Nhs students and lack of consent.

[MarbleQueen]

I’m wondering if something has changed within the Nhs. At one time you were asked if you minded having a student being present.In my area they are present at every appointment without any discussion and I’m getting fed up with it.

In the last two years these things have happened.

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.

I went for a smear and when I walked in the room there was a nurse and 3 very young women present. When I asked who they were I was told they were trainee health care assistants. I objected and the nurse insinuated I was being a bit silly and shy. I left that appointment without it being done.

I had a dentist appointment for my first ever dental treatment. I told them I was nervous. Again when I went in, I was told, not asked that the 2 people present were dental students and would only be observing. The dentist focused on explaining things to them and actually allowed one to place the filling. I didn’t agree to this.

I went to a gp apointment for something intimate to find a man around 18 years old sat in the room. Again I had to ask who he was and was told he was a student. I had to ask for him to leave and it was really uncomfortable.

I had an apointment to have a very unpleasant procedure. There was the usual student perched in the corner without any discussion. Again I had to ask who they were and was told, not asked, that they would be observing. The doctor focused on explaining things to them and when the procedure was finished I actually realised 3 more students had been brought in to watch without me noticing.

I have previously had a type of abdominal cancer. I have checks with scans and have seen the same consultant for years. On my last visit there was the usual student perched in the corner without any discussion. On this occasion, and this occasion only, the surgeon suggested doing a VE. I asked him what information he was hoping to get from this considering he had a recent MRI scan in front of him and he simply dropped it. I strongly suspect this was going to be for the students benefit because it certainly wasn’t going to benefit me.

Each of these places have standard notices in their waiting rooms informing you that a student might be present but this is not consent. I think this is now something you have to actively opt out of instead of opting in.

Has anyone else noticed this happening? I worry about what these students are learning about consent in these circumstances.

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, including being able to witness the professional attitude of the staff there in conversing with patients.

I think sadly, you have had a duff run of people who haven't properly asked you for consent. And you haven't felt confident enough to ask them to leave, probably because of the atmosphere?

I am not sure logistically asking NOT in the presence of the student is feasible in the modern NHS though. They barely have time to go to the loo, let alone be constantly going in and out of a room for people to ask without them there.

Sorry you've had bad experiences. But it's been bad enough the effect of Covid on medical schools and teaching of the next level of doctors. Half DDs year group are doing "virtual placements".

@LonelySock

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, including being able to witness the professional attitude of the staff there in conversing with patients.

I think sadly, you have had a duff run of people who haven't properly asked you for consent. And you haven't felt confident enough to ask them to leave, probably because of the atmosphere?

I am not sure logistically asking NOT in the presence of the student is feasible in the modern NHS though. They barely have time to go to the loo, let alone be constantly going in and out of a room for people to ask without them there.

Sorry you've had bad experiences. But it's been bad enough the effect of Covid on medical schools and teaching of the next level of doctors. Half DDs year group are doing "virtual placements".

As a medical student, is it really so inconvenient to leave a room before a patients comes in to allow a mentor to check if it's ok and gain their consent. They could use the time to go to the loo.

Not overly impressed with the "medical-student mums" coming onto this thread and advising OP and others about how we should feel about medical students being present without proper consent at our most vulnerable moments.

Hopefully some medical students are reading this and reflecting, but no one needs or has asked for a little lecture from the parents.

I always say yes to medical students because I personally have no reason not too. But that doesn’t mean everyone should say yes because we are all different.

Ds is 12 now so if when asked he wasn’t happy with having someone in then I would respect that (he has a complex medical history so is often a magnet for students!)

Never had a problem I have epilepsy so end up at hospital a lot my local one is a teaching hospital so there's always students with the doctors it was a student who stitched up my head last time I had a seizure they need to learn somehow

Not read the full thread.

The student should be introduced to you snd you should be asked (always) if a student is able to be present for your consult/examination. This is best practice.

You can always inform reception to message the GP/nurse at time of appt check-in that you don't want students present during your consult.

PS Work in GP practice and these ^^are standard practice.

I am not sure logistically asking NOT in the presence of the student is feasible in the modern NHS though. They barely have time to go to the loo, let alone be constantly going in and out of a room for people to ask without them there

I might be mistaken but this sounds like your daughter is already in the room when the patient arrives for a smear test and the patients are asked or told in front of her.

This is very wrong if this is the case and I really disagree they don’t have time to go out of the room.

I’ve just walked out of my living room which is much bigger than the standard gp office and it took FIVE SECONDS. Are you really suggesting your daughter cannot spare 5 seconds?

I don’t really know what a medical student actually is but what I would want to know is will your daughter be performing smear tests once she is qualified?

If not, why is she there?

I am a nurse I dont mind students being present for some things but as my job involves me teaching students I dont want any present when I have to expose myself so gynae or maternity I have all over any medical records no students.

