Approved policy seeks to balance the realities of practice with respect for patient preferences
Following consultation, Council approved a policy that sets expectations for physicians involved in providing medical education and training.
The policy consolidates expectations from two previous policies.
Overall, the majority of feedback heard during the consultation for the Professional Responsibilities in Medical Education draft policy was supportive of the expectations. However, significant and divergent perspectives emerged in the requirement for express consent from patients for learner participation.
Many consultation responses showed strong support of the importance of respecting patient autonomy and choice in the context of involving learners. However, many respondents raised significant concerns with the implications of requiring express consent for learner participation. Most notably, the Council of Faculties of Medicine (COFM) undergraduate and postgraduate deans were concerned these expectations might conflict with existing institutional approaches to education, which could lead to barriers to care and the disruption of learning environments.
In response to stakeholder feedback, a number of changes were made to the final policy that seek to balance the realities of practice with respect for patient preferences, says Dr. Karen Saperson, a professor of psychiatry at McMaster University and a member of the Policy Review Working Group.
The policy requires consent be obtained when the participation of medical students (or postgraduate trainees) is solely for their own education (e.g., observation, examinations unnecessary for patient care, etc.). But where medical students are participating in patient care, the policy no longer requires consent be obtained in all circumstances.
Consent needs to be obtained in appropriate circumstances and this determination must be made by taking into account several factors, including: the type of examination, procedure or care being provided; a patient’s characteristics; the increasing responsibilities medical students have in patient care; the level of involvement of the most responsible physician (MRP)/supervisor; and the best interests of the patient.
While some respondents suggested posting a sign informing patients that medical students and/or postgraduate trainees may be involved in their care should be sufficient, the Policy Review Working Group disagreed. “A sign is helpful, and promotes patient education and understanding, but it is not sufficient in terms of meeting the policy’s expectations,” said Dr. Saperson.
To allow greater flexibility and ensure workflow, the policy does allow for a medical student to obtain consent.
The expectation in the consultation draft requiring MRPs and/or supervisors to use their professional judgment to determine whether to obtain express consent from patients when postgraduate trainees participate in patient care was removed from the final policy.
“It was the Working Group’s view that postgraduate trainees are viewed as full members of the health-care team and asking for consent for their participation in care undermines their role as physicians and members of the team,” said Dr. Saperson.
As set out in the policy, patients must be informed postgraduate trainees are part of the health-care team and that there is an MRP responsible for their care.
Things to Know
The policy:
- Explicitly addresses violence, harassment, intimidation and discrimination against medical students and postgraduate trainees;
- Addresses expectations regarding availability of MRPs/supervisors;
- And sets out a new expectation that prohibits MRPs and/or supervisors from entering into sexual relationships or relationships with medical students and/or postgraduate trainees that could present a risk of conflict of interest, bias or coercion.
Obtaining Consent
Some specific examples of when it would be appropriate to obtain consent include, but are not limited to:
- Medical student will be performing a sensitive examination, e.g., pelvic or genital examinations.
- Patient is a member of a vulnerable population who may have had negative experiences in the health care system.
- Patient has experienced trauma.
- Patient is fearful of the examination, investigation or procedure.
- Medical student is early on in their medical school education.
- Examination, investigation or procedure is invasive or painful.
- Supervisor or MRP will not be present.
If the medical student’s involvement is minimal or the task is very low risk, such as taking a patient history, consent may not be required.
