Nhs students and lack of consent.

Its true, this has been a big issue. The NHS has been sexually assaulting women for years.

In living memory, vaginal and rectal examinations were performed without consent on anaesthetised patients solely for the purpose of teaching. This is no longer permitted, but if digital rectal or vaginal examination is foreseeable during a procedure under general anaesthetic, should explicit consent be obtained?

https://www.uhs.nhs.uk/health-professionals/clinical-law-updates/examining-patients-with-their-consent

What really angers me about this is that people who have been sexually abused as children, often find things like smear tests very traumatic, but its also often much harder for them to say no to something like that. Its an unreasonable pressure to put on anyone for intimate examinations and procedures, let alone someone with trauma in their past.

"A student midwife was brought into my room and participated in my delivery without any discussion. She was instructed to break my waters and deliver my baby without any discussion with myself. The midwife focused on talking her through things instead of supporting me. I was alone because of covid restrictions. I later discovered it was the first baby she delivered. I felt like a piece of meat.

Sorry, but I'm calling BS on this one. A first birth is literally hands on hands helping to deliver the baby, so no student midwife facilitating a first birth would be breaking waters and delivering baby. Some tall story you got going on here.

• Mum of 1st year student midwife.

I'm coming to this thread from the future. However, I think something has changed becuase I've always been introduced and asked if I minded (and I've not). However, recently (2026) I was not asked. I was also shocked that the actual practitioner was a nurse (I was expecting a consultant dermatologist) and she didn't explain why I was seeing her and not a consultant. She was very arrogant and threw her 'extensive' knowledge about teenagers around the consultation (I was there with my son for his acne). While I let my son lead the conversation I did ocassionally interject to explain things about family history and my experience of some of my son's issues as he's always embarrased by anything medical and doesn't say much. But things went from bad to worse and I got the distinct feeling the nurse was new to the job herself and making a few errors but was using her 'nurse' knowledge to wing it. She even used my first name in the consult to emphasise a point she felt that I was not getting! I didn't make a fuss but I got the distinct feeling she and the student discussed me as a 'difficult mother' after the consult and I felt completely humiliated (I also got the feeling neither woman had children of their own as the nurse said the oddest things that simply did not resonate to me as a mum but maybe she was playing up for the student). I don't think we should have to feel that way after going to a consultant for a straight forward health issue! Come on NHS - sort it out!

Wow you've been really unlucky. There have been students a few times here but they have always checked that it is ok and never for anything intimate.

I'd be ok with one student at a time but not with more than one. I'd feel quite intimidated.

@BetsyBigNose

@LonelySock - you write "My medical school daughter is on a placement at the moment at a GPs. She is enjoying being put with the nurses best of all as they have taught her so much. She of course is too young (grrrrrrr, another issue!) to have ever had a smear test herself and now she's seen several tricky ones and has learnt an enormous amount

Do you realise how completely inappropriate it is for your daughter to have told you this? To have been in a privileged position as a medical student to have been given consent by a patient to be present during their smear test - an intimate and incredibly private medical procedure - for your daughter to have then come home and discussed seeing these patient's genitals and describing particular "tricky" appointments to their Mum? I would be horrified if I was one of those patients, she sounds as if she has a lot to learn about being professional

It depends how much information was given. As long as patients could not be identified it is reasonable.

Disclaimer - I have not read the thread.

I did placement in a teaching hospital/trust. It was work in theatres... I am not sure anyone gets asked if it is ok for students to participate in your care when you are under anaesthesia. Totally different when you are awake.

As a patient, I always let students participate... how on earth will they learn otherwise?
The only time I said no was in a psych ward on a weekly ward round. Already 6 staff there looking at me, and I could not cope with a student there too.

@BetsyBigNose Actually recanting difficult procedures/consultations following the fact can be completely professional and is encouraged for a multitude of reasons, both with colleagues for peer review/development, or with friends and family as a coping mechanism for example.

The caveat is that the patient individually cannot ever be identifiable from the discussion. For example I've just submitted a case study to university giving a very detailed account of a patient I'd seen and the management provided as part of a masters programme. There was no need to consent the patient and they have no idea their case will be published. However they are not identifiable in the document. Its a requirement of my course for this type of document to be written, if they were identifiable I would fail the module obviously!

As someone with several uncommon genetic organ malformations, I am often used as a teaching resource for medical students. However, I have always been asked beforehand - if I wasn't, I would feel comfortable asking who the extra person in the room was and would be unlikely to give my consent for them to stay had it not been sought in the first place - make it a teaching moment for them on the importance of asking for consent!

