Resolution: S-20-25: SOMA ENCOURAGES THE AOA TO ADOPT THE GUIDELINE OF SPECIFIC INFORMED CONSENT FOR SENSITIVE EXAMS UNDER ANESTHESIA FOR EDUCATIONAL PURPOSES

[Valerie Lile]

1  WHEREAS, Patient consent is critical to patient care; and

2  WHEREAS, Physicians, residents, and medical students have a duty to respect the autonomy of
3  patients; and

4  WHEREAS, Sensitive exams are defined as pelvic exams, rectal exam, clinical breast exam, urogenital
5  exams¹; and

6  WHEREAS, The performance of sensitive exams under anesthesia without specific informed consent
7  can lead to severe psychological stress for the patient, damage to the patient provider relationship, and
8  a distressing experience for the medical student or resident²; and

9  WHEREAS, Thirty-nine states have no law explicitly banning the practice of performing pelvic exams
10  on anesthetized patients without their specific consent³; and

11  WHEREAS, In a study conducted in 2003, 90% of students surveyed had completed a pelvic exam on
12  anesthetized patient who had not given informed consent⁴; and

13  WHEREAS, If asked for specific consent prior to surgery, 62% of women claimed they would consent
14  to a medical student performing a pelvic exam while under anesthesia for educational purposes,
15  showing that asking does not significantly impact learning opportunities⁵; now, therefore, be it

16  RESOLVED, that SOMA encourages the AOA to adopt a guideline that requires obtaining specific
17  informed consent before performing a sensitive exam for educational purposes on a patient who is
18  under anesthesia.

Explanatory Statement

Performing sensitive exams on unconscious patients for educational purposes is not a new practice⁵. Public awareness in the 1990’s saw the introduction of limited state legislation against the practice². Today there are 11 states that have banned the performance of sensitive exams under anesthesia without specific consent³; Wisconsin and Florida have proposed bills under consideration^6,7. It is difficult to predict the number of educational pelvic exams under anesthesia without specific consent being performed today but recent lawsuits as well as reports from patients and medical students indicate the practice is still occurring nationally^2,3,6,7.

References

1. University Health Service. (n.d.). University of Michigan. Retrieved February 21, 2020, from

https://www.uhs.umich.edu/sensitive-exams

2. Friesen, P. Educational pelvic exams on anesthetized women: Why consent matters. Bioethics. 2018; 32: 298– 307. https://doi.org/10.1111/bioe.12441

3. Goldberg, E. (2020, February 17). She Didn’t Want a Pelvic Exam. She Received One Anyway. New York Times. Retrieved February 21, 2020, from https://www.nytimes.com/2020/02/17/health/pelvic-medical-exam-unconscious.html

4. Ubel, Peter A, et al. (February 2003). Don’t ask, don’t tell: A change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. American Journal of Obstetrics & Gynecology, Volume 188, Issue 2, 575 – 579

5. Cundall, H., MacPhedran, S., & Arora, K. (2019, December). Consent for Pelvic Examinations Under Anesthesia by Medical…: Obstetrics & Gynecology. Retrieved February 21,2020, from https://journals.lww.com/greenjournal/Fulltext/2019/12000/Consent_for_Pelvic_Examinations_Under_Anesthesia.23.aspx?casa_token=oPri3J4ogx8AAAAA:k-v1Z0A8izkAtAX3vcyWc_0MTL7uUDLFIPKzbSVUxGlVULCEd7SQcmEtOi4bM48xh-nbgFr312d8Yk6VhtT9z5X_

6. Wahlberg, D., & Wisconsin State Journal. (2020, January 7). Bill seeks informed consent for pelvic exams under anesthesia by medical students. Retrieved February 20, 2020, from https://madison.com/wsj/news/local/health-med-fit/bill-seeks-informed-consent-for-pelvic-exams-under-anesthesia-by/article_ab30b282-0507-5c0f-93c5-83143f74ae86.html

7. Press, T. A. (2020, February 19). Florida bill would require consent to perform pelvic exams. Retrieved February 21, 2020, from https://www.wfla.com/news/florida/florida-bill-would-require-consent-to-perform-pelvic-es/

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Submitted by:

Alaa Alghalayini, OMS-II — Kentucky College of Osteopathic Medicine
Ala’a Grace Khattab, OMS-I — Kentucky College of Osteopathic Medicine
Batoul Sadek, OMS-I — Kentucky College of Osteopathic Medicine
Chris Moore, OMS-II — Kentucky College of Osteopathic Medicine
Ian Keith, OMS-II — Kentucky College of Osteopathic Medicine
Joseph Roesch, OMS-II — Kentucky College of Osteopathic Medicine
Julie Alvarez, OMS-I — Kentucky College of Osteopathic Medicine
Kelsi Harden, OMS I- Michigan State College of Osteopathic Medicine
Maya Braden, OMS I – Michigan State College of Osteopathic Medicine

Action Taken:
Date:
Effective Time Period: Ongoing

[Amreeta Jammu<br>ATSU-KCOM]

I am in full support for this resolution, but feel like some additional information could be added to make it even stronger, as well as some clarification. For example, are we referring to all healthcare providers that are doing these sensitive exams with uninformed consent? Or just students and those that are training. Also, are these sensitive exams performed while undergoing a surgery for something that is not related anatomically or pathologically? For example, if you’re performing a GI surgery but also doing a pelvic exam without consent? Because it is common practice for physicians to perform a prostate exam while doing a colonoscopy on a patient. Perhaps mentioning some of these things will make the case even stronger. Great topic and great work!

[Victoria Siracusa<br>TouroCOM Middletown]

I am in full support of this resolution. It is very disheartening to learn that are no guidelines set in place across the board for such a sensitive topic.

[Reshma Pinnamaneni<br>AZCOM]

Hello,

My name is Reshma Pinnamaneni and I’m a rising OMS-II at AZCOM. I am speaking on my behalf. I fully support this resolution. I am glad to see that there will be more guidelines to help and empower patient decisions on what can/cannot be done to them under anesthesia.

Thank you,
Reshma

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