Nhs students and lack of consent.

Some of these comments are wild

Of course you should be asked if you're ok having intimate appointments observed

The less intimate ones I think it might be a matter of scale but I wouldn't expect to be asked at a dental appt for example.

And agree that for many patients they wouldn't be able to speak up and say they're uncomfortable, many also wouldn't feel ok saying no when the student(s) are right there

Considering how ott many on here are around dignity for women especially, these comments are very odd.

PinkSparklyPussyCat's comment about how it would stop her going for screening if she HAD to have students present is indicative of how presumed consent and a cultural expectation that its your duty to perform for medical students could damage health outcomes.

Are there really people who don't understand why some women might not want students observing their gynae appointments?

Oh I think they damn well understand. I think the problem is more that they don't care. The attitude is that as long as they are getting the health care they want to a standard they are happy with, to hell with anyone else.

If they cared they'd bother to acknowledge a bunch of the posts on here explaining the reasons why it causes them distress. Rather than ignoring them or using words like 'duty', 'bravery' or the emotional blackmail of how it affects other patients (by this they mean themselves) or their student children.

Women saying "No" are somehow bad. Women shouldn't be able to say "No" because thats bad for society. Women shouldn't be expressing the word "No" because that means we might have to acknowledge and address a problem rather than just ignore it, because its inconvienent and makes us face up to some unpleasant realities about life.

*indicative

Those arent questions for me, those are questions to ask at the time!

I dont understand your behaviour or your attitude, but if its inductive you how you may have broached the subject with the medical staff, I can see why they were less than polite with you too.

And worrying some of these attitudes are from healthcare workers too.

The children's hospital in Glasgow is a teaching hospital, and when DS1 was little I was always being asked if students could observe, because apparently he's such classic CF patient. But I was always asked. Not being asked is appalling.

My last smear was so painful that I'm in two minds whether to have another one when it's due this year (no lectures please). If anyone thinks I'm going to agree to being gawped at while it's done they can think again!

Are there really people who don't understand why some women might not want students observing their gynae appointments?

If I were at such an appointment, I'd be panicky and probably in tears at the thought of getting undressed in front of a stranger. I'd insist that the practitioner was female. I'd be consenting to the examination/procedure, but very distressed by it. Can you see why I might not want extra onlookers, be they students, experienced doctors or anyone else?

I can understand that women with different views and life experiences from me would be totally fine and not mind at all who was there. Is it so hard to imagine that not everyone is like you?

When I trained as a nurse, both as a General and psychiatric nurse, we were NHS employees and did most of the hands-on, basic nursing care from our very first ward, as there's never be more than 2 trained nurses on duty, often only one. Having said that, all patients should be asked for permission for students to observe procedures and examinations, especially intimate ones and the focus should always be more on the patient. We were taught to explain to our patients what we were doing- it's part of treating them as whole persons, not just their conditions!!!
One thing that has baffled me is why on Earth do trainee HCAs need to observe a cervical smear? I was never even brought to observe one when I was training to be a Registered General Nurse! It's a procedure done by Practice Nurses who have completed post -Reg speciality training and only needs to be observed by those undergoing such training and are already Registered, or so I would have thought.
You were perfectly within your rights to ask all of them to leave (it's your body and there will be other patients who do not mind. That said they should always BE ASKED!!) but especially in this case and the trained nurse was out of order to imply it was "silly" of you as HCAs do NOT do smears! (Hell in my day even RGNs didn't do smears, one had to have had the post Reg training!) Not as far as I'm aware anyway! Not unless even THAT'S changed since I was practising but feckin' hell, I HOPE not!!!

Unacceptable that it hasn't been discussed with you. I know students must learn but I'll always ask them to leave if it's anything personal.

Unless it’s a hypothetical question, which I doubt it is, people definitely are expected to provide a solution, especially if they don’t want to consent. Some people have even used the word “duty”.

I have no idea how you “square the circle”. When I’m receiving medical care I won’t be thinking about whether a medical student’s training is adequate and if it isn’t, what I can do to resolve that problem.

