Medical students, sensitive examinations and patient consent: a qualitative review.

Aim: We set out to explore the question, what ethical challenges do medical students identify when asked to perform or observe a sensitive examination, given a historical background relevant to this context.
Method: Thematic analysis of 21 Ethics Reports from 9 female and 12 male students.
Results: Overall 14 students undertook a sensitive examination without the patient's consent; three did not carry out a sensitive examination because of a lack of consent; and two students (or their senior colleagues) gained the patient's written consent for the student to undertake the examination. One patient refused the student's request for consent to perform a digital rectal examination; and in the final case, verbal consent was given by the patient for the student to observe a bimanual examination only. Three interrelated core themes arose from thematic analysis of the research question: systemic constraints on getting consent; internal conflicts of interest; and, power and hierarchy.
Conclusions: A number of senior medical students at our institution disclosed observing or performing sensitive examinations on patients without the patients' knowledge or consent.
Competing Interests: Dr Merry chairs the Health Quality and Safety Commission and is Head of the School of Medicine.