Genitalia and Rectal Exams:Learning the Right Words and Right Technique

In past blog postings, I have explained how medical students are given standardized patients, actors, to interview and examine, thus allowing them to make mistakes or meet patient challenges without being embarrassed or hurting a patient. In a posting in November of last year, I discussed real patients who are trained to teach medical students about their illnesses. Today, as a segue from the last discussion of patient modesty in examinations, I would like to introduce my visitors to a common activity now in medical schools where medical students practice pelvic, male genitalia, rectal and breast examinations… on their teachers! With attention, calmness and understanding along with their other teaching skills, these uncommon and altruistic “patients” guide medical students through the process of these examinations from the beginning with the development of the initial informing the patient of what is to be done, the use of the “right” words, the behavior of the doctor during the exam and the technique of the exam itself and the final discussion with the patient. Since these folks are in real time experiencing the comfort or discomfort of the exam and can feel where the student’s finger is located they can update the student moment to moment as to what the student is doing right or wrong. Hopefully, by the time the student examines the first real patient, of course with the patient’s informed permission, there will be less apprehension by the student and the examination will be more comfortable for the patient.

A very descriptive article about this topic titled “Intimate Subjects” can be found in the Stanford Medicine Summer 1999. The article starts out as follows: AT A RECENT MONDAY NIGHT TEACHING SESSION, THIRD-YEAR STUDENT REBECCA LEIBOWITZ WAS A STUDY IN COMPOSURE AS SHE SAT, FINGER POISED, READY TO BEGIN HER FIRST RECTAL EXAM. Her subject, Barry Forgione, had already demonstrated the four possible positions for the exam, and now waited patiently, knees-to-chest, to talk her through the procedure. "That wasn't so bad," Leibowitz said when the ordeal was over. "The anticipation was a lot worse."

Forgione and others regularly lay aside their inhibitions and submit their bodies to repeated explorations by hesitant student fingers to coach the novices through these most intimate of examinations. Known as patient educators, these trained specialists teach medical students how to conduct pelvic and breast exams for men and women.

The reason why I write about how we go about teaching medical students to become doctors is that there is much detail in medical education which is unknown to the public, even those watching ER or other medical TV programs. It is important for the public to be aware of the techniques and goals and then they can size up the results as they experience physician behavior to themselves as patients. When behaviors are noted that cause patients concern, it is important to reflect that concern back to the medical school teachers. Maybe our teaching techniques need to expanded or modified. I am trying to promote that feedback though this blog. ..Maurice.