Content note: This post contains discussions of sexual and medical assault.
This is the time when scores of new med school graduates flock out into the world, getting ready to dive into their internships and direct patient care. But long before young doctors work directly with real patients, they practice with simulators, volunteers, and paid personnel so they can get confident and comfortable with sometimes invasive procedures. Learning to practice medicine, especially sensitive, emotionally-loaded medicine, can be awkward and sometimes stressful, even for those who are deeply passionate about medicine and excited for careers in the field.
One of the most sensitive sets of procedures to learn surrounds the land of internal genitals. Pelvic exams, pap smears, transvaginal ultrasonography, and various medical procedures in the nether realms are emotionally sensitive, but can also be quite painful when not performed properly, as anyone who's dealt with a poorly-inserted or painfully yanked-out speculum knows. Care providers need to learn how to perform these procedures in a physical clinical sense, but also how to put patients at ease and make sure they're comfortable and relaxed.
Medical schools address the need for actual bodies to practice on in a variety of ways. One is with simulators. Another is with professionals who are trained to specifically help medical students learn about internal genital anatomy and performing gynecological exams — in fact, in 2012, a vagina educator wrote for us about her experiences in that very role. But sometimes, they use volunteers.
Which brings us to Valencia College, where a suit alleges that attendees of a sonography program were "encouraged" to "volunteer" for transvaginal ultrasounds from their classmates as often as once a week. And by encouraged, the nameless students involved in the suit claim, the school meant threatened with penalties like poor marks and blacklisting from future employers.
No really: "In fact, Valencia’s established and widespread policy was to browbeat students who did not consent to those invasive probes and threaten Plaintiffs’ academic standing as well as their future careers until the students complied. This policy, although not express, was a widespread practice that was so permanent and well settled as to constitute a custom or usage with the force of law."
First of all, no student should be compelled to act as a demonstration body for classmates, for a whole host of reasons. In this case, it's particularly loaded, because transvaginal ultrasounds are incredibly invasive and uncomfortable — one reason people were so infuriated when states began passing laws requiring them for abortion patients. While we certainly don't want practitioners learning them out in the wild on actual patients, there are 1) adequate simulators to assist with this and 2) paid professionals for circumstances in which students want to interact with a living human to develop their bedside manner.
The plaintiffs describe a situation in which they had no privacy, people present in the room made crude remarks, and they were reduced to objects on which people could practice their skills — which is gross. Especially in the context of a world where women still face discrimination and harassment, and both of the plaintiffs were women, it's a telling and troubling reminder of the attitudes medical schools and certificate programs have about women — for the vast majority of people with vaginas are cis woman, and the vagina carries a loaded cultural burden because it's associated with femininity.
I'm trying to imagine a similar situation, one where students with prostates — as most people with prostates are cis men — are forced to regularly undergo prostate exams "to become better care providers." Experiencing an examination — voluntarily, for someone who wants to — can certainly help someone understand what it feels like, but experiencing it week after week in a hostile, charged environment is not a learning opportunity: It's abuse, harassment, and sexual assault. When students are compelled to do something they do not want to do and threatened with severe, career-ending consequences, that's not okay.
Valencia, of course, has leaped into PR damage control mode. First it reiterates that these students were "volunteers," belying their repeated testimony that they were making a coerced choice. Then they noted that this is a "nationally accepted practice." As if the sexual assault of students is okay because, well, everyone else does it. I feel like I've heard this defense before and it didn't hold water then, so why should it hold water now? No one — medical student, person seeking abortion, person who needs basic medical care — should be forced to undergo an invasive medical procedure, especially with no privacy and crude comments to go with it.
Paul Brinkmann, reporting on the situation for the Orlando Sentinel, notes that dummies are available to learn the procedure, reflecting the growing availability of incredibly sophisticated medical education tools that don't involve, you know, people. Furthermore: "While student-on-student testing may be common for many education programs, there’s no data available on the invasive transvaginal probe and how that is learned in college programs, said Cindy Weiland, executive director of the Maryland-based Joint Review Committee for Education in Diagnostic Medical Sonography."
So yes, students volunteering to help their classmates learn may be "accepted practice," but what's acceptable really changes when you're talking about highly personal procedures, and when you can safely and competently learn those procedures with dummies. Instead, this seems like yet another way to haze and torment female medical students by reducing them to literal objects for the use of their classmates.
The response to this might be a sigh and "oh, Florida," the perennially scathing remark from people who think that mocking the Sunshine State is good times, but this isn't a Florida problem. It's a medical education problem. Many students are afraid to speak out about harassment and assault for fear of jeopardizing their places in highly competitive medical programs, or of being blackballed from employers.
There's a huge power imbalance between students and supervisors in this case, many of whom have decades of experience and scores of connections throughout the field. If you anger the wrong person in a medical program, your career can be over before it starts — and people very much take advantage of that. These Jane Does are taking an important stand not just for themselves, but also for medical students in general: When we talk about harassment and hostile workplaces, and sexual assaults on college campuses, we need to make sure that the specific issues women in med school face get addressed.