Medical students continue to be involved in legally and ethically concerning intimate examination practices
Terra pericolosa was the cartographical term used to denote dangerous land — regions likely to put travellers in jeopardy. Despite the degree of governance and regulation in modern health care,1,2,3 medical literature,4 student‐authored ethics reports5,6 and the media7 continue to document medical students being involved in legally and ethically concerning intimate examination practices. This article summarises the ethico‐legal aspects of medical student involvement in patient care, and reviews international best practice and the factors which influence why medical students continue to find themselves in terra pericolosa situations.
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- 1. Medical Board of Australia. Sexual boundaries in the doctor–patient relationship. Melbourne: MBA, 2018. https://www.medicalboard.gov.au/codes-guidelines-policies/sexual-boundaries-guidelines.aspx (viewed Jan 2021).
- 2. Medical Board of Australia. Good medical practice: a code of conduct for doctors in Australia. Melbourne: MBA, 2020. https://www.medicalboard.gov.au/codes-guidelines-policies/code-of-conduct.aspx (accessed Jan 2021).
- 3. Breen KJ, Cordner SM, Thomson CJ. Good medical practice: professionalism, ethics and law. 4th ed. Canberra: Australian Medical Council Limited, 2016.
- 4. Rees CE, Monrouxe LV. Medical students learning intimate examinations without valid consent: a multicentre study. Med Educ 2011; 45: 261–272.
- 5. Pascoe R, Campbell J. An ethical dilemma: Informed consent, balancing patient dignity and medical student participation in sensitive examinations. N Z Med J 2018; 131: 13–15.
- 6. Malpas PJ, Bagg W, Yielder J, Merry AF. Medical students, sensitive examinations and patient consent: a qualitative review. N Z Med J 2018; 131: 29–37.
- 7. Noyes J. Medical student acquitted of sexual assualt over ‘practice’ genital exam. The Sydney Morning Herald 2020; 11 Aug. https://www.smh.com.au/national/nsw/medical-student-acquitted-of-sexual-assault-over-practice-genital-exam-20200807-p55jjs.html (viewed Jan 2021).
- 8. Beauchamp TL. Informed consent: its history, meaning, and present challenges. Camb Q Healthc Ethics 2011; 20: 515–523.
- 9. Coldicott Y, Pope C, Roberts C. The ethics of intimate examinations — teaching tomorrow’s doctors. BMJ 2003; 326: 97–101.
- 10. Australian Law Reform Commission. Equality, capacity and disability in Commonwealth laws (ALRC Report 124). Review of state and territory legislation. Consent to medical treatment. https://www.alrc.gov.au/publication/equality-capacity-and-disability-in-commonwealth-laws-alrc-report-124/10-review-of-state-and-territory-legislation-2/consent-to-medical-treatment/ (accessed Jan 2021).
- 11. Australian Commission on Safety and Quality in Health Care. Australian Charter of Healthcare Rights. https://www.safetyandquality.gov.au/consumers/working-your-healthcare-provider/australian-charter-healthcare-rights (accessed Jan 2021).
- 12. Bagg W, Adams J, Anderson L, et al. Medical students and informed consent: a consensus statement prepared by the Faculties of Medical and Health Science of the Universities of Auckland and Otago, Chief Medical Officers of District Health Boards, New Zealand Medical Students’ Association and the Medical Council of New Zealand. N Z Med J 2015; 128: 27–35.
- 13. General Medical Council and Medical Schools Council. Achieving good medical practice: guidance for students. London: GMC, 2016. https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/student-professionalism-and-ftp/achieving-good-medical-practice (viewed Jan 2021).
- 14. McGurgan P, Calvert KL, Narula K, et al. Medical students’ opinions on professional behaviours: the Professionalism of Medical Students’ (PoMS) study. Med Teach 2020; 42: 340–350.
- 15. Cassell EJ. Consent or obedience? Power and authority in medicine. N Engl J Med 2005; 352: 328–330.
- 16. Mid Staffordshire NHS Foundation Trust Public Inquiry. Final report. London: The Stationery Office, 2013. https://webarchive.nationalarchives.gov.uk/20150407084231/http://www.midstaffspublicinquiry.com/report (viewed July 2021).
- 17. General Medical Council. Ethical hub. Speaking up. https://www.gmc-uk.org/ethical-guidance/ethical-hub/speaking-up (viewed Jan 2021).
- 18. University College London Medical School. Raising concerns. https://www.ucl.ac.uk/medical-school/current-mbbs-students/qa-enhancement-unit/raising-concerns (viewed Jan 2021).
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