Updated policy about consent for pelvic exams in Canada needs revision

An updated policy guiding pelvic examinations of women under anesthetic in Canada has created a gap in terms of consent, states an analysis in CMAJ (Canadian Medical Association Journal).

The Society of Obstetricians and Gynaecologists of Canada and The Association of Professors of Obstetrics and Gynaecology of Canada released an updated policy statement in September 2010 about consent for pelvic examinations performed on women under anesthetic. The updated statement is more specific, referring to exams performed by "medical students" whereas the previous statement referred to "medical trainees," a more comprehensive term than includes both students and residents.

In recent years, there has been media criticism of the practice that medical schools allowed pelvic exams by medical trainees without explicit consent from patients. Many women did not know that a medical trainee might conduct a pelvic exam while they were under anesthetic for a gynecologic procedure. A 2009 study indicated that only 19% were aware that a medical student might conduct a pelvic examination, and 72% thought they would be asked to consent.

The updated statement, while it does require explicit consent regarding medical students, does not include residents, which means some women are actually less protected than before regarding consent for educational examinations.

"With the replacement of the 2006 practice guideline by the 2010 policy statement, a substantial gap was created," write professors Elaine Gibson and Jocelyn Downie, Health Law Institute, Dalhousie University, Halifax, Nova Scotia. "Residents are subject to fewer requirements with respect to pelvic examinations for teaching purposes than are medical students, but there is no logical or legal justification for this. When conducting pelvic examinations for educational purposes, residents should be subject to the same requirements as set out for medical students in the 2010 policy statement."

The authors conclude that the statement should be updated to include both groups, or an additional statement should be drafted that covers residents.