and this is not something that would fall within those regulations.

[SoonerTexan]

Anyway, several of you here know which med school dh attended - so I'm not sure how things have changed over the last 8+ years there.

I guess I'll let you know when DH get's there.

[MissCrabette]

He said that while he was in medical school it was common practice before a transvaginal hysterectomy for the attending present to allow the medical students and/or residents to perform practice pelvic exams on the unconscious patients right before the surgery. He said the reasoning was that they were going to have to do a pelvic prior to the surgery anyway - so why not make it a teaching moment. No lining up to my knowledge. And, he said he had no idea if the patients ever consented to this prior to the surgery

That's basically what I was told as well. That this happens in OB/GYN cases where they would have to do a pelvic exam anyway and that the consent is given, though not necessarily explicitly. What I mean by that is that most likely the patient signs a paper that says she consents to the medical team treating her (that includes the student) to examine her. The picture of students lined up at the door to do pelvic exams is grossly exaggerated.

[Michele]

One of my vet classmates made extra money by being the practice patient. She was one of the actors. She tried to get me to do it. No way! At UF they used hired "patients" for all that stuff (prostate, oelvics). Funny aside, the main dude who did the prostate teaching, was a known undergrad professor and was known to offer up outside "practice."

[medpedspouse]

Funny aside, the main dude who did the prostate teaching, was a known undergrad professor and was known to offer up outside "practice."

Ugh - I hate hearing about stuff like this. Totally unacceptable in the standardized patient world. Perhaps they were just people the school hired not true standardized patients who followed the Association for Standardized Patient Educator guidelines.

[Michele]

Yeah, he was probably just hired via the university like my friend was. He wasn't pushy or anything with the med students, but he *was* rather weird (per Russ).