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Posts Tagged ‘medical school’

Teaching hospitals and consent

From Tuesday’s Globe and Mail Published on Tuesday, Feb. 02, 2010 12:00AM EST

Re Time To End Pelvic Exams Done Without Consent (Life, Jan. 28): Medical students would not “parade” into the operating room after a gynecologic procedure is finished, to undertake a pelvic floor examination on an anaesthetized woman. The usual practice is for a single medical student to be present throughout as a member of the surgical team.

In Calgary, patients give written consent for medical students to be involved in their surgical care, including medically necessary examinations, and patients are specifically informed before surgery, by the surgeon, that they may be examined by a trainee. If a patient objects, their wishes are honoured.

A medical student can only undertake a pelvic exam if the exam is required as part of surgery and the student is part of the surgical team.

Dr. Sara Wainberg’s paper discussed women’s attitudes to pelvic floor examinations being undertaken by medical students, in relation to consent. The concern expressed by a number of scholars is whether implicit consent for pelvic-floor exam under anesthetic, by a trainee, as recommended by the Society of Obstetricians and Gynecologists of Canada guidelines, is sufficient.

Implicit consent should be supplemented by the surgeon explicitly informing the patient that she may be examined by a trainee, as stressed by the guidelines. Of paramount concern is the need for medical students to learn basic examination techniques in a safe, well supervised setting. In the case of pelvic examination on an anaesthetized woman, it is also important to ensure the patient is adequately informed.

Sue Ross, director of research; R. Douglas Wilson, head, Obstetrics and Gynecology, University of Calgary

Lack of strategies to manage MRI wait lists a key reason for excessive wait times

By Jordanna Heller

MRI wait times excessive

A new study headed by Dr. Tom Feasby, Dean of UCalgary’s Faculty of Medicine, shows that while Canada lags behind other countries in the number of diagnostic imaging devices, more machines are not the only solution to long wait times. The study’s authors say it is critical to prioritize MRI (magnetic resonance imaging) requests effectively.

“This study shows there are important deficiencies in the current system. We hope this research will help health system decision-makers and managers improve the provision of this important service,” says Feasby, the senior author of “Management of MRI Wait Lists in Canada,” published in Healthcare Policy.

A MRI provides detailed images of the body, and is technology that is being used more frequently, especially in the areas of abdominal, pelvic, cardiac and breast imaging. The technology can be used to evaluate tumours, show abnormalities in the heart, brain and joints.

To determine how requests for MRI studies are managed the study’s authors surveyed public MRI facilities in Canada. Although almost all of the facilities have some methods to triage MRI requests, less than half documented their guidelines for prioritization, and none used quality assurance methods to ensure guidelines were followed. The report determined that despite wait times of up to several years in some facilities, strategies to reduce wait times are diverse, uncoordinated and largely ineffective.

Dr. Derek Emery, one of the report’s authors, says, “most MRI facilities in Canada have a substantial wait list problem. Improvement in wait list management will be necessary for better access, fairness and quality in the provision of MRI services in Canada. We do not currently know the extent of inappropriate overuse of MRI, nor do we know the extent of inappropriate underuse.” Emery is an Associate Professor in the Department of Radiology and Diagnostic Imaging at the University of Alberta.

“This paper shows that many MRI centres do not employ effective and standardized processes to track and manage the appropriateness of the scans they perform. Such processes are crucial to ensure that patients in different regions of Canada have equitable access to MRIs, and that patients who really do need an MRI get one rapidly. This is a challenging problem, and needs the focused attention not only of radiologists, but particularly the physicians who are ordering the scans,“ says Dr. Andreas Laupacis,  a general internist, the Executive Director of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, and a professor in the Departments of Medicine and Health Policy Management and Evaluation at the University of Toronto.

This study was supported by the CIHR (Canadian Institutes of Health Research).

Full text of the study available here.

About the Faculty of Medicine at the University of Calgary
UCalgary’s Faculty of Medicine is a national leader in health research with an international reputation for excellence and innovation in health care research, education and delivery. We train the next generation of health practitioners and move new treatments and diagnostic techniques from the laboratory bench to the hospital bedside, improving patient care. For more information visit http://medicine.ucalgary.ca. or follow us on twitter.com @UofCMedicine.