Consent requirements for pelvic examinations

I write on behalf of the College of Physicians and Surgeons of Ontario, in response to the recent article in CMAJ “Consent requirements for pelvic examinations performed for training purposes.”1 We appreciate that the authors of this article were commenting only on new policy guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the Association of Professors of Obstetrics and Gynaecology of Canada (APOG), and the “flaw” in that policy related to medical residents.

Gibson and Downie1 note that the new policy fails to require residents to obtain consent prior to conducting pelvic examinations for educational purposes. Although the policy does not specifically address resident responsibilities in this area, this college’s policy — Professional Responsibilities in Postgraduate Medical Education2 — explicitly addresses the issue. Our mandate is to regulate physicians in the public interest, and our policy clearly states that patients must be given an explanation about the educational purpose of any proposed examination or clinical demonstration and that express consent of the patient must be obtained (whether the patient is conscious during the examination). The policy also clearly states that if, for any reason, express consent cannot be obtained, the examination cannot be performed. Unfortunately, Gibson and Downie1 leave the impression that the guideline of the SOGC and APOG is the only policy relevant to this issue. That patients are assured that in Ontario, and probably in most other provinces, this is not the prevailing policy is critical.

Although societies and associations should and do have policies that guide member behaviour, regulatory colleges have the authority to hold physicians accountable in a way those organizations do not.