When Halifax medical resident Tyler Johnston was a student at Dalhousie University, he was assigned to perform a pelvic exam on a pregnant patient. But he ran into a problem: The patient said no.In what he says is standard practice for medical students who perform pelvic exams (among countless other procedures), the trainee is expected to get patient consent first, though that has never been officially spelled out.
Now, the Society of Obstetricians and Gynaecologists of Canada and the Association of Professors of Obstetrics and Gynaecology of Canada has revised its policy on pelvic exams performed by medical students to explicitly say that consent is required. Until Wednesday's revision, the policy only stated that patients should understand and be aware that trainees may perform exams.
This policy change, says André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, is a reaction to news that caused a public outcry earlier this year.
Fewer than one in five women were aware that a student might do a pelvic exam in an operating room, according to a poll of 102 women conducted at Calgary Pelvic Floor Clinic, published in the Medical Post and the Journal of Obstetrics and Gynecology. In another poll conducted by the researcher, Sara Wainberg, a doctor in training at Foothills Hospital in Calgary, 72 per cent of medical students surveyed said they had performed exams on unconscious patients without consent.
Medical professionals and students reacted negatively to the reports, suggesting that was not the case in their hospitals or training programs.
"I think it was blown a bit out of proportion and it gave graphic pictures of a bunch of medical students running around and doing pelvic exams on other surgical patients. That's not happening in Canada," Dr. Lalonde says.
Pelvic exams performed in operating rooms are rare, Dr. Johnston adds. In most cases, medical students perform them in a family doctor's office, an obstetrics and gynecology office or in the emergency room.
When patients enter a training hospital, they sign off that they understand they may be attended to by medical trainees. This updated policy, Dr. Lalonde says, is meant to prompt physicians to remind patients before surgery that they may be examined by a gynecological team that includes a medical student.
Dr. Lalonde says no research has been done into how patients feel about participating in medical education, but finds that "there are very few people refusing [co-operation]when they try to explain why it's important to have medical students or medical trainees learn how to do gynecological exams."
When Dr. Johnston's patient refused undergo an exam, he understood why: Some patients prefer female examiners; others want as few people involved in the exam as possible.
He welcomes the policy change, though he says it doesn't change what has always been standard practice for him.
"An attempt to make anything more explicit and more clear is a step in the right direction."