Pelvic Exams Under Anesthesia

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.

Pelvic examinations under anesthesia: a teachable moment.

York-Best CM, Ecker JL.

 

Obstet Gynecol. 2012 Oct;120(4):941-3.

Practicing pelvic examinations by medical students on women under anesthesia: why not ask first?

Barnes SS.

 

CMAJ. 2012 Jul 10;184(10):1159-61. Epub 2012 Mar 26.

Consent requirements for pelvic examinations performed for training purposes.

Gibson E, Downie J.

 

BMJ. 2012 Mar 29;344:e2426. doi: 10.1136/bmj.e2426.

Canadian trainees could be accused of “battery” for performing pelvic examinations under anaesthesia, say legal analysts.

Kermode-Scott B.

 

J Obstet Gynaecol Can. 2010 Jan;32(1):49-53.

Teaching pelvic examinations under anaesthesia: what do women think?

Wainberg S, Wrigley H, Fair J, Ross S.

 

Ir Med J. 2009 Nov-Dec;102(10):336-7.

Written consent for intimate examinations undertaken by medical students in the operating theatre–time for national guidelines?

Martyn F, O’Connor R.

 

J Health Care Law Policy. 2005;8(2):240-63.

Autonomy suspended: using female patients to teach intimate exams without their knowledge or consent. (FREE FULL-TEXT)

Wilson RF.

 

J Okla State Med Assoc. 2005 Aug;98(8):386-8.

Ethics versus education: pelvic exams on anesthetized women.

Schniederjan S, Donovan GK.