I’m not disputing that. In fact it doesn’t surprise me in the slightest. What did surprise me was the PP who stated she wouldn’t allow a student in any of her gynae appointments.

Why?

The day that I went into hospital to deliver my deceased baby, I was fine with having a student nurse site a cannula. It took four goes, both arms and ended up in my elbow crease rather than my hand, but it was OK.

Five days later, when I had a raging womb infection, a high temperature and felt like I was on the edge of collapse, I wasn't in the mood to be a pin cushion for someone practising.

I think there's another issue too, which is the level of the trainee/student.

After all, even a junior doctor or registrar is still officially "training" and under the control of the consultant. But few people would object to being treating by a registrar!

A medical school student on a placement is a very different matter to, say, a qualified nurse "training" in a specific specialism.

[quote user1497207191]@SleepyRich

I'm a Paramedic and due in part to a lack of placement opportunities the first time I'd ever seen a baby delivered was when working as a solo responder, it was just myself and mum on scene and no crews available. I certainly didn't admit at the time I'd only seen it on video and put on my best air of calmness I could. Fortunately all went well. Would have loved to have a student with me that day!

An emergency situation is completely different. If you'd already been occupied with another call, it could well have been delivered by a taxi driver, or someone with a St John's or other first aid certificate (if in a workplace or shop etc), or even a random passer by or neighbour.[/quote]
Whilst I completely agree there are a number of differences between planned and emergency procedures, there are also very different expectations placed on a Paramedic from a taxi driver.

My OH has long term incurable cancer and has regular blood tests and infusions. He always refuses a trainee or HCA if one is allocated to take blood or place the canula. That's simply because his veins are absolutely shot at due to years of needles etc and even the most experienced nurse can struggle to successfully insert the needle into a vein.

He's finally managed to get it written into his notes and most times he can now avoid the embarrassment of having to ask for a more experienced nurse (and he goes so often, the staff at the day treatment centre now know him!). He's even managed to get his GP practice to write it into their notes too so he now gets put on the list of their more senior nurses rather than their HCAs!

What is needed is an easy and non confrontational way for the few who don't want students present to be able to say so, preferably in advance to avoid embarrassment. Ideally it should be something the receptionist sorts out when checking in, with a note on the records to signifiy consent or non consent.

Which is EXACTLY what some here are saying. I have personally done this. And I'm STILL asked or put into situations I have explicitly in writing have said I'm uncomfortable with.

I don't feel respected precisely BECAUSE its ignored.

Thats not consenting to things. Thats being put under pressure to 'comply'.

No one is asking you to provide solutions, students need to learn practically, you can't learn this just from text books. There isn't a safe alternative to students observing/undertaking consultations and procedures so the practice will continue. To take that away would cripple training programmes.

@SleepyRich

I'm a Paramedic and due in part to a lack of placement opportunities the first time I'd ever seen a baby delivered was when working as a solo responder, it was just myself and mum on scene and no crews available. I certainly didn't admit at the time I'd only seen it on video and put on my best air of calmness I could. Fortunately all went well. Would have loved to have a student with me that day!

An emergency situation is completely different. If you'd already been occupied with another call, it could well have been delivered by a taxi driver, or someone with a St John's or other first aid certificate (if in a workplace or shop etc), or even a random passer by or neighbour.

[quote Promleafyus]@RedToothBrush what do you think of HCAs/support workers who start work on the ward their first day more or less, potentially with zero experience in this type of work? Where do you propose mental health student nurses (yes it is specialised and the course is one in its own right) gain experience?[/quote]
I think that students do a different job to health care workers.

A health care worker certainly shouldn't be there for intimate examinations nor deeply private conversations.

Does that help?

@Warmduscher

No it’s not (although the NHS constitution says that service users should be consulted) but, to be frank, you’ve made it an impossible circle to square. It’s not about whether you, personally, would turn down medical care from a student or otherwise but what the rules should be in general, especially for sensitive situations or for those who lack capacity. Service users have a right to respect and dignity but at the same time students have to learn-and there are some things that you can’t learn through role play/video. Somewhere the line has to be drawn and it does help to know what service users think, even if it isn’t their “job” to solve.