Resolution: S-21-23: NON-DISCRIMINATION AND RESPECTING DIVERSITY IN PEER-PHYSICAL EXAMINATION COURSES

[Valerie Lile]

Whereas, respectful inclusion and diversity are integral to the well-being and effectiveness of students, and are essential to delivering appropriate care¹; and

Whereas, peer-physical examinations are defined as students physically examining one another for educational purposes, in which one student assumes the ‘doctor’ role and carries out the physical examination and the other student assumes the ‘patient’ role and is physically examined²; and

Whereas, in these peer-physical examinations, the student assuming the role of the patient has a right to informed consent where they can ask questions, express their concerns and request alternative learning approaches³; and

Whereas, A large scale international longitudinal and cross sectional study looking at students across the United Kingdom, Hong Kong, Japan, New Zealand, and Australia found that religious and nonwhite students were more likely to be more uncomfortable with aspects of peer physical examination than their nonreligious and white counterparts⁴; and

Whereas, 99% of students were more comfortable examining a partner of the same gender compared to only 70% of students were comfortable with a peer of the opposite gender⁵; and

Whereas, a survey of 27,504 allopathic medical students found that 6.8% of females reported being subjected to unwanted sexual advances while in medical school⁶; and

Whereas, a literature review on barriers to peer-physical examination recommends that students be provided with adequate choice as to who they want to be examined by with specific reference to existing peer relationships, gender, religious and ethnic backgrounds; in order to maximize participation as well as reduce student perceptions of anxiety and discomfort, with regards to peer physical examination ⁷; and

Whereas, there is limited data available on the current prevalence of osteopathic medical schools that academically penalize students without offering exemptions or accommodations for religious attire in their dress code policy for peer-physical examination courses; and

Whereas, The Commission on Osteopathic College Accreditation (COCA) College of Osteopathic Medicine (COM) Continuing Accreditation Standards states that non-discrimination includes discrimination based on race, ethnicity, color, sex, sexual orientation, gender, gender identity, national origin, age, disability, and religion⁸; and

Whereas, COCA Continuing Accreditation Standards on learning environment states that a COM must ensure that its educational program occurs in professional, respectful, nondiscriminatory, and intellectually stimulating academic and clinical environments⁹; and

Whereas, COCA Continuing Accreditation Standards on diversity states that a COM must have in place practices that engage in ongoing, systematic, and focused recruitment and retention activities, to achieve mission-appropriate diversity outcomes¹⁰; therefore, be it

RESOLVED, that the Student Osteopathic Medical Association (SOMA) oppose all student dress code policies in which the student is academically penalized without an alternative non-discriminatory dress code policy provided, as outlined by COCA non-discrimination standards, and be it further

RESOLVED, that SOMA work with COSGP to encourage action by osteopathic medical schools to respect diversity by providing alternatives and accommodations for discriminatory dress codes, such as but not limited to: the investment of privacy screens, same-sex, or selective partner pairing, in the setting of peer physical examination courses in which the student is acting as the patient and without academic penalty, and be it further

RESOLVED, that SOMA work with COCA and/or other appropriate stakeholders to assess the current dress-code policies of osteopathic medical schools and their inclusion of alternatives and accommodations on the basis of race, ethnicity, color, sex, sexual orientation, gender, gender identity, national origin, age, disability, and religion, in the setting of peer-physical examinations and without academic penalty, and be it further

RESOLVED, that SOMA recommends upon completion of the assessment that COCA establish guidelines for osteopathic medical schools to provide alternatives and accommodations that are free of academic penalty, for dress-codes that are discriminatory on the basis of race, ethnicity, color, sex, sexual orientation, gender, gender identity, national origin, age, disabilities, or religion, in the setting of peer-physical examination courses.

Explanatory Statement

Inclusivity and acceptance of medical students is integral in establishing a healthy environment conducive for learning. Peer-physical examination courses, including osteopathic manipulative medicine, where students are required to act as the patient and be inspected by their peers, can oftentimes violate the students’ right to provide informed consent and may infringe upon religious students’ beliefs. Many religious students are still required to partake in a specific dress code or partner with students of the opposite gender, despite directly conflicting with their modest and religious values. Medical students are left without options to opt-out or obtain accommodations, which may hinder their learning and may isolate them from faculty and peers. In order to support diversity in our medical schools, we must address this issue and involve the necessary stakeholders to hold universities accountable for providing solutions and accommodating their students’ individual beliefs, so they are not conflicted between receiving a medical education and upholding their religious values.

Relevant Existing Policies:

S-19-11 EDUCATION OF STUDENTS AND FACULTY ON OBTAINING INFORMED CONSENT BEFORE ALL STUDENT AND PATIENT ENCOUNTERS

References:

1. Roberts L. W. (2020). Belonging, Respectful Inclusion, and Diversity in Medical Education. Academic medicine : journal of the Association of American Medical Colleges, 95(5), 661–664.
2. Koehler, Nicole & Currey, Judy & Mcmenamin, Christine. (2014). What Should Be Included in a Peer Physical Examination Policy and Procedure?. Medical Science Educator. 24. 10.1007/s40670-014-0068-4.
3. Delany, C., Frawley, H. (2011). We Need a New Model for Obtaining Students’ Consent to Conduct Peer Physical Examinations. Academic medicine: journal of the Association of American Medical Colleges. 86. 539.
4. Rees, C.E., Wearn, A.M., Vnuk, A.K. (2009) Medical students’ attitudes towards peer physical examination: findings from an international cross-sectional and longitudinal study. Adv in Health Sci Educ 14, 103–121.
5. Chang, E. H., & Power, D. V. (2000). Are medical students comfortable with practicing physical examinations on each other?. Academic medicine: journal of the Association of American Medical Colleges, 75(4), 384–389.
6. Hill, K. A., Samuels, E. A., Gross, C. P., Desai, M. M., Sitkin Zelin, N., Latimore, D., Huot, S. J., Cramer, L. D., Wong, A. H., & Boatright, D. (2020). Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation. JAMA internal medicine, 180(5), 653–665. https://doi.org/10.1001/jamainternmed.2020.0030
7. Hendry G. J. (2013). Barriers to undergraduate peer-physical examination of the lower limb in the health sciences and strategies to improve inclusion: a review. Advances in health sciences education : theory and practice, 18(4), 807–815.
8. Commission on Osteopathic College Accreditation. (2019). Accreditation of College of Osteopathic Medicine: Continuing Accreditation Standards (Standard 1, Element 1.5a). Retrieved from https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf
9. Commission on Osteopathic College Accreditation. (2019). Accreditation of College of Osteopathic Medicine: Continuing Accreditation Standards (Standard 5). Retrieved from https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf
10. Commission on Osteopathic College Accreditation. (2019). Accreditation of College of Osteopathic Medicine: Continuing Accreditation Standards (Standard 5, Element 5.2). Retrieved from https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf

Submitted by:

Deena Abdelhalim, OMS II – Touro College of Osteopathic Medicine
Madeline Jentink, OMS IV – Chicago College of Osteopathic Medicine
Sarah Abdel-Karim, OMS III – New York Institute of Technology College of Osteopathic Medicine

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