Medical students and intimate examinations: What affects whether a woman will consent?

Abstract

Objective: Undergraduate medical students often struggle to gain satisfactory competence levels in intimate examination. What factors increase the likelihood of a woman allowing a student to perform an intimate examination?

Methods: Questionnaires were given to women attending a tertiary gynecology hospital. Women were asked a series of questions about what would influence their decision to agree to be examined by a student. Demographic data and data on previous gynaecological history and preferences on any student who might see them in clinic. We asked women to indicate their willingness to agree to vaginal examination (but not to undergo the examination).

Results: Age, parity or civil status or the source of the request did not affect willingness to have a vaginal examination. The woman’s hypothetical agreement was positively affected by the student’s gender (female) and age (preferring older students); positively affected by an informal/relaxed manner and smart presentation, and positively by whether the woman had experienced gynecology clinics before. An association existed between being willing to be examined and whether the student had engaged with the woman by finding out what her presenting complaint was.

Conclusions: Women’s willingness to agree to vaginal examination is influenced by several student-related factors, some modifiable.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

Dr Ellayne Fowler, Co-Director of the Teaching and Learning for Health Professionals, University of Bristol, undertook the free-text content analysis presented in this article.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

Intimate examinations: Can be embarrassing or distressing for patients and whenever you examine a patient you should be sensitive to what they may think of as intimate. This is likely to include examinations of breasts, genitalia and rectum, but could also include any examination where it is necessary to touch or even be close to the patient.

https://www.gmc-uk.org/guidance/ethical_guidance/30200.asp

Informed consent: How a patient learns about and understands the purpose, benefits, and potential risks of a medical examination or intervention and then agrees to have the examination or treatment.

Barriers: Processes which might affect an individual’s ability to provide substantial informed consent (such as content and readability of the consent form, timing of discussion, and amount of time allotted to the process).

Notes on contributors

Alexander J. Armitage, MB ChB, DTM&H, DCH(SA), DRCOG, MRCPCH, is a paediatric registrar training in south-east London. He graduated from the University of Bristol and worked for a year in Obstetrics and Gynaecology in London, gaining the Diploma of the Royal College of Obstetricians and Gynaecologists. He has an interest in medical education.

David J. Cahill, MD, FRCPI, FRCOG, FHEA, is a Professor in Reproductive Medicine and Medical Education in Bristol Medical School, where he has been the lead in the undergraduate medical program for the past 9 years. His clinical research is in infertility and his educational research is in novel ways to add value to the curriculum.