Experience of a peer physical examination policy within a New Zealand medical programme

Dear Sir

We read with interest the exploration of the state of play for peer physical examination (PPE) policy in Australia (Koehler & McMenamin 2014). We support the suggested policy components and would like to share aspects of a successful implementation of a faculty-wide PPE policy.

We have been using a formal policy for PPE since 2002. The process has local ethics committee approval, which is reviewed on a cyclical basis. Students are given written information about PPE and the reason for having a consent process during their introductory week at the start of the programme. This is backed up with a lecture and is discussed at the beginning of their first clinical skills learning session. Documents include a participant information sheet and students are asked to sign a consent form. We have an ‘event recording form’ which is used to record any clinical abnormality found as part of learning that requires action. Related personal and professional skills are covered in the documentation and discussions. Any unprofessional behaviour is managed through our fitness to practice policy.

The other issue raised by the Australian survey is equity and opt-out. This concern has appeared often in the literature over the last 15 years. In a multicentre study that we were part of, concerns about culture, ethnicity and religious beliefs are not borne out. Occasional student objections appear to be more individual than related to specific groups. At Auckland we tackle the issue in this way: examining as part of PPE is compulsory, being examined is voluntary. Although we use written consent, verbal consent is required at the time of examination. In our experience we find that students will engage at a level where they feel comfortable – there is heterogeneity of engagement. It is important to note that our MBChB intake shows considerable diversity – around 40% are of European origin and the majority declare ethnic and cultural identities that include Māori, Pacific, Central and Far-east Asian, African, Middle Eastern and North American.

We have more than a decade of experience in successfully applying a PPE policy, including an early validation of our approach which was cited (Wearn & Bhoopatkar 2006). It is time to stop discussing a need for policy, and to take action.

Declaration of interest: The authors report no conflicts of interest.