Medical students, sensitive examinations and patient consent: a qualitative review.

N Z Med J

Head of School, School of Medicine, University of Auckland, Auckland; Specialist Anaesthetist, Auckland City Hospital, Auckland District Health Board, Auckland.

Published: September 2018

Aim: We set out to explore the question, what ethical challenges do medical students identify when asked to perform or observe a sensitive examination, given a historical background relevant to this context.

Method: Thematic analysis of 21 Ethics Reports from 9 female and 12 male students.

Results: Overall 14 students undertook a sensitive examination without the patient's consent; three did not carry out a sensitive examination because of a lack of consent; and two students (or their senior colleagues) gained the patient's written consent for the student to undertake the examination. One patient refused the student's request for consent to perform a digital rectal examination; and in the final case, verbal consent was given by the patient for the student to observe a bimanual examination only. Three interrelated core themes arose from thematic analysis of the research question: systemic constraints on getting consent; internal conflicts of interest; and, power and hierarchy.

Conclusions: A number of senior medical students at our institution disclosed observing or performing sensitive examinations on patients without the patients' knowledge or consent.

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