Medical students learning intimate examinations without valid consent: a multicentre study

Abstract

This study aimed to explore medical students' explanations of their behaviour when instructed to observe or perform intimate examinations or procedures without valid patient consent. We used a qualitative design employing individual and group interviews to elicit narratives of dilemmas associated with professionalism. Qualitative thematic analyses of narratives were followed by a qualitative and quantitative analysis using a validated coding scheme of students' explanations of their behaviours within dilemmas involving intimate examinations carried out without valid consent. Participants (n=200) were medical students drawn from each academic year of three medical schools, representing two 5-year undergraduate programmes and one 4-year graduate-entry programme in England, Wales and Australia. Of 833 narratives collected, 112 involved dilemmas associated with intimate examinations. Of these, 63% (n=71) described dilemmas which came about because students were instructed to observe or perform intimate examinations or procedures without valid consent. A total of 82% (n=58) involved students complying with instructions and contained 349 distinct explanations. Thirteen narratives described cases in which students had refused to comply and contained 84 explanations. A high proportion of explanations of compliance included statements by students that they 'had to' observe or perform the examination or procedure. Explanations of compliance behaviours significantly downplayed the intentionality of actions, whereas explanations of refusal emphasised intentionality (χ(2)=14.225, d.f.=2, p=0.001). Despite clear policies at each school, students in all schools observed or performed intimate examinations or procedures without having gained valid consent from the patient. Faculty development initiatives are clearly essential to help clinical teachers put intimate examination policy into practice.