I was scanning my Facebook page and came across a blog post shared by my friends over at the OSATF on the issue of pelvic exams under anesthesia. While this practice is not legal in the state in which I reside, the fact of the matter is that most states don’t have laws on the books prohibiting the practice of allowing students to learn how to do pelvics on anesthetized women who have not specifically consented to the exam. It’s still apparently happening in enough hospitals that the October 2012 issue of the green journal addresses this in two opinion pieces.
I understand that educational opportunities are difficult to come by, that being able to learn a skill that’s critical to our work is a priority, but without the explicit consent of the patient to undergo any type of vaginal examination by a student while under anesthesia, we are engaging in behaviors that at best would be described as being antithetical to the ethical tenants of our professions (both medicine and nursing). Many teaching hospitals have moved to the use of Gynecological Teaching Associates (GTAs) to help build this skill set. In my nurse practitioner program, we had the option to learn on one another before being unleashed on actual patients (strictly voluntary–and also, did you know that if you mash around on someone’s ovaries long enough they will get vagal?). There are plenty of good options that can serve our educational needs better (for instance, an anesthetized patient cannot give us feedback about our technique). In forensic healthcare we have some excellent examples of educational programs using GTAs to help fulfill the clinical requirements for the sexual assault medical-forensic exam.
Here’s what the professional literature says on the issue (by date)–note that I don’t include organizational policy/position statements:
Obstet Gynecol. 2012 Oct;120(4):741-2.
York-Best CM, Ecker JL.
Obstet Gynecol. 2012 Oct;120(4):941-3.
CMAJ. 2012 Jul 10;184(10):1159-61. Epub 2012 Mar 26.
Gibson E, Downie J.
BMJ. 2012 Mar 29;344:e2426. doi: 10.1136/bmj.e2426.
J Obstet Gynaecol Can. 2010 Jan;32(1):49-53.
Wainberg S, Wrigley H, Fair J, Ross S.
Ir Med J. 2009 Nov-Dec;102(10):336-7.
Martyn F, O’Connor R.
J Health Care Law Policy. 2005;8(2):240-63.
J Okla State Med Assoc. 2005 Aug;98(8):386-8.
Schniederjan S, Donovan GK.