Policy and procedures for physical examination of students by peers and tutors

Senate Request Number:  2020 UGRD-MED-04

Approved by the Undergraduate Contingency COVID-19 Committee:  July 28, 2020

Approved by the Faculty Council:  August 25, 2020

 

Purpose

The purpose of this document is to provide a student-centered approach to consent for physical examination of students by peers and tutors that is respectful of students’ privacy and to provide a clear procedure for negotiating adverse events.

Scope

This document applies to all students and faculty involved in the teaching and learning of clinical skills in the MD Program curriculum. In this document, the term “peers” refers to MD Program students.

Guidelines

  1. Examining peers is part of the Clinical skills training in the MD Program.
  2. Students and tutors may examine head, neck, and limbs typically exposed with T-shirts and shorts. Abdomen and chest (anterior and posterior) and spine exposed by removal of top layer of clothing may only be examined with students’ explicit consent and in accordance with appropriate draping procedures.
  3. Students and tutors will not be expected to examine breasts, the genitals or rectal area.
  4. Students must obtain verbal consent from peers to be examined before each physical examination encounter. Any concerns regarding consenting to peer exam in general should be discussed with the Clinical Skills Directors at the beginning of the academic year.
  5. Students may withdraw verbal consent to be examined at any time. Students are not required to disclose their reasons for withdrawing consent.
  6. Students may decline to give consent to be examined by tutors and peers. Students are not required to disclose their reasons for refusing consent.
  7. Students who refuse or withdraw consent for any component of the physical exam may discuss this decision with either their tutor or Clinical Skills Director. All parties will handle this discussion sensitively and confidentially.
  8. Students may opt to pre-select partners from within the group with whom they are comfortable.
  9. Tutors must not coerce students into consenting to be examined. They should only invite students to volunteer for demonstration purposes who have previously given consent. Any instances of perceived coercion or discomfort should be discussed with the Clinical Skills Directors.
  10. Tutors will have access to ongoing faculty development opportunities to ensure they have clear, ongoing understanding of these guidelines.
  11. Tutors shall not take a refusal of peer participation into account when considering the student’s academic performance.
  12. In the event that peer participation for physical examination is not possible within the student’s group, other avenues to ensure that student learning is not compromised will be implemented (i.e. combining groups, use of standardized patients, etc).
  13. In the event of discovery of a suspicious finding, inappropriate behaviour, or a breach in confidentiality, tutors and students will follow the adverse event procedures outlined below.

 

Adverse Events Procedures

Discovery of a suspicious finding

During physical examination of students by peers and tutors it is possible that a new concerning or suspicious finding may be discovered, for example, discovery of a mass, a heart murmur, or elevated blood pressure. The goal is to enable the student to obtain timely medical attention.

The following steps will be taken:

  • The examining student confidentially informs the examined student of the concerning or suspicious finding.
  • The examining student determines whether the student is already aware of the concerning or suspicious finding.
  • Both students confidentially inform their tutor.
  • The tutor asks permission to perform the same physical examination.
  • If the tutor confirms the concerning or suspicious finding, the tutor recommends that the student seeks medical advice.
  • The tutor reminds both students of the duty of the examining student to maintain confidentiality regarding the incident.

Inappropriate behaviour

Inappropriate behaviour, is defined  as inappropriate use of medical equipment, offensive language, or physical abuse  during physical examination of students by peers and tutors. Appropriate steps must be followed if either Tutors directly witness inappropriate behaviour or are  alerted to it by a student. The consequence for inappropriate behaviour will vary and will be determined on a case-by-case basis.

The following steps will be taken:

  • The tutor speaks to the student(s) behaving inappropriately.
  • The tutor informs the student that their behaviour is inappropriate and may be a breach of University or Faculty policy or standard.
  • For serious breaches of behaviour, the tutor contacts the course director regarding the incident.
  • The course director checks applicable policies and standards regarding the incident and takes required actions.
  • If a student has potentially been harmed by the inappropriate behavior, the tutor ensures that he or she seeks appropriate care (i.e. counseling).

Breach in confidentiality

Confidential information about a student may be revealed during history taking or physical examination. For example, students may reveal a history of medical issues, or physical examination may reveal surgical scars. It is possible in these situations that a breach in confidentiality may occur despite students being taught about the importance of confidentiality.

NOTE: Some students may willingly provide specific consent to have their physical findings used for the instruction of others, which would not breach confidentiality.

The following steps will be taken in the case of a breach in confidentiality:

  • The tutor takes the student(s) who breached confidentiality aside to speak with them.
  • The tutor informs the student(s) that sharing confidential information without consent is unacceptable and a breach of standards.
  • The tutor contacts the Clinical Skills Directors regarding the incident.
  • The Clinical Skills Director checks applicable policies and standards regarding the incident and takes required actions.
  • The tutor ensures the student whose confidentiality has been breached is informed and, if required, seeks appropriate care (i.e. counseling).
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