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Letters to the Editor

We Need a New Model for Obtaining Students' Consent to Conduct Peer Physical Examinations

Power, David V., MB, MPH

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doi: 10.1097/ACM.0b013e318213e5d9
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In Reply:

I agree that students participating in a curriculum that includes peer physical examination (PPE) should be asked for their informed consent and that such consent is similar to that ideally obtained from patients receiving clinical care. As our research indicates,1,2 virtually all of our medical students had no problems with participation in PPE and actually believed it provided a superior experience to practicing on standardized patients. However, our surveys revealed that a small number of students are uncomfortable with being examined by a peer, and some are very uncomfortable (“By far the worst experience of my entire medical education,” a practicing physician recently told me about her required PPE in the mid-1990s). This fact requires that we offer students an alternative to PPE, such as practicing exam skills on a standardized patient or a friend or family member. I have experience of this—and it works fine. In addition, students who elect not to participate in PPE should not be subjected to any “shaming” for making such a choice or have anxiety that their nonparticipation may negatively affect their evaluations. This requires that the course director directly communicate the components of the PPE module to all students before the course starts and that the alternatives be widely advertised and encouraged.

David V. Power, MB, MPH

Director of medical student education and clerkship director, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota; [email protected].


1 Chang EH, Power DV. Are medical students comfortable with practicing physical examinations on each other? Acad Med. 2000;75:384–389. Accessed January 21, 2011.
2 Power DV, Center B. Examining the medical student body: Peer physical exams and genital, rectal and breast exams. Teach Learn Med. 2005;17:337–343.
© 2011 Association of American Medical Colleges