Law and Public Policy

Apprenticeship Rules For Medical Students

Medical students sponsored by schools with which our institution has

a formal affiliation are welcome to participate in certain clinical

activities related to patient care.

Students from some medical schools are required to register with the

New York State Department of Education and this should be completed

prior to beginning the clinical rotation.   Students must have

evidence that they are free of certain communicable diseases (e.g.

tuberculosis) and that they have been vaccinated against or are

otherwise immune to others (e.g., hepatitis, rubella). 

The Chief Residents will assign medical students to a "team" that

consists of PGY-1s, PGY-2s, PGY-3s and a teaching attending.

Although medical students will work closely with the PGY-1s, it is

the PGY-2 (and/or PGY-3) who is responsible for the student's

overall activities, teaching, supervision, and evaluation.  

Students must follow the same "universal precautions" as resident

physicians to avoid infections to themselves and to prevent

transmission of pathogens among patients. 

Chaperones

The following is a summary from the hospital policies on chaperones

and its application to histories and physical examinations performed

by medical students:

After receiving permission from the attending physician of record and

the patient, medical students may speak with patients and their

families for the purpose of obtaining a medical history and

performing a physical examination.  In all such interactions,

medical students must wear appropriate identification and introduce

themselves as medical students or student doctors.  The medical

student should explain their role as a member of the team of

physicians and nurses helping to care for the patient. The student

should make certain that they are not interrupting another

activity (e.g., eating a meal, going for a shower, going to a

procedure).  The medical student should inquire if there is anything

they can do to make the patient more comfortable before they begin

the history (and/or physical examination) such as providing a drink

of water or helping to adjust a pillow. 

All aspects of the history and physical examination should be done

in a courteous and professional manner, taking privacy and modesty

into account.  Clear, non-technical language should be used to

explain the purpose of the exam and to reduce patient anxiety.

This communication is essential, especially in situations where

no previous professional relationship exists between the medical

student (or resident physician) and the patient.

 1. Pelvic examinations performed by a male physicians must be

    chaperoned by a female staff member.  The purpose of the exam

    exam must be explained in clear, non-technical language.

 2. Before performing a breast or rectal exam of a female patient by

    a male resident or medical student, the patient must be asked if

    if she desires a chaperone (who must be female). If the patient
    declines a chaperone, the breast or rectal exam may proceed
    without a chaperone. 

    Female physicians may prefer to have a male chaperone present

    when they perform a rectal or genital examination on a male

    patient. 

 3. When barriers of language exist between physician and patient,

    all reasonable efforts must be made to obtain a translator.  If

    a translator can not be found, this is probably not an appropriate

    patient to be evaluated by a medical student.  For resident

    physicians in training, breast, rectal and rectal exams should be

    deferred until a translator is available (unless there is an

    overwhelming clinical indication to proceed, and this requires

    that a member of the opposite sex from the examiner be present

    during the exam).

 4. The rest of the general physical examination of patients is

    usually obtained without the presence of a chaperone, but good

    clinical judgment should be employed.  While chest and cardiac

    examination may require some female breast manipulation, chaperones

    are generally not required for this portion of the examination.

    However, the physician should explain what is being examined:

    "Now I am listening to your heart."   If you are in doubt, or

    your instincts suggest, err on the side of having a chaperone

    present.