Virtual Mentor. January 2005, Volume 7, Number 1.
Case 4.1: Balancing Patient Care and Student Education—Mr. Harvey's Central Line
Related topic: Medical students as "patients"
Just as it is important to get permission for students to perform procedures on patients, trainees should also be aware of the ethical concerns surrounding the use of their peers as "patients" for training purposes.
Medical students pretending to be patients are not in a patient-physician relationship with each other. Consequently, the information disclosed to students should differ from that disclosed in a clinical context. Students should also consider the potential effect of the exam and the possible (unexpected) findings on their relationships with fellow students. As the invasiveness or intimacy of the procedure increases, greater care must be taken to ensure that students' informed consent is explicit and uncoerced.
Voluntariness and the forces that may undermine it deserve special scrutiny in this context. It should be recognized that coercive influences may stem from individuals or from situational factors, eg, the mere fact that students are in an educational setting and are being evaluated. Some students may have conditions that they do not wish to reveal but that might be detected upon physical examination. Unless they are presented with an explicit choice to volunteer, students may feel compelled to submit to the procedures, especially if they believe that their participation impacts the evaluation they receive from instructors. Instructors should refrain from including students' willingness or unwillingness to participate as a contributing factor in their evaluations. Some students may give reasons for not participating as "patients," but reasons should not be required, and the decision not to offer reasons must be respected.
In short, students should be given the choice to volunteer in a non-coercive setting prior to entering the classroom and there should be no requirement that the students provide a reason for their refusal to participate.
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