Last Thursday, two students at Orlando’s Valencia College alleged in a lawsuit that instructors forced them into submitting to weekly transvaginal ultrasound exams performed by fellow students as part of their training.
The details of these allegations are shocking. But a closer look at “medical diagnostic sonography” programs at several other colleges in the United States reveals that there is potential for abuse. Regardless of what happens with the Valencia case, the attention it has drawn could help future students if it causes colleges to tighten practices surrounding student volunteers.
For its part, Valencia has defended itself, saying in a statement that such student-as-patient examinations are common practice throughout sonography training programs nationally. It offered a rather tone-deaf promise, to “review this practice,” but it should have gone further in acknowledging the seriousness of the specific allegations and pledging to investigate them.
The lawsuit filed in Orlando’s federal district court says that while the college first told the students that participation in the ultrasound exams would be voluntary, instructors later coerced them onto the exam tables. When they complained, says the suit, the instructors told the two women they must participate or find another program, and they threatened to have local hospitals blacklist them from employment.
The plaintiffs describe a program they say is reliant on student “volunteer” patients systematically subjected to painful and humiliating pelvic exams in a classroom setting in front of the instructors and other students. A male student repeatedly examined them too, they allege. The lawsuit describes crass instructors who demeaned the students with inappropriate remarks about their bodies. In one almost unbelievable detail, the students allege classmates in some instances had to sexually stimulate the alleged victims in order to insert an ultrasound probes.
If any of this is a remotely common practice in the training of our allied health care professionals, we have a serious problem to address. I think back to my own experience in medical school and residency training, where certainly we made use of ourselves as subjects, but for benign examinations in more modest body regions. (Practicing phlebotomy or nerve conduction studies on each other is a far cry from what these sonography students allege.)
When teaching male genital and prostate examination, a volunteer physician from the community met with a small group of medical students, including myself, and actually used his own anatomy as our model. Yes, that was a bit awkward. But when the examination subject is also your teacher, the power dynamic is flipped entirely.
For the vaginal examination, my program taught us first on paid community volunteers. For every kind of procedure and examination, real patients are where trainees will gain their most important skills, but for certain types of intimate examinations, it makes sense to have some form of practice before the real-world setting. The very first patient will appreciate it.
Myka Campbell, diagnostic medical sonography program coordinator at Armstrong State University in Savannah, Georgia, told me this is why some of her students choose to perform transvaginal examinations on each other — so that their very first experience with the technique isn’t on a patient who’s every bit as stressed as her students.
The Armstrong State program is equipped with anatomically correct mannequins designed to train students on the basics of transvaginal ultrasound, and many students use only such simulated models before starting real-world clinical experience. Campbell says her program is careful to present practicing on one another as an entirely voluntary option, and in no way does it affect students’ grades or employment prospects.
When students do examinations on one another, it’s reciprocal, she says — so there’s no way a male student could end up performing a transvaginal exam on a female student, as is alleged to have occurred in Orlando.
I also spoke with Kathleen Megivern, the executive director of the Commission on Accreditation of Allied Health Education Programs, or CAAHEP, the organization responsible for accrediting sonography training programs, including Valencia’s. She said she was “mystified” to read about this lawsuit when CAAHEP hasn’t even received a complaint about the matter, which would have prompted an investigation.
CAAHEP’s guidelines state that programs “must ensure voluntary and prudent use of students or other human subjects for non-clinical scanning. Students’ grades and evaluations must not be affected by participation or non-participation.”
It’s hard to get a handle on precisely how many programs permit students to participate in such intimate examinations with one another, and since CAAHEP’s guidelines leave a lot of room for variation, I’d expect to see a variety of practices across the country. CAAHEP actually oversees more than 20 different allied health training programs, and it subcontracts with a variety of professional bodies in each area, like the Joint Review Committee on Education in Diagnostic Medical Sonography.
A representative for that organization told me via email that it doesn’t collect data on the type or frequency of exams students practice on fellow students.
But to craft the kind of specific guidance that’s apparently needed, the Joint Review Committee will need to start collecting that data. Once the committee learns what its training programs are actually doing, I’d suggest that it survey students in order to select the right path forward.
My best guess is that training programs simply find it cheaper using captive students rather than paid subjects.
I spoke with Brenda Hall, who until recently was the ultrasound supervisor at Emory University Hospital Midtown. She said she was floored by the allegations about Valencia; during her training at Grady Memorial Hospital’s program, students only did abdominal examinations during group laboratories. If students wanted to practice transvaginal exams, they did so separately from the group, on each other.
She pointed out that it’s never appropriate to sexually stimulate a subject in order to insert the probe, and that it’s often simplest, and most modest, just to let the patient insert the probe herself.
Health care careers do have a way of making people less modest. There are plenty of embarrassments to be suffered once you’re helping patients in the real world. But they don’t include anything like what these sonography students may have experienced. I hope medical training programs of all stripes will use this episode to reflect on how easily vulnerable students can end up consenting to situations they later regret.