My maternity notes had a big label on stating it (in hospital post natal I had no issue except for any personal care) so home and needed treatment/checks for me so daily midwife one rocks up I am asleep mum wakes me and says there is 2 of them (they were due late afternoon came mid morning) walking down the stairs a midwife I had never met says "I know your notes say no student but brought her anyway as thought once here you wouldn't say no" - erm yep I will my mum saw my face and hid in the kitchen

My reply " As with any consent No means no so please remove your student from my home" she still tried to argue saying but its winter and she will be cold in the car!!! I didnt back down and opened the door for the student. Had I not needed the treatment from the midwife I would have made her leave also.

It's so so wrong I have students working with me I ask in advance of an appointment not when the patient is sat there as its much harder for them to say No. My patients are children and I love it when one of them says No because it teaches them they have a voice and are listened to and hopefully take that into adulthood.

@2Gen is it relevant to a medical students training to be involved in smear tests?

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

If not, why is she there?

I asked the same thing about childbirth. Students have to tick off a certain number and so for things like forceps births they will all troop in at once as they are harder to view.

Great for their blank tick box but not ideal for the mum.

The whole idea of "needing" to watch births in person, staring silently and crowding a woman at her most vulnerable, is so dated and sexist. Many won't go on to deliver babies. There are a million birth videos on YouTube. Yes I know it's not quite the same as being in the room, but too bad – the mother's wellbeing is more important.

I would always recommend stating NO MEDICAL STUDENTS plastered over my maternity notes, because birth is often traumatic enough without spectators.

@AutomaticMoon

Well something must’ve changed because in 2020 the NHS felt entitled to enrol all citizens on the organ donor list, without asking or anything.

I think it was decided by parliament and not by the NHS

@draramallama

I worry about what these students are learning about consent in these circumstances.

I agree with you. Unfortunately these completely reflects the NHS's toxic culture around consent - or rather the culture of failing to seek consent and assaulting patients instead.

Apt username.....

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, including being able to witness the professional attitude of the staff there in conversing with patients

The phrase medical student is a bit loaded I think. It can imply someone is a trainee doctor when they’re not.

Another description for a medical student is a teenager with no medical experience who’s recently started university.

How old is your daughter and how long has she been at university?

@eastmidswarwicknightnanny

I am a nurse I dont mind students being present for some things but as my job involves me teaching students I dont want any present when I have to expose myself so gynae or maternity I have all over any medical records no students.

My maternity notes had a big label on stating it (in hospital post natal I had no issue except for any personal care) so home and needed treatment/checks for me so daily midwife one rocks up I am asleep mum wakes me and says there is 2 of them (they were due late afternoon came mid morning) walking down the stairs a midwife I had never met says "I know your notes say no student but brought her anyway as thought once here you wouldn't say no" - erm yep I will my mum saw my face and hid in the kitchen

My reply " As with any consent No means no so please remove your student from my home" she still tried to argue saying but its winter and she will be cold in the car!!! I didnt back down and opened the door for the student. Had I not needed the treatment from the midwife I would have made her leave also.

It's so so wrong I have students working with me I ask in advance of an appointment not when the patient is sat there as its much harder for them to say No. My patients are children and I love it when one of them says No because it teaches them they have a voice and are listened to and hopefully take that into adulthood.

I hope you did this in front of the student or made a formal complaint.

Its really not on to be doing that. If shes done that to you as a nurse, she'll do it to others.

Admitting that she has read notes and deliberately ignored is even worse than not reading the notes.

*The phrase medical student is a bit loaded I think. It can imply someone is a trainee doctor when they’re not.

Another description for a medical student is a teenager with no medical experience who’s recently started university.*

That's a really good point as well.

I'd feel massively different about having a literally just out of sixth form young lad expecting to observe my intimate medical care (as in over my dead body is that happening) than I would the wonderful student midwife who id met at antenatal appointments (and where consent was always sought from me) who stayed for ages with me at a postnatal visit to my house after my first baby was born, taking her time with my care and chatting with me, when I was feeling fragile and struggling. She was a mum herself and was so wonderful.

It should always be down to the patient as to what they feel comfortable with.

I'd feel massively different about having a literally just out of sixth form young lad expecting to observe my intimate medical care (as in over my dead body is that happening) than I would the wonderful student midwife who id met at antenatal appointments

Absolutely.

I think some posters think I’m objecting to students who are like your student midwife.

I’m not. These types of students are warm and professional and go out of their way to make you feel comfortable.

I’m talking about kids who are barely out of school who stand around gormless with zero social skills feeling entitled to watch intimate examinations. I’m really getting fed up with the insinuation these teenagers are trainee doctors when they’re not.

I had a student midwife and they hadn't told me that's what she was so I was not happy. It was all a bit of a nightmare as they were telling me I should go home because the baby wouldn't come for ages. Luckily, I refused because an hour later he arrived.

