Patient consent if a medical student is involved

[PurpleCath]

Hi, I’ve been living in the UK for a long time, but I wasn’t born here, so I’m not entirely familiar with all the laws. Does the NHS have a legal requirement to ask for your consent if a student performs a procedure on you?
I am pregnant and recently had an ultrasound. There were two women in the room — one doing the ultrasound, the other sat next to her. At no point was I informed that the person performing the ultrasound was a student. However, when I received my report, it stated that the ultrasound had been done by a student under supervision.

I am not opposed to students gaining practice, but I believe they should have informed me, as reading this afterward caused me anxiety and me question safety in that hospital. Before writing an email to the hospital, I wanted to find out if it is a legal requirement for them to obtain consent in situations like this.

My husband had a procedure done at another NHS hospital, and he was asked for his consent, which makes me even more curious about the policy.
Thank you

The principle of consent is a big thing in terms of medical ethics. You should have been informed and asked if you were happy. If you weren’t then definitely contact the hospital - via PALS - as it sounds like more training in this area is needed. Good luck with your pregnancy and congratulations.

Any test or procedure needs consent by a patient regardless of the staff status, unless of course the patient is unable to consent and the procedure is done in their best interests or to save their life. Staff do get complacent but they do know they should introduce themselves, wear Id and gain consent. It would be worth contacting pals if the obstetric manager to let them know what happened but the ultrasound sounds safely performed under supervision. Congratulations

Student are basically working on their mentor's qualifications, so everything they do is supervised to the extend deemed necessary by the professional they are with.

While I would have introduced you to my student, I'd have allowed them to do the procedure without specifically asking if it was ok. I've only ever worked in teaching hospitals, where it's absolutely essential that our students learn.

None of us will risk our registration by not supervising properly. In this case, it's not an invasive procedure and I assume the qualified member of staff could see the monitor as well?

That should say, after introducing the student, I would of course done consent for the procedure!

They should have introduced the med student and asked for them to be present and undertake the scan. But they have competencies to pass and need patients to agree, Did the sonographer repeat it?

They should definitely introduced themselves so you knew, but I presume you consented to being scanned, but providing directly supervised I don't see an issue worth complaining about

I would always introduce myself "I'm Sarah one of the 5th Yr medical students, would you mind if i examined you tummy" for eg. For invasive stuff or to be present in theatres etc it needs to be documented on your consent form

You should have been informed - it was mentored so I wouldn't have concerns about the scan. I would certainly raise consent with the hospital.

I've experienced a number of students in various scenarios and they always asked permission. As you say - they have to learn but it may not be suitable for those who have experienced loss for example.

Twice in the last 10 years I have had an invasive medical procedure done by a student without knowing they were a student until I recieved the print off afterwards. Both times it was very very painful and very unpleasant.

The first time I thought I'd missed it in the consent form.

The second time I very very carefully read everything and made sure I was introduced to everyone in the room. Still no mention of them being a (qualified Dr but still a) student in that specialism.

The next time I had it done I explained to the nurse at the pre op who was appalled, said it was completely unacceptable. When I signed the consent form that time, I wrote 'no students please' across it - there was no mention either way, not even the 'teaching hospital' blurb I usually see on things - and as I came in the room they were asking someone to leave and I only had one person doing the procedure rather than one doing it and one watching on a monitor.

They should have introduced themselves as a student. Apart from that I do not think they have done anything wrong. They were being supervised.

The person supervising will have been watching closely. We all take supervising students very seriously. It can put our registration at risk if a mistake were to be made.

She was looking most of the time, but there were times where, she turned away and typed smth on the computer

No, when we walked in, they both introduced themselves and I assumed they were a sonographer and an assistant, or a junior and senior sonographers, but it not a student with a supervisor.

@GrannyAchingsShepherdsHut if they were a qualified doctor they are not a student? Technically everyone below consultant level is in training but that’s not the same as being a student

Was this a medical or allied health professional student or trainee?

A student has not qualified and I would ask permission, a trainee has already qualified but is working and receiving further training. Trainees provide most of your hospital care and I would not ask for permission as this is their job.

The supervisor carries the legal responsibility for the images and measurements taken during your scan and would not have approved the report if they were unhappy with them.

Theres no such thing as a student in a specialism. We are doctors and many of us have been in our specialism 10 years and work independently in all but name when oncall. Many training programmes are 14 years long meaning 5 yrs of uni, 2 yrs general training then 14 further years, many of whom are early 40s.

For most scenarios I'd actually much rather be treated by a senior registrar than a very senior consultant, as as we approach the end of training we are peak of our knowledge and cover every subspecialty oncall vs a consultant who becomes v niche and may not have done x procedure for many many years, so that's the fallacy of not understanding medical careers

it's pretty unlikely to have been a medical student - wouldn't even have known where to find the sonographers as a medical student! The supervisor will have been watching and taking responsibility for the scan and would have intervened if the student had not been able to complete the scan. However, they should have introduced themselves properly.

Ok, so to be a bit more specific, it was an endoscopy, and the report at the end said nurse:x supervising clinician: y trainee: z (and z was I think Dr Z on at least one of the occasions)

One of them put a cannula in me but did something so bizzare with it that I was just bleeding through it, a lot, and instead of trying to stop it he was panicking at the nurse that 'it's not the sort I'm used to!' while blocking her getting to me to sort it out.

So I don't know what level of training they were at, but it wasn't a level I was comfortable with at all. The nurse from the endoscopy department certainly felt it was something I should have been asked consent for.

All cannulas bleed through them as its an open ended tube into a blood vessel. It just depends on if you occlude tiny end point in the vein properly, I sometimes misjudge it slightly and they bleed on the floor... I've been doing them 14 years, we get called to do the most difficult in the hospital as anaesthetists

More recently they've started using cannulas with 1 way valves on them so they don't bleed back, as they're better for infection control risk, but they're a total pain in the butt as now means can't take bloods off the cannula and have to stab the patient twice. They've obviously worked in the latter hosp before the former

Sorry you feel worried by this. You should have been introduced and asked to consent so you can flag this to the hospital and raise a complaint to ensure procedures are always followed. Sorry this left you feeling anxious. You can also put on your birth plan that you don't want students if it deeply worries you.

However, I would agree with PP that students are brilliantly supervised, their work is checked and two eyes are better than one. I had students throughout my care and couldn't fault them. They want to do well and I am so grateful to them.

The fact that someone is in training or a student doesn’t mean they aren’t qualified to do a procedure. The fact that someone is qualified doesn’t mean they don’t need a supervisor.

@GrannyAchingsShepherdsHut I'm a senior registrar. I've been in my specialty 10 years. Often I'm the most senior doctor of my specialty in the hospital. I'm still a trainee and it would say so on paperwork. I don't ask specific consent for it to be me and not a consultant. I just consent for the procedure in general.