Almost half of University of Toronto medical students say they have felt pressure from their teachers to act unethically, including being asked to perform pelvic examinations on women under general anesthesia who had not given their consent.
The survey of 103 students a year away from completing medical school is a disturbing glimpse of the kind of care patients may be getting at teaching hospitals, and not only those associated with the University of Toronto. Previous studies have identified similar problems in other medical schools, but not in as much detail.
In the survey, done three years ago, medical students at U of T complained of being asked to perform unnecessary procedures on unwary patients, including those who were comatose or unconscious.
They also said they were left to close wounds when they didn't know how, give psychotherapy sessions without supervision, complete postdelivery visits with patients who hadn't seen a doctor since giving birth, and ask patients to return for follow-up visits that were purely for teaching purposes.
Dr. Richard Frecker, the U of T's associate dean of undergraduate medical education, said that since the data was collected, changes have been implemented to let students know they don't have to comply with requests to act in a way they feel is unethical.
"It means there was a problem and I'm not suggesting we have eradicated the problem but we have certainly taken it seriously," he said.
Dr. Frecker said the study will have an impact across North America.
"I think it will stir up a lot of fuss -- and it's not just us. If this is happening here, it's happening across Canada and the U.S., I'm sure."
He said the university would proceed with disciplinary action if any of the students lodged a formal complaint, but said so far that hasn't happened.
Dr. Frecker seemed surprised that the paper is being published in today's edition of the British Medical Journal.
The study is accompanied by an editorial calling for a new policy on the rights of patients being treated in teaching hospitals. Both the editorial and the research study suggest that these kinds of incidents are not unique to the University of Toronto.
"Our study's premise was that the prevalence and the nature of medical students' ethical dilemmas need to be recognized and understood as a first step in resolving them," says the paper.
It was prepared by four doctors and a medical student.
It found that 47 per cent of 103 students interviewed reported they had felt pressure to act unethically very frequently, frequently or occasionally.
More than 60 per cent said they had witnessed a doctor training them acting unethically.
The study consisted of both a survey and follow-up focus groups, and the researchers say they found three distinct categories of ethical dilemmas:
The first involved conflicts between patient care and the student's education, for example, being asked by doctors who were teaching them to perform pelvic exams without the patient's permission.
The second category involved situations in which the students felt their responsibilities exceeded their capabilities and included having doctors refuse to respond to their requests for help in assessing patients.
The third category involved incidents in which students felt they were providing substandard care. These included being instructed by a doctor to repair a child's scalp with inappropriate supplies and being part of a team that secretly administered intravenous drugs to a woman who had requested a narcotic-free vaginal delivery of her baby.