Canada OB-GYNs Now Require Explicit Consent for Pelvic Exams

The Society of Obstetricians and Gynaecologists of Canada issued the following press release on September 15, 2010.

OTTAWASept. 15 /CNW/ - Featured in the September edition of the Journal of Obstetrics and Gynaecology Canada is a revised joint policy statement developed by the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Association of Professors of Obstetrics and Gynaecology of Canada (APOG) that provides clear guidelines regarding the performance of pelvic examinations by medical students.

Regardless of the specialty that medical students choose to pursue, as health-care practitioners, they need to learn to perform pelvic examinations. These assessments are an integral part of a complete physical examination, any gynaecological visit and are fundamental to planning any gynaecological medical or surgical intervention.

While the use of standardized patients and models can be effective in teaching medical students, the best means of consolidating the knowledge acquired is to examine a patient in a real clinical setting.

“Most patients are willing to participate in medical education. What this new policy statement does is make it clear that patients must be aware of, understand, and consent to the involvement and roles of medical students in the care they are going to receive”, said Dr. André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada.

Many women undergoing pelvic surgery may not be aware of the role medical students play, or of the importance of performing a pelvic examination at the time of surgery. This joint policy statement clearly outlines the requirement for physicians and students to be explicit about student participation.

The sensitive nature of pelvic examinations makes it challenging to teach and to learn. This is why it is so important that medical students perform these exams only under the supervision of an appropriately qualified health-care professional.

Although the previous guideline stated that patients should be informed when medical students are involved in performing a pelvic examination under anaesthesia, this document goes further to ensure that patient consent is explicit.  Dr. Alan Bocking, President of the Association of Professors of Obstetrics and Gynaecology of Canada, stated that “we want to ensure an environment whereby the student receives the best possible training, under the watchful eye and expert guidance of an experienced health-care professional, and the patient receives the highest quality of care possible.”

 

The new clinical guidelines clearly address expectations of medical students and their supervisors, as seen in this excerpt.

OBTAINING INFORMED CONSENT TO PELVIC EXAMINATIONS PERFORMED BY MEDICAL STUDENTS

1. On Patients in Clinical Settings (in-patient wards, out-patient clinics, and birth units)

Medical students must introduce themselves to patients and identify themselves as medical students. If a student will be performing a pelvic examination, he or she must explain the procedure that will be performed and seek the patient’s permission to perform the examination. Patient consent must be voluntary and not coerced.

2. On Patients Under Anaesthesia During Surgery

All members of the gynaecologic surgical team (including medical students, residents, and fellows) are expected to introduce themselves to the patient before her gynaecologic surgery. Medical students must identify themselves as medical students, and they must explain that they will be assisting in the surgery. As part of the surgical consent, patients should be informed that pelvic examinations will be performed by members of the gynaecologic surgical team following the induction of anaesthesia and before initiation of surgery. Verbal consent for a medical student to be part of the surgical team and to perform an examination under anaesthesia should be obtained and documented. Patient consent must be voluntary and not coerced. When possible, a discussion about the teaching environment in the operating room should take place with the patient in the office when she signs consent for surgery.

In summary, in out-patient clinics, in-patient settings, and birth units, medical students must introduce themselves and identify themselves as medical students to the patient. Verbal consent from the patient is required before a pelvic examination is performed.

When pelvic examinations are to be performed during surgery while a patient is under anaesthesia, medical students must introduce themselves and identify themselves as medical students to the patient before the surgery. Consent for the pelvic examination under anaesthesia by the gynaecologic surgical team, including the medical student, must be obtained.

Pelvic examinations under anaesthesia should not be the primary means of teaching pelvic examinations to medical students, and students must not be brought into the operating room solely to perform a pelvic examination on an anaesthetized patient.

 

The Globe and Mail reported that the Society of Obstetricians and Gynaecologists of Canada and the Association of Professors of Obstetrics and Gynaecology of Canada revised their policy on pelvic exam consent as a direct result of public outcry from earlier this year.

 

We’re still waiting for someone to send in a .jpg of a consent form which specifically states that medical students will perform pelvic exams, etc., while patients are under general anesthesia. Anyone?