Pelvic Exams Under Anesthesia Performed by Medical Students

Effective July, 2003

University of Pennsylvania Health System, Department of Obstetrics & Gynecology Policy Statement:

Medical students are frequently assigned to the operating room as a member of the surgical team during the core clerkship and elective courses in Obstetrics and Gynecology. The attending physician, who is responsible for the care of the patient, also is responsible to determine the level of participation of the student, the specific tasks that the student may perform and to assure the appropriate supervision of the student. 

As a part of many gynecologic surgeries, a pelvic examination under anesthesia (EUA) is performed to provide valuable information for the safe conduct of the operation. When an EUA is planned as part of the procedure, it is important that all aspects of the surgical procedure, including the EUA, be discussed with the patient and that the written consent specifically include “examination under anesthesia” along with other elements of the procedure. In addition to the surgeon, other physician members of the surgical team may perform an EUA to confirm the findings or render an additional opinion. In this circumstance, the EUA also may provide an opportunity to teach other physician members of the team regarding the surgical decision-making process, and the selection of the surgical approach. 

A medical student who is part of the surgical team may not perform an EUA unless the patient specifically consents to also having a medical student perform the examination. This written consent for a medical student to perform an EUA should be obtained using the form entitled “Pelvic Examination under General Anesthesia”. This form must be signed by the patient and must be present in the medical record at the time of the EUA by the medical student, and will remain part of the permanent medical record. At all times, the personal wishes of the patient should determine the extent of her participation in the education process. Refusal to have a medical student perform an EUA should not in any way affect the care of the patient. 

• EUA should be performed only by members of the surgical team who are directly involved in the care of that patient. 
• The EUA should only be performed when it is an appropriate part of the evaluation of the patient and should never be performed solely for teaching. 
• An EUA planned as part of the procedure should only be performed with the written consent of the patient.
• Prior to a medical student performing an EUA, the form entitled “Pelvic Examination under General Anesthesia” must be signed by the patient and be part of the medical record. 
• When an EUA is performed, the patient should be draped similarly to when a pelvic examination is performed in the office.