Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Medical students are sometimes used as embedded simulation participants (ESP) to facilitate ultrasound training on live volunteers. There is little guidance on how to safeguard the autonomy and dignity of medical student ESPs serving in this role. Based on real student experiences, we used four cases to illustrate the ethical dilemmas that can arise when ESPs are used, including the examination of sensitive body areas, risk for coercion, discovery of incidental findings in a public and professional setting, and social media posting of training events. Through these cases, we explore and articulate the relevant ethical obligations educators have to obtain informed consent, sensitively address incidental findings, and ensure the psychological and physical safety of ESPs.

Methods: We developed interventions and procedures at our institution to address the obligation to promote ESP autonomy and bodily dignity, including a comprehensive consent form, ombudsperson role, and restrictions surrounding photography and social media posting of educational events.

Results: These interventions were implemented in January 2024 in the emergency department of a large academic medical center affiliated with a medical school. Since implementation, 96 ESPs have participated in 16 discrete educational events. There has been anecdotal positive reception of these interventions. Recruiting and training individuals for the ombudsperson role carried some challenges.

Conclusion: Proactive measures are necessary to support the autonomy and safety of medical student ESPs. There are practical challenges associated with recruitment, training, and implementation of the ombudsperson role. We hope that other institutions who use medical student ESPs will consider incorporating similar practices to promote the psychological and bodily safety of their volunteers.