Ethical participation of children and youth in medical education

Question 1

What are general recommendations?

Answer 1

Institutions and physicians should inform parents and children about their rights and expectations in clinical settings where medical education is a component.

Question 2

What are the recommendations re: trainees and patient care?

Answer 2

1. Paediatric medical education programs should ensure that children and families are aware that care may be provided by medical students, residents and/or fellows. Such care should always be provided under the supervision of a responsible staff physician.
2. When indicated or appropriate, children and families should also be informed that they may be asked to participate in other aspects of an education program.
3. All trainees should clearly explain their specific roles to parents/guardians and children (as appropriate for age).
4. Patients and parents have the right to request that trainees not be involved in their care, although the attending physician should discuss with patients and families the feasibility and limits of such a request.
5. All trainees and supervising physicians should be honest and truthful with patients and families about the skill development stage of the trainees. When inexperienced students or residents are performing procedures, they should be appropriately supervised. The supervising physician (whether a senior trainee or staff physician) should explain how the procedure/intervention will be performed, and explain that teaching or instruction may occur during the procedure. This recommendation also applies to procedures performed under sedation or general anesthesia.
6. Chaperones are not explicitly required for physical examinations but should be strongly considered for intimate examinations.

Question 3

What are the recommendations regarding educational activities apart from patient care?

Answer 3

1. Ask for informed consent from the child if possible
2. Only relevant non-identifying clinical information should be presented in teaching case presentations
3. Inform children and families when planning to present their case for teaching
4. Informed consent must be obtained and documented to use images or videos
5. Always maintain privacy and confidentiality

Question 4

What are the recommendations regarding use of children in evaluations and examinations?

Answer 4

1. When children, parents or families are being used for evaluation purposes, the faculty member involved in the evaluation should clearly ask for informed consent and assent, as appropriate.
2. When children, whether actual patients or volunteer SPs, are being used in an OSCE, they or their parents should provide informed consent and/or assent as appropriate. The well-being and comfort of the child should always be paramount and he/she should have the option to withdraw or be withdrawn from participating in the OSCE. Administrators of OSCEs should always be aware of the impact that portraying a sick or troubled child has on the volunteer child, and should provide appropriate limits and counselling.
3. If other SPs are remunerated for their participation in an OSCE, children should also be compensated in a manner that does not constitute undue inducement.