Teaching pelvic examinations under anaesthesia: what do women think?

OBJECTIVE: Medical students need to undertake supervised pelvic examinations to achieve competence. This experience is frequently obtained by conducting pelvic examinations on anaesthetized patients who are undergoing gynaecological surgery. Our research was carried out to determine patients' expectations of medical students performing intraoperative pelvic examinations.

METHODS: Patients at the Calgary Pelvic Floor Disorders Clinic were asked to complete questionnaires including items about who would be present in the OR, what procedures students might undertake, and whether patients would give consent for students doing pelvic exams during surgery. A sample size calculation determined that 100 questionnaires were required.

RESULTS: Completed questionnaires were received from 102 women. Their mean age was 57 years, range 21 to 91; 64 (63%) had previously undergone gynaecological surgery; 56 (55%) expected a medical student would be present during surgery; 80 (78%), wanted to be told if a medical student would be present; 19 (19%) were aware that a medical student might do a pelvic examination in the OR; 73 (72%) expected to be asked for consent before medical students undertook pelvic examinations under anaesthesia. Fifty-eight respondents (62%) said they would consent to medical students doing pelvic examinations, 5 (5%) would consent for female students only, 17 (18%) were not sure, and 13 (14%) would refuse.

CONCLUSION: The majority of patients wish to help medical students to learn but expect consent to be sought if medical students are to perform pelvic examinations on anaesthetized patients. Before introducing explicit consent in Canadian teaching centres, it will first be necessary to determine the feasibility of seeking consent specifically for this procedure.