RLH interviews Yvette Coldicott

Coldicott Y, Pope C and Roberts C. The Ethics of Intimate Examinations – Teaching Tomorrow’s Doctors. BMJ 2003: 326. Pages 97-101

This paper deals with the difficult issue of how vaginal and rectal examinations are to be taught to medical students. The paper explores the ethical problems for students and educators and discusses the existence of guidelines. Yvette Coldicott and her colleagues report on an exploratory survey. The findings suggested that best practice is not always followed and that in many cases consent has not been given for procedures.

This paper has caused considerable interest amongst doctors, medical educators, and students. The editors of the Website felt that it would be of interest to interview Yvette Coldicott to ascertain why and how the study was undertaken.

RLH – Tell me a little about yourself.

Yvette – I was born and brought up in the UK. My mother is Dutch and I have spent a considerable amount of time in Holland. My father is an airline pilot. I have one sister.

I have spent the last few years at Bristol Medical School. In 1998/99 I studied for a BSc. I wrote a thesis on ‘Euthanasia in the Netherlands – a framework for reform in the UK?’ During the year I undertook a module in Medical Law –working with law students from the Faculty of Law in the University of Bristol. At this time my interest in medical law and medical ethics crystallised. My objectives have been firstly to teach others what I have learned and secondly to continue my own learning. I have been involved with teaching medical students on various ethical subjects, both as a student and now as a qualified doctor. I also teach on the Medical Ethics module of the Developing Professional Skills Course for Senior House Officers and Specialist Registrars in the south-west. I have recently co-written a book – The Practical Guide to Medical Ethics and Law. Chloe Baxter, Mark G Brennan and Yvette Coldicott. The book was published in October 2002 by Pub. Pastest (ISBN 1.901198.966 6). I have also been working with the Medical Defence Union on a consultancy basis dealing largely with the issue of how the MDU can relate to medical students and junior doctors--- providing a series of questions and answers on common aspects of medical law.

RLH – I would be very interested to learn about the project published recently in the BMJ.

Yvette – This project was iThe New Academies – article by Dr David Cahillnitiated following conversations with other medical students. I found that they were also worried about what they were being asked to do in relation to intimate examinations. The topic came up at a session which was chaired by Dr. Clive Roberts and Professor Alastair Campbell. At that time there were guidelines for fourth year medical students doing gynaecology, but none for more junior students. I had not seen any guidelines at all at the time that I initiated the project. Subsequently, more ambitious guidelines have been produced and these are now available for all students.

RLH – Who suggested the topic?

Yvette – I did.

RLH – Who undertook the work?

Yvette – I undertook virtually everything in the study. Clive Roberts was very helpful as supervisor for the project.

RLH – I understand that there were two parts to the project. Perhaps you would be kind enough to tell me about these.

Yvette – The first part involved sending out a questionnaire to medical deans in 25 medical schools in the UK. We received 17 responses. Most of the responses were positive and some respondents indicated that they had considered similar studies themselves.

The second, and major, study involved a large number of students from one of the UK medical schools. 386 students responded to a questionnaire which occupied two sides of A4. I analysed the data myself using the spreadsheet in Excel. I have had no real training in statistics and for this reason there is little attempt in the paper to analyse the results in strictly statistical terms.

RLH – Who thought up the questions?

Yvette – I thought up the questions myself and Clive Roberts went through them closely with me at each stage.

RLH – How did you find the time to do this study?

Yvette – Each student has to do special study modules. This study was undertaken during the course of a study module, so I was allocated time over a 6 week period of time in the third year. I had to spend a large amount of my own time in addition to this – in total the research took me about 6 months to complete.

RLH – Collecting data is one thing but writing it up for publication is another. How did you cope with this?

Yvette – The paper was put to one side. I was then, unexpectedly, invited to give a 20 minute paper at a conference in Dublin (The Annual Scientific Meeting of the Association for the Study of Medical Education). This was a daunting experience as I had not previously spoken in public. However, it did enable me to get my thoughts together. This invitation was through the good offices of Mark Brennan who introduced me to the panel in Dublin and helped to get the presentation accepted.

Thereafter, I was much helped by Catherine Pope at Canynge Hall. She offered help and support and really taught me how to write a paper.

RLH – Was it easy to get your paper accepted by the BMJ?

Yvette – The paper was accepted quite rapidly but it was subsequently necessary to make a number of changes and there was a considerable delay between acceptance and publication.

RLH – What has happened since publication?

Yvette – The paper was given considerable prominence in the BMJ both in \"Editor’s choice" and in an editorial by Peter Singer. Since publication there have been many expressions of interest. The Chief Medical Officer and the General Medial Council have expressed interest. Most of the comments have been positive and supportive.

RLH – You are to be much congratulated on this study. Firstly, it is unusual for medical students to have a paper published in the BMJ as a result of work done during a study module. Secondly, the topic under discussion is clearly important but also potentially contentious. We are all grateful to you for having highlighted a subject that some people would not wish to be openly discussed.

You are also to be most warmly congratulated on having pursued your interest in ethics and law and for having co-written a book on the subject. I understand that you are intending to pursue a twin career in anaesthetics and law. I do wish you well in your career and shall watch your progress with much interest. Thank you for taking time from your busy job in the intensive care unit at the BRI to do this interview.