Recently, I was in hospital and needed to have a catheter inserted. There was a Nurse and a HCA, who both introduced themselves and explained what was going to be happening, then another young woman entered the bay (I can only assume she was an HCA, as she was in the same scrubs but failed to introduce herself or explain why she was there). I looked at the new arrival pointedly, and eventually asked "Can I help you?", when no one had told me what she was doing there. She looked like a rabbit in headlights, the 2 other HCPs in the room looked up, registering her presence for the first time and looking a bit confused. I suddenly felt really cross, like she had absolutely no right to be there and I wanted her gone, so I announced "This is not a spectator sport, find someone else to stare at." She left without saying a word and the Nurse apologised and said she wasn't sure what she was doing there. It made me wonder what would have happened if I hadn't said anything - would the other HCPs have asked her to leave? Would I have just had to put up with feeling distinctly uncomfortable whilst I had this personal care carried out? I didn't see her again after that, it felt like she could have been a random person off the street who had dressed in scrubs and wandered into the department. This experience really magnified for me how important it is for medical professionals to introduce all of those present to the patient and ensure they have consent to be there.

@LonelySock - you write "My medical school daughter is on a placement at the moment at a GPs. She is enjoying being put with the nurses best of all as they have taught her so much. She of course is too young (grrrrrrr, another issue!) to have ever had a smear test herself and now she's seen several tricky ones and has learnt an enormous amount,"

Do you realise how completely inappropriate it is for your daughter to have told you this? To have been in a privileged position as a medical student to have been given consent by a patient to be present during their smear test - an intimate and incredibly private medical procedure - for your daughter to have then come home and discussed seeing these patient's genitals and describing particular "tricky" appointments to their Mum? I would be horrified if I was one of those patients, she sounds as if she has a lot to learn about being professional.

Second year student nurse here. We are trained to introduce ourselves, explain our 'role' and ask the patient if they are okay with us being present. I always say to any patients, "hello, my name is 'howtostopthinking' I am a student nurse working with the nurses here in the clinic/ward/GP practice, are you happy with me being here or would you prefer for me to not be". If there is a minor procedure that the patients need and I can do under supervision I gain consent by asking the patient again. Also when I continue to gain consent from patients, I like to let them know what my experience is in the particular procedure, for instance administering certain injections such as a subcutaneous injection as part of ward medication rounds. I have a lot of experience with that and find that patients are more at ease with more information from me. I will also be completely honest and tell a patient if I have never actually performed the particular procedure and again I gain consent.

As a patient I personally don't mind having students in my appointments, although I would probably think twice if there is a student there that I have worked with or go to Uni with but dependent on the appointment type I would probably still allow them to be there.

However, you definitely should be; A. made aware, B. have it explained who they are and why they are there, C. Be asked for consent, D. be under no obligation to have a student in your appointment. Plus they absolutely should not make you feel silly or bad for saying you would rather not have a student in your appointment or taking part of a procedure if you don't want or consent to that.

below is guidelines from BMA is clearly states that professionals should seek consent prior to the arrival of observers if possible. Do I think it frightening and bad practice this is not happening

on-making capacity 19 10. Consent for teaching purposes

Key points
– Consent should be sought for medical students or other observers to be present during a consultation or treatment.
– Specific consent must be obtained to carry out any practical procedures on patients whilst they are anaesthetised, for training purposes.
– Doctors must obtain consent from the patient prior to a recording being made and for its subsequent use for teaching purposes.
– Consent is not required for the storage and use of material from living individuals for teaching purposes provided it is anonymised. The use of identifiable samples for teaching requires consent.
Is it necessary to seek a patient’s consent for medical students or other observers to be present during a consultation or treatment?
Yes. The doctor carrying out the consultation should explain to the patient that an observer would like to sit in on the consultation, who that person
is and why they would like to observe. Patients should feel able to say no, knowing that it will not impact on their treatment in any way.
Wherever possible, patients should be given the option of considering the request before the arrival of the observers.
Is specific consent required to teach practical procedures on a patient who has been anaesthetised?
Yes. Before any anaesthetic is given, specific consent must be obtained from the patient, to carry out any practical procedures on them for teaching purposes.
Is it necessary to seek consent from patients for the use
of visual and audio recordings of procedures, for teaching purposes?
Yes. Doctors must obtain consent from the patient prior to a recording being made and for its subsequent use for teaching purposes.
Patients may withdraw their consent to the use of visual and audio recording for teaching purposes at any time. If they do so, the recordings must be erased.
What type of consent is required for the use of human tissue for educational purposes?
Consent is not required for the storage and use of material from living individuals for teaching purposes, provided it is anonymised.

I can't say I've noticed this happing recently. When I went for my smear test 10 months ago,a student nurse was present,but I was asked beforehand if I was OK with this. The only time I've not been asked was going back quite a few years ago,when my 12 year old DD was in hospital for tests. Every time the doctor came to see her, several students would be present,and neither myself or my DD were ever asked if it was OK. After this had happened several times,I mentioned it to the doctor,who acted surprised that I 'objected'. I said I wasn't objecting to the students being present,it was the fact that I was never asked if I was alright with it!

Thank you chesirecat99. I no longer have the report, but it said "trainee nurse" something. Nice to know they wouldn't have been a student, even if they did seem intent on pushing their camera out through my left hip. I honestly didn't know whether to be relieved or disappointed when the procedure was abandoned.

