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

Abstract

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.