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Teaching hospitals in two states may soon have to add a new line item to their budgets: gynecological teaching associates (GTAs).
Lawmakers in Kansas and Missouri want to ban the practice of nonconsensual pelvic exams on patients under anesthesia in their states. The practice, which is legal in 29 states, is thought to be helpful for medical students—though in recent years, it has fallen out of favor due to the lack of consent from patients.
“I just can’t really think of anything more invasive than waking up and realizing that this has been done on you,” Rui Xu, a representative in the Kansas Legislature, told Healthcare Brew. “The issue at hand is to what level of consent are they getting, right?”
A 2022 study of 305 medical students who had completed their ob-gyn rotations between June 2019 and March 2020 found that 84% had performed at least one pelvic exam on a patient under anesthesia. Nearly 70% of students reported that they “never or rarely” saw someone explicitly explain to the patient that a medical student may perform a pelvic exam on them under anesthesia.
Some institutions, such as the Rutgers New Jersey Medical School (NJMS), have hired GTAs in place of unconscious patients to help students practice performing pelvic exams. In these programs, students perform pelvic exams on GTAs, who give feedback and guidance during the process. Though New Jersey banned the practice of nonconsensual pelvic exams recently in 2022, the NJMS has had GTAs on staff for over two decades.
It is unclear how much the GTA teaching method costs hospitals, but a 2016 survey of anonymous ob-gyn clerkship directors from 135 US medical schools found the practice to be cost-effective. GTAs act as both a patient and a teacher, thus saving faculty time and effort, according to the survey.
Still, efforts to ban the practice have faced some pushback.
Missouri Sen. Lauren Arthur said that when she tried to pass a bill requiring patient consent before a pelvic exam in 2021, medical groups claimed that legislators “demonized” medical professionals who had performed the exam.
Arthur is trying to ban the practice again with Senate Bill 106, and her Republican colleague, Rep. Hannah Kelly, filed a similar bill in the Missouri House of Representatives.
“We not only want to protect patients and ensure that they have the right to say what happens to their bodies, but we also [want to] help those doctors, residents, and medical students, so that they feel like they’re making the right choice here, too,” Arthur said.