In February, Ubel et al reported that 90% of medical students at four Philadelphia-area medical schools performed pelvic examinations on anesthetized patients for educational purposes during their obstetrics/gynecology rotation. Although trumpeted as proof that physicians are lax in securing permission, the study was not clear on the matter of consent. Caldicott et al reported in January that 53% of students at a single English medical school performed pelvic or rectal examinations on anesthetized patients. Students acted without any written or oral consent in 24% of the exams.Research in the United States, Canada, and Great Britain has shown that the unauthorized use of women is not confined to 1 or 2 medical schools. Using anesthetized patients before surgery to teach abnormal anatomy “has long been practiced.” Women are also used to teach normal anatomy. As late as 1992, Beckmann found that 37.3% of US and Canadian medical schools reported using anesthetized patients to teach pelvic exams.
“It’s a crucial teaching point to see how a procedure is done, what the pathology is, and to tie that to the pelvic exam,” said Dr. Purdon of the Arizona Health Sciences Center in Tucson.
In Dr. Purdon’s view, patients who get treated at a teaching hospital “should already know that it’s not just one single doctor who’s taking care of them.”
Although the practice of performing pelvic exams on paid volunteers has gained popularity in some institutions over the last 15 years, physicians are never going to get enough paid volunteers to adequately teach students, he said.As an educator, “it’s frustrating for me that people who want to go to university centers for the latest treatments and technology pick apart something that’s an area of importance,” he said.It’s common in a teaching situation for a medical student, one or two residents, and a faculty person to compose a surgical team. It’s not as if 12 medical students are in the operating room examining the anesthetized patient, he said.
Preventing a competent pregnant woman from leaving the hospital under these circumstances is no less egregious than compelling her to have an abortion. Forcing additional intrusive care upon her, such as unwanted vaginal exams or cervical assessments, is legally-sanctioned digital rape.