Volume 190 - Issue 6
Peer physical examination: time to revisit?
Author: Suzanne Outram
Med J Aust 2009; 190 (6): 342-343. || doi: 10.5694/j.1326-5377.2009.tb02437.x
Published online: 16 March 2009
Published online: 16 March 2009
In reply: Marley states that consent for peer physical examination “always contains elements of coercion”. It could be argued that this applies equally to medical practice and research, as one can never be 100% sure that participants have not felt some coercion. The ethical imperative is to balance the issues, to gain the best outcome.
The article by Nair and myself reviewed the literature, reported additional research in the main area where difficulties had been noted (culturally and linguistically diverse students) and, on the basis of that evidence, suggested best practice.1 Contrary to Marley’s assertion, the articles we reviewed do support high levels of acceptability: 98%,2 97%,3 and 94%,4 respectively. Marley’s statement that emotionally vulnerable students are most likely to accede to peer physical examination and then be distressed may sound correct, but there is no evidence for this. In our experience, medical students are assertive, including those from the minority groups surveyed.
Although the cost of direct payment to non-medical university students acting as “models” may be relatively small, the process of recruitment, training and processing by overstretched academic staff has significant opportunity costs. Additionally, medical students acting as models have the opportunity to experience the patient’s perspective.
We acknowledge some criticisms of the practice of peer physical examination. However, it is currently widely used and will continue to be. The intent of our article was to draw attention to unforeseen difficulties and to improve practice.
References
- Outram S, Nair BR. Peer physical examination: time to revisit? Med J Aust 2008; 189: 274-276. <eMJA full text>
- Chang EH, Power DV. Are medical students comfortable with practicing physical examinations on each other? Acad Med 2000; 75: 384-389. 0_CBBBGFBH
- Rees CE, Bradley P, McLachlan JC. Exploring medical students’ attitudes towards peer physical examination. Med Teach 2004; 26: 86-88. 0_i1091842
- O’Neill PA, Larcombe C, Duffy K, Dorman TL. Medical students’ willingness and reactions to learning basic skills through examining fellow students. Med Teach 1998; 20: 433-437. 0_i1091846