Physical Examination of Students by Peers and Tutors Policy

The purpose of this Standard Operating Procedure (SOP) is to provide the specific procedures to support safe and effective implementation of the Peer and Tutor Physical Examination Policy. In particular, to outline the procedures for requesting student consent to participate in peer and tutor physical examination. This procedure aligns with the Peer and Tutor Physical Examination policy.

As much as possible, the College of Medicine tries to arrange simulated or real patients for medical students to practice their physical examination skills; however, for various reasons this is not always possible to accomplish. In this situation, it is still important that students have the opportunity to practice and get feedback on these skills; thus, we may request that students examine one another. This SOP was developed to create a safe and supportive learning environment for students in situations where they engage in peer physical examination.

Student: Any learner in the College of Medicine MD program at any stage.

Peer: any learner in the College of Medicine MD program at any stage relative to the
student, who would be examining the student.

Tutor: The person most responsible for and supervising all learners in a clinical session,
who may be examining the student.

NOTE: A learner may be a “student” or “peer” depending on if they are examining or
being examined in a clinical session.

These procedures only apply to instances of physical examination of students by peers and tutors.

Student:

• At the beginning of the year, to read the consent request and to provide a response to the consent form.
• At the time of the physical examination, to respond to a verbal consent request from peer or tutor.

UGME Administrative staff:

• To distribute consent to all learners in the program.
• To track and record all consent responses. To work with the Module/Course Director to organize groups based on consent responses.
• To distribute specific consent information to individual preceptors, if a student does not consent to a specific examination.

Preceptor:

• To request verbal consent from learners prior to any peer or tutor physical examination.
• To respect the decision of the learner who does not provide consent for a specific procedure.

Course/Module Director:

• To provide information in a timely manner to the administrative staff about the need to employ the option to engage in physical examination by peers (as opposed to simulated patients or real patients).

1. At the beginning of the year, likely at the time of either the Year Orientation or the Clinical Skills Course Orientation, students will be informed about the potential that physical examination by peers and tutors may be requested of learners, and that a consent request will be sent to students from the UGME admin team. See consent form in Appendix A.
2. Consent request sent via one45 as a specific “to-do” for all students to complete.
3. UGME admin staff will collate and record all responses.
4. UGME staff will communicate specific non-consent responses to the appropriate Clinical Skills Course Director and to the most responsible Module Director or Section lead.
5. Clinical Skills Groups may need to be re-organized to ensure the correct proportion of consenting students.
6. Specific non-consent information for any student will be sent to the preceptor of that session to let them know. Non-consent information will also provided to CLRC staff for quick reference should a situation arise where groups may have changed or a tutor may have been changed on short notice.
7. The most responsible planner for the sessions (Module Director/Section Lead) will remind all tutors of the Physical Examination of Students by Peers and Tutor policy as part of the tutor orientation.
8. Tutors will request verbal consent for all physical exam activities that involve peer examination immediately prior to engagement to ensure consent for those students who will be participating in the peer examination.
9. If a student(s) changes their mind and withdraws consent at the time of verbal consent, it must be respected without prejudice. Tutors should not try to convince a student to change their mind. If the group can function effectively, then the session can proceed. If the group is small enough that it cannot proceed, then the tutor should contact the UGME admin and most responsible planner to determine if it is possible to reorganize students in order to proceed. 
   

Adverse Events Procedures

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.

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).

Physical Examination of Students by Peers and Tutors Consent Form – Appendix A (See Below)

Internal References
Physical Examination of Students by Peers and Tutors Policy – which contains procedures for adverse events related to peer examination.

External References
Physical Examination of Students by Peers and Tutors Policy

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

This procedure will be posted on the College of Medicine website, under the Policies, Procedures and Forms tab of the Students dropdown menu.

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

As much as possible, the College of Medicine attempts to provide simulated and real patients for students to practice their physical examination skills. In some cases, it is not possible to recruit patients. In such cases, we may ask that students examine each other to ensure students get the opportunity to practice specific skills to achieve the objectives of the course.

Prior to engaging in any peer examination, we want to ensure that you have the opportunity to provide consent to allow other students in your clinical skills group to practice their physical exams skills on you. This is a good opportunity to help your classmates to learn the skills in a safe environment and to get feedback from a peer.

We acknowledge that there may be some discomfort in participating in peer physical examination and it is important for you to know that you are not required or obligated to provide consent and your learning will not be adversely affected should you not give consent. If you choose not to consent to peer examination in general, or of any specific regions, this will not adversely affect your assessment of performance. You may also change your mind about providing consent at any time and this similarly will have no adverse effect on your learning or assessments.

If you have any additional specific concerns or needs related to participating or not participating in physical examination by peers, you may confidentially contact the course administrative coordinator, course director, and/or the Office of Student Affairs to help address any specific needs or concerns.
Please also refer to the Peer and Tutor Physical Examination Policy on the College of Medicine website for further information.

**THERE WILL NEVER BE peer or tutor assessment for breast, genitals, inguinal or rectal areas. Please indicate your consent from the options below:

A. Consent

• I give consent to all peer physical examination activities

B. No Consent

• I do not give consent for any peer physical examination

C. Connect with OSA

• I have / will connect with OSA to discuss my consent decision and will work with them to
  inform the administrative team.

D. Partial Consent

• I give consent to some peer examination, but the below physical exams are those that I
  DO NOT give consent for (check any that you do not consent to):
  • Chest/Thorax (cardio/respiratory examination)
  • Abdomen
  • Upper Limb
  • Lower Limb
  • Head and Neck (Eyes, Ears, Nose, Mouth/Throat, nodes)
  • Back
    
    

Assistant Dean, Curriculum
Phone: 306-966-5623
Email: medicine.ugme@usask.ca