I've also had a smear in the past with a student present. The doctor said to her 'do you want to have a go?'. I was like 'do you mind?!!! I am still here'.

I've also had a smear in the past with a student present. The doctor said to her 'do you want to have a go?'. I was like 'do you mind?!!! I am still here'

Have a go, ffs. How dare they.

You’ve perfectly described in one sentence what I’ve been been struggling to put into words.

@RedToothBrush You said earlier that the lack of empathy or care from many on this thread is astounding. I agree, it’s demoralising and v upsetting for someone with cPTSD to witness this. But I’d rather know the sad truth than live in land of make believe where body autonomy and consent is respected. I grew up under communist totalitarianism and Ceausescu would’ve loved the blind NHS worship exampled here, it would make the CCP dictator proud too.

@Fordian Are you trolling or...?

@Newmum738 OMG disgusting. There’s another thread with some vile examples of consentless membrane sweeps, so upsetting to read. What did they say to you when you reminded them you’re still there?

First of all no one should have anyone in the room for an intimate examination they don’t want (with the caveat that if the medical professional wants a trained chaperone and the patient dosent then the exam should not go ahead and visa versa)

If people think medical students aren’t in training to be doctors what are they? I’m surprised that people think that doctors don’t need to know how to deliver a baby or perform a gynaecological exam! Medical students are sometimes referred to as “student doctors” so it’s clear they are the same level as “student nurses” or “student midwives”, that is desperate to “trainee doctor” which refers to qualified doctors who are not yet consultants or GPs.

Medical students are on a five (or 4 or 6) year undergraduate course after which they become a FY1 doctor registered with the GMC. An FY1 doctor should be competent to independently examine patient, this means they should be able undertake a speculum exam independently, take blood independently etc - they only require supervision writing death certificates and outpatient (fp10) prescriptions. This means they need to be competent in all the stuff before they qualify.

It used to be that med students spend 3 years in lectures and two years in hospital but it was felt that this created book smart but not people smart doctors so programmes are inter grated clinical and theoretical.

It would be unusual for the placement in obs and Gynae to be first year stuff as they tend to cover the basics like chest and abdomen first but in their second or third year the student will get their obs and Gynae block as this is their only training in that before they qualify. They are only gonna be 19-21at this point. They’re gonna be qualified doctors by 22-23 and could be an independent GP partner by 27 so I’m not sure how it’s possible to object to them being late teens early twenties at the start of training is logical - they are going to only be a year of so out of school because in only a handful of years out of school they are going to be doctors!. I don’t think womens health should be changed to a post qualification super specialist area!

With regard to sending the student out the room to ask - it’s easier in hospital when you go into the room the patient is already in as you can go in first and then call the student in. In places where the doctor is already in the room it’s a serious up and down business and cuts into the teaching time which is on more than the patient interaction as it’s 10min per patient including the walking time! Most doctors review notes and discuss possible learning points with the student as patients walks in from the waiting room - I think we would have to add 1-2min to appointments to make time for this to happen and then for the student to pack their stuff and remove PPE, leave the room, patient then to be called and then to call the student back in from the staff room or reception or wherever (as we can’t really have them lurking in the corridor outside the room) who then has to unpack stuff and re don PPE. In a morning surgery that’s one or two less appointments.

Personally I have the student in the room to review the notes then leave them there (doing something useful like the covid clean of the chairs and couch and equipment) and then go to fetch the patient from the waiting room and ask them on the walk back so it’s before the room but without the jumping Jack nature. If patient says no I can then speed up and as student to leave and have a nice covid secure cleaned down room and the student has benefitted from the learning from the note review etc

Are you seeing a gynaecologist in hospital? You can certainly ask that students are not present for your consultation when you check in and the reception team would tell us that and we wouldn’t bring them in. They would be around though as they are a ubiquitous part of any hospital department - unless it was not term time there were always students present when I worked in Gynae - which there should be, I’d be reporting them for non attendance if they didn’t turn up as it’s mandatory for their course!

When you say no students I assume you mean pre qualification doctors? The doctor you see may well be post qualification trainee? It’s not always possible to request a consultant - their might not be one at that clinic.

[quote AutomaticMoon]@Newmum738 OMG disgusting. There’s another thread with some vile examples of consentless membrane sweeps, so upsetting to read. What did they say to you when you reminded them you’re still there?[/quote]
Nothing at all. Don't think they noticed!

When you say no students I assume you mean pre qualification doctors?

I suppose it means 'anyone who is not clinically needsd for patient care'.
I don't care if the additional person in the room is s student, a training hcp, a cqc observer.

anyone in the room needs to introduce themselves and explain why they need to be there.

plus the practicioner needs to read the patient note in case it is vital for the patients not to have anyone else present.