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Medical students, sensitive examinations and patient consent: a qualitative review
Phillipa J Malpas1, Warwick Bagg2, Jill Yielder3
1Assoc Prof in Clinical Medical Ethics, Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland.
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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