I’ve only ever had a student once and that was when I was giving birth. She was very sweet actually, probably only about 18/19. The midwife left the room and said, when PeacockPartyTime has her next contraction, feel her abdomen. The student did but whispered ‘I’ve got no idea what I’m feeling for’ 😂😂 Bless her, it was her first placement and first time in the delivery suite. Luckily I didn’t have anyone there for the actual delivery.

A medical student wouldn't be writing a report that is sent to a GP or patient. Was their job title ST (Specialty Training) or CT (Core Training) followed by a number? They aren't students, they are junior doctors. They used to be called Senior House Officers and Registrars. After 5/6 years of med school, doctors them spend a further 2 years working in a range of fields before choosing a specialism. It then takes 7+ years further training and exams to become a consultant. I hope that puts your mind at rest a little that they were a highly qualified doctor, not a medical student.

Completely agree @HeadPain. That’s a perfect (if unintended) example of what’s wrong with this process @SC215. Of course it’s hard to say no to a student directly, never mind in the open setting of a waiting room. Surely you can see that? It’s making an already stressful wait even more stressful. All I would be thinking is ‘good grief, let me just get this apt over with’, and I’d definitely be starting that apt feeling more flustered and stressed.

I wasn't asked for permission when a student carried out, or rather failed to carry out, my colonoscopy. I only found out from reading the job title on their report. I raised the issue with the consultant in charge but they stonewalled me.

I think you should ask, not the student, because some people e.g. like me who might want to say "no" (depending on what it is) won't feel comfortable saying "no" to the face of the individual they're saying "no" to. I'd feel mean and pressured.

??? What???

I've noticed they've stopped asking too

I went for a smear test was very nervous have ptsd , walked in for students to be in room without being asked before I went in appointment ,could not go through with smear test I got very distressed was so shocked to see them sat there, wouldn’t mine but my history and ptsd my gp aware of. But me off re booking appointment

*Well, good; I'm glad that men are realising that they are making women uncomfortable, and therefore their presence in women's healthcare causes as many problems as it solves.

The fact that women's healthcare is struggling to recruit doctors into its specialism needs to be solved in another way than putting men in, because men can't provide the care that many gynae patients need. (In fact, I'd go as far as to say that any man who is driven to pursue a career in gynae despite knowing the female patients are uncomfortable with him is a very clear sign that that man should not be a doctor in gyn).

So we need to encourage more women into medicine and encourage more women doctors into Obs & Gyn, by making it a better and more appealing specialism (yes, that will need money spending). That is the solution, not adding men when women don't want them.*

Agree with all of this , 100%

4. There are not enough gynaecology specialists to staff the existing clinics. There is a crisis in gynaecology training. Not enough people want to train in it and not enough opportunities to gain the needed experience. I don’t know any male UK graduates in Gynae training. Most say it’s because they realise they are not welcome or wanted by the patients and can’t get any experience.

Well, good; I'm glad that men are realising that they are making women uncomfortable, and therefore their presence in women's healthcare causes as many problems as it solves.

The fact that women's healthcare is struggling to recruit doctors into its specialism needs to be solved in another way than putting men in, because men can't provide the care that many gynae patients need. (In fact, I'd go as far as to say that any man who is driven to pursue a career in gynae despite knowing the female patients are uncomfortable with him is a very clear sign that that man should not be a doctor in gyn).

So we need to encourage more women into medicine and encourage more women doctors into Obs & Gyn, by making it a better and more appealing specialism (yes, that will need money spending). That is the solution, not adding men when women don't want them.

I would incentivise women to train in gynaecology. Big pay incentives and other benefits etc.

Never going to happen in a million years for a variety of reasons, mainly that women are never prioritised in anything, but incentivising women to specialise in gynaecology would help with the staffing issues and with comfort and wellbeing of women.

1. The reason students need to examine patients after they have learnt the techniques on each other/models/volunteers is they need to see pathology. Medicine may be all fancy and technological but most of it still is pattern recognition- seeing/feeling/hearing lots and lots of normal and abnormal whatevers (heart sounds/prostates/wombs/ear canals) - fortunately students tend to be a healthy lots so there’s not much pathology to find

1. Never said it’s not a big deal to have students there. It is. Nor that consent should not be sought. Am trying to challenge the idea that students should not be present in the department/clinic at all.

1. The body is connected - sorry if this sounds patronising. Ovarian cancer is missed because people and their doctors think it’s their bowels or their bladder - removing gynaecology from the medical school curriculum is not going to help this.

1. There are not enough gynaecology specialists to staff the existing clinics. There is a crisis in gynaecology training. Not enough people want to train in it and not enough opportunities to gain the needed experience. I don’t know any male UK graduates in Gynae training. Most say it’s because they realise they are not welcome or wanted by the patients and can’t get any experience.

To make this perfectly clear IT IS NOT THE INDIVIDUAL PATIENTS JOB TO MAKE THEM FEEL WELCOME. Currently we have unhappy patients and not enough doctors- not sure the solution to this is going to be to have the students examine each other.