Survey Says?

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We’re hearing from our clinician readers and we seem to have a clear verdict. ‘Encouraging’ female medical/medical technicians to have transvaginal ultrasounds as part of the learning experience is probably not legit.

From TPM Reader CL

I’m a neurologist with a Masters of Public Health, and I spend a fair amount of my time in both clinical research and teaching of medical students, residents, and other trainees.

The article about Valencia State College is disturbing on a number of levels, so thanks for bringing this up. Clearly, whatever was happening there was terrible. In analyzing it, several points strike me.

First, students always should freely give consent for any procedure they are being asked to undergo for teaching, research, or any reason. This is no big deal for things that impose no burden on a student – fairly obvious for something like using a stethoscope to listen to breathing patterns. But in something that is invasive such as a transvaginal ultrasound, a participant must be able to give or decline consent. Free consent requires absence of coercion or the implication of coercion. If a researcher wants to use a particular population in a study — e.g. children, adult students, prisoners – one has to establish why there is no undue coercion for these individuals who may not realize or agree that participation is optional. There are even appropriate safeguards that prevent excess compensation as a form of coercion. E.g. if students from a different college were asked to participate in this education, and were paid a lot of money, this might be seen as coercive, particularly if there were medical risks to such a procedure (in the case of the ultrasound, there do not appear to be significant medical risks from the procedure, but it is clearly quite invasive). All of these same ideals should hold to an educational program, and I don’t see how they can remove the implication of coercion in students within the program.

In this school’s case, there is also no way to remove the idea that students who participate may be favored compared to those who deny consent. Further, any burden from teaching exams should be equitable among students, and the vaginal ultrasounds clearly impose an undue burden to the women in this school, as men are not being asked to undergo this procedure. There is also no real compelling reason why practitioners need to have procedures done on themselves to be good at this. We do not expect this of heart surgeons.

For these reasons, administration at this school should have stopped this long ago.

Though medical students do not typically learn ultrasound, teaching more invasive types of exams is challenging. Patients often do not want more invasive exams performed than is necessary – particularly for vaginal or rectal exams. These are often taught on patients in hospitals with students rotating with more experienced physicians, and some medical schools hire “standardized patients” who are willing to have such exams as part of teaching, and they are compensated for this. Of course, there has to be a lot of oversight to avoid the pitfalls above.

Meanwhile TPM Reader JB is a bit more to the point …

The fact that you have to ask an “Honest Question” suggests to me that we are approaching end-times. Let me answer your question thusly: And how were the male sonography students supposed to gain an understanding of the procedure: colonoscopy? They didn’t encourage “students.” They encouraged FEMALE students. RED FLAG! In med school, there were women who volunteered to help us learn about the pelvic exam when we did it the first time. These women were heroes.

I have no idea, but, I will bet you dinner that a good portion of the instructors are men.

Finally TPM Reader CB has a slightly different take but ends up with the same conclusion …

I’ve been through everything from phlebotomy training all the way through nursing school. Yes, med professionals practice on each other all the time.

Phelbotomy and IV training, you had to do at least 10 sticks, draw blood and do hemoglobin, urine, and glucose testing and give injections. Most students let themselves get stuck, but if someone couldn’t, they didn’t really have to. Some people have a severe vasovagal reaction to getting stuck. No punishment if you didn’t do it. But lots of us were willing guinea pigs and volunteered to get stuck scores of times. That’s the only way you can learn something like that, by doing it.

Nursing school — yeah, all the time. We had a class where we teamed up to do an entire physical exam head to toe.

Breast exam, EKG, pelvic, rectal, eye ear nose throat and everything in between. You couldn’t pass the class if you or your partner didn’t complete it, meaning, the examiner and the examinee.

About this vaginal ultrasound though. There should be no repercussions if the student didn’t want the invasive procedure practiced on them. I didn’t read just what kind of punishment they received. But a sonogram usually isn’t invasive. Yes, they should have the sonogram on their belly or whatever, to see what it’s like, which is the usual practice, but they shouldn’t have to submit to an invasive vaginal sonogram.

Somebody will volunteer, trust me. Somebody always will volunteer. And that’s the purpose of the training: to learn how to DO it. It’s extra added fun to learn how the patient feels.

My 2¢.

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