Obtaining Consent for Educational Pelvic Exams Under Anesthesia: Patient Perspectives [ID: 1337224

Abstract

INTRODUCTION: Historically, procedural education on pelvic exams has included students performing them on anesthetized gynecologic surgical patients—oftentimes, without the patient's explicit consent. What constitutes acceptable consent in this situation? We surveyed patients on minimally acceptable methods of obtaining verbal consent for a medical student to perform a pelvic exam while a patient is under general anesthesia (EUA). METHODS: Our study population was Vanderbilt University Medical Center gynecology outpatients 18+ who had no history of gynecologic surgery under anesthesia nor planned surgery of this kind in the future. Patients were screened for eligibility via chart and then approached at clinic. If they agreed to participate, they received a secure REDCap survey to submit an anonymous response. RESULTS: Overall, 31 patients received surveys and 21 responses were collected (response rate 67%). Results demonstrated patients are willing to participate in educational exams and consider informed consent via verbal discussion to be critically important. Among these respondents there was consensus the surgeon is the ideal person to lead discussion. A resident was acceptable, but a medical student alone was considered unacceptable by significant portion of respondents (38.1%). Free text responses indicated chaperoning or supervision of a medical student was of great importance, both during consent process and exam. Respondents indicated multiple time points (before and day of surgery) and locations (office and in hospital) were ideal, but day of surgery was acceptable. Finally, there was consensus language used to describe the exam should be specific and detailed; generalizations or omissions were considered unacceptable, not just unideal. CONCLUSION: Responses suggest informed consent discussion before pelvic EUA with student and supervising educator present is highly important to these participants and should be as detailed and specific as possible. Additionally, these results agree with prior evidence that this discussion would not likely cause patients to decline to participate in EUAs.