Unauthorized Practice: Teaching Pelvic Examination on Women Under Anesthesia

Abstract

Recent reports of medical students performing gynecological exams on anesthetized women without their knowledge or consent have generated a firestorm of controversy and prompted calls for greater regulation. This Commentary examines studies spanning three decades showing that such unauthorized practice is neither a recent phenomenon, nor one unique to the United States.

In this Commentary, Professor Wilson tests the justifications for such unauthorized practice offered by teaching faculty, focusing in particular on whether patients have actually or impliedly consented to such exams by coming to a teaching hospital. It then examines newly enacted legislation in California that would criminalize unauthorized exams and argues that it does little to make unauthorized exams more discoverable or to remedy the underlying pressures that have fostered the use of patients as teaching tools without permission. The Commentary ultimately concludes that meaningful change within medical education can only be achieved when key players begin a dialogue about the barriers they face to establishing better practices.

JEL Classification: I0, I1, J7, H7, K4