New research has revealed University of Auckland student doctors are performing sensitive examinations such as breast and genitalia check ups without patients knowing they're in training.
New research has revealed some University of Auckland student doctors are performing sensitive examinations without patients knowing they're still in training.
More than 20 students - who had worked at general practices and hospitals around the country - told researchers they felt uncomfortable with the situation and said some senior clinicians responded by saying it was too difficult to explain to "uneducated" patients.
The University of Auckland study, published in the New Zealand Medical Journal today, received 100 reports from students about patient consent which raised ethical concerns.
Of those, 21 detailed consent issues around particularly sensitive examinations - including breast and genitalia check-ups.
In 14 cases, the students performed the examination without the patient knowing they were in training. Others observed the examination without consent while some students refused to carry it out without permission.
• Students reporting patient consent often went out the window in order to maximise time and get through the theatre list.
• Students feeling discomfort when their supervisors commented that getting consent "would take forever to explain to someone [the patient] that is uneducated."
• Students terrified that their registrar could destroy their future career with a bad reference so not raising the issues.
Lead researcher associate professor in clinical medical ethics Phillipa Malpas said they wanted to publish the research because this practice was "absolutely unacceptable" and needed to stop.
She had received reports for the last eight years and each year students had reported performing sensitive examinations without consent.
"Our students are legitimate members of the medical team but of course they are in training and under supervision and it's important that patients understand that."
The University of Auckland Faculty of Medical and Health Sciences.
She said students were examining deeply personal parts of patients body and it was really important that people were aware that this kind of examination was happening, why it was happening and who was examining.
"We know that when patients are asked if a medical student could observe or perform a sensitive examination, most patients say yes but most want to be asked," Malpas said.
Chair of the New Zealand Medical Council and surgeon at Middlemore Hospital Andrew Connolly said not getting consent was technically an assault.
"You never know someone's personal situation. A woman could have been sexually assaulted earlier in the past and it might have taken everything she had to actually come to the hospital that day for an examination in the first place."
Connolly said he was shocked that 14 students had reported performing on patients who had not given consent.
"There must be explicit consent, it's unambiguous, it's mandatory, it's well known and it's just unacceptable that these patients were not given the right to consider if they were happy for the student to examine them or not."
Connolly said the patient must have the right to understand what was occuring and why and he "completely dismissed" the excuse that there wasn't enough time to get consent.
"If there is not the time, then the student cannot be involved, that's very straight forward.
"The majority are carrying out the consent process adequately but a small number of supervisors are not following the rules and that is unacceptable."
University of Auckland medical programme head Professor Warwick Bagg, one of the report's authors, said: "We're definitely concerned and that's why [we're] speaking out."
Ministry of Health chief medical officer Dr Andrew Simpson said the ministry sympathised with both the students and the patients as New Zealand overall had a very good framework for seeking and obtaining informed consent for medical examination and treatment.
"The Ministry will be working with all DHBs with responsibility for training medical students, and their Chief Medical Officers, to ensure there are good processes for obtaining informed consent and also for ensuring they follow best practice in this regard.
"Clearly there remain gaps. The honest and frank reporting by the students reinforces the value of our existing reporting systems," Simpson said.
Malpas' team published a number of recommendations to ensure this practice did not continue. Recommendations included:
• More information provided to patients and their families about the likelihood of medical and other allied health students being involved in their treatment and care under supervision.
• Increasing the emphasis on the importance of ethical leadership within the supervisory environment is critical.
• Further research to be undertaken to improve knowledge of the prevalence and type of sensitive examinations that were observed or performed without consent, including the medical settings in which such examinations took place.
