Undergraduate Clerkship Courses, University of Toronto

Purpose

To ensure patient safety, uphold ethical standards, and provide a supportive learning environment, this policy outlines the requirements for medical students performing sensitive examinations, otherwise known as “intimate exams”.

Scope

This policy applies to all medical students in the undergraduate clerkship curriculum at the University of Toronto.

Definitions

Sensitive Examination (ie. Intimate exam): Any physical examination involving breast, external chest tissue, perineal, rectum, anus, genital, or pelvic anatomy, regardless of the patient's gender identity or expression.

Supervisor: A staff physician, resident, or fellow who is physically present during the examination to provide oversight and ensure appropriate conduct. Registered nurses (RNs) are not considered appropriate supervisors.

Policy Guidelines

Presence of Supervisor

A supervisor must be physically present during all sensitive examinations performed by medical students.
Sensitive examinations include but are not limited to examinations of:

● Breast or external chest tissue
● Perineal area
● Rectum or anus
● External genitalia
● Internal pelvic organs including the vagina, uterus, and prostate

Informed Consent

Medical students must obtain informed, explicit consent from the patient before performing any sensitive examination, in the presence of a supervisor. The patient must be informed:

● That the examination involves sensitive areas of the body
● That a medical student will be performing the exam
● That a supervising faculty member will be present
● That the patient may halt the examination at any time for any reason

Training and Education

Medical students must receive structured training before participating in sensitive examinations. Training must include:

● Clinical technique and communication strategies
● Ethical and legal aspects of consent
● Respect for patient diversity, including gender identity and cultural background

Policy Enforcement

Failure to adhere to this policy may result in disciplinary action as per the Faculty of Medicine’s Code of Conduct. Students may report concerns or policy breaches to the Office of Student Affairs or the relevant clinical site leadership.

Supervisors may report concerns to the respective course director.

Alignment with Standards and Guidelines

This policy is consistent with the principles and expectations outlined in the CS2 Gyne/Urology and Breast/Chest Student Guide, which emphasize trauma-informed care, the use of inclusive and respectful language, patient-centred communication, and mandatory supervision during all sensitive examinations. It also reflects the professional and ethical standards established by the College of Physicians and Surgeons of Ontario (CPSO), including the policies on Professional Responsibilities in Medical Education, Consent to Treatment, and Boundary Violations, ensuring that medical students engage in clinical activities with informed patient consent, clear role identification, and strict adherence to professional boundaries.

Furthermore, this policy aligns with the Society of Obstetricians and Gynaecologists of Canada (SOGC) Guideline No. 246: Pelvic Examinations by Medical Students and the Canadian Medical Protective Association (CMPA) publication, Consent: A Guide for Canadian Physicians, both of which underscore the importance of explicit consent, faculty oversight, and the preservation of patient dignity in all sensitive clinical encounters.

Collectively, these documents provide the ethical, legal, and educational framework within which this policy operates, ensuring that the conduct of sensitive examinations by medical students upholds the highest standards of professionalism, patient safety, and academic integrity.