Procedures and Guidelines

Physical Examination of Students by Peers and Tutors Policy

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The purpose of this policy is to provide clear direction for the approach to and consent for physical examination of students by peers and tutors in the Clinical Skills courses, specifically, but will also apply to any learning context where peers and tutors may be examining other volunteer students.


History and physical examination skills are the core to clinical medicine. Where possible, when teaching these skills to students, the College will engage simulated patients and actual patients in order to practice and develop their skills.  However, depending on availability of standardized or actual patients, examination of peers may occur in clinical skills teaching.  This policy will apply student-centred principles in its approach to peer physical examination and consent.  This policy will respect and adhere to student privacy and confidentiality principles.


Peer: any student in the College of Medicine MD Program
Tutor: any faculty responsible for teaching clinical skills to MD Program student

Scope of this Policy

This document applies to all students and faculty involved in the teaching and learning of clinical skills in the MD Program curriculum.

Other relevant policies:  Student mistreatment, discrimination, and harassment; Procedures for concerns with medical student professional behaviour.


  1. Students and tutors may examine head, neck, and limbs typically exposed with T-shirts and shorts. Abdomen and chest (anterior and posterior) exposed by removal of top layer of clothing may also be examined.  All examinations must have the students’ explicit written consent (obtained at the beginning of the academic year). Any concerns regarding consenting to peer exam in general should be discussed with the Clinical Skills Course Chair and Course Director, or the Office of Student Affairs at the beginning of the academic year.

  2. Students and tutors will not examine breasts, the genitals or rectal area.

  3. Students must obtain verbal consent from peers to be examined before each instance of physical examination.

  4. Students may withdraw verbal consent to be examined at any time. Students are not required to disclose their reasons for withdrawing consent.

  5. Students may decline to give consent to be examined by tutors and peers. Students are not required to disclose their reasons for refusing consent.

  6. Students who refuse or withdraw consent for any component of the physical examination, if they choose, may discuss this decision with either their tutor, Clinical Skills Course Chair or Director, or Office of Student Affairs.   All parties will handle this discussion sensitively and confidentially.

  7. Tutors must not coerce students into consenting to be examined. They should only invite students who have previously given consent to volunteer for demonstration purposes. If a student experiences an instance of perceived coercion or discomfort, they should report it to the Clinical Skills Course Chair or Director and/or with the Office of Student Affairs. Tutors will have access to ongoing faculty development opportunities to ensure they have clear, ongoing understanding of these expectations.

  8. Declining participation in peer/tutor physical examination will have no bearing on a student’s assessment of performance.

  9. In the event that peer participation for physical examination is not possible within the student’s group, other avenues to ensure that student learning is not compromised will be implemented.

  10. In the event of discovery of a suspicious finding, inappropriate behaviour, or a breach in confidentiality, tutors and students will follow the adverse event procedures outlined below.
* adapted from University of Toronto Guidelines and Procedures for physical examination of students by peers and tutors

Adverse Events Procedures

A. Discovery of a suspicious finding:
During physical examination of students by peers and tutors it is possible that a new suspicious finding may be discovered, for example, discovery of a mass, a heart murmur, or elevated blood pressure. The goal is to enable the student to obtain timely medical attention.

The following steps will be taken:
  1. The examining student confidentially informs the examined student of the suspicious finding.
  2. The examining student determines whether the student is already aware of the suspicious finding.
  3. Both students confidentially inform their tutor.
  4. The tutor asks permission to perform the same physical examination.
  5. If the tutor confirms the suspicious finding, the tutor recommends that the student seeks medical advice.
  6. The tutor reminds both students of the duty of the examining student to maintain confidentiality regarding the incident.
B.   Inappropriate behaviour
Inappropriate behaviour may occur during physical examination of students by peers and tutors.  Examples include, inappropriate use of medical equipment, offensive language, or any form of abuse. Tutors may directly witness inappropriate behaviour or be alerted to it by a student. Any inappropriate behaviour will be addressed according to the Procedure for Concerns with Medical Student Professional Behaviour. If a student has potentially been harmed by the inappropriate behavior, the tutor or Course Director ensures that he or she seeks appropriate support (e.g. referral to the Office of Student Affairs).

C. Breach in confidentiality
Confidential information about a student may be revealed during history taking or physical examination. For example, students may reveal a history of medical issues, or physical examination may reveal surgical scars. It is possible in these situations that a breach in confidentiality may occur despite students being taught about the importance of confidentiality.

NOTE: Some students may willingly provide specific consent to have their physical findings used for the instruction of others, which would not breach confidentiality.

The following steps will be taken in the case of a breach in confidentiality:
  1. The tutor takes the student(s) who breached confidentiality aside to speak with them.
  2. The tutor informs the student(s) that sharing confidential information without consent is unacceptable and a breach of standards.
  3. The tutor contacts the Course Director and Year Chair (Year Site Coordinator) regarding the incident.
  4. The course director follows the Procedures for Concerns with Medical Student Professional Behaviour and takes required actions.
  5. The tutor ensures the student whose confidentiality has been breached is informed and, if required, seeks appropriate support (e.g. referral to the Office of Student Affairs).


Course Directors, Course Chairs and Year Chairs are responsible for operationalizing the policy and procedures, with oversight and consultation from the Assistant Dean, Curriculum; Director Academic; and Associate Dean, Undergraduate Medical Education.


Instances or concerns of non-compliance with the Physical Examination of Students by Peers and Tutors Policy should be brought to the attention of the Vice-Dean, Education or the Associate Dean, Undergraduate Medical Education, within the College of Medicine.

Communication & Distribution

This policy will be housed on the College of Medicine Sharepoint, in the UME Admin common folder.  It will also be housed in Curriculum Committee Sharepoint folder.

This policy will be posted on College of Medicine website, under the Policies tab of the Students dropdown menu, as well as the policies tab of the Faculty Dropdown menu.

Any updates approved by the Curriculum Committee will be distributed to all Year Chairs and all admin coordinators/support staff responsible for the MD program across the province, who will distribute it to all faculty leads and relevant sub-committees.


Assistant Dean, Curriculum
Phone: 306-966-5623