Teaching of the sensitive examinations: An international survey

Selena A. Hunter, Alice McLachlan, Takayoshi Ikeda, Michael J. Harrison, Duncan C. Galletly

Dean’s Department, University of Otago, Wellington, New Zealand.
Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand.
Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand; Department of Anaesthesia, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand.
Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand.

DOI: 10.4236/ojpm.2014.41007                

Abstract

Background: The teaching of the sensitive examinations—i.e. that of the female breast, female pelvis, female and male rectum and male genitalia—is a challenging part of the undergraduate curriculum. There are no studies to date detailing how national and international medical schools teach all of these examinations. Purposes: This research sought to document the teaching strategies used by national and international medical schools regarding the sensitive examinations. Methods: The sensitive examinations surveyed are the: 1) Female breast; 2) Female pelvis; 3) Male genitalia; 4) Female and male rectum. The term “female sensitive examinations” is used to refer to female breast and female pelvis examinations. This was a questionnaire study, which polled national New Zealand medical schools as well as international medical schools. Questions included: a) sensitive examination teaching method; b) stress reduction strategies; c) perceived graduating student confidence. Results: A total of 104 medical schools participated in this survey in 2010. Artificial manikin usage was the most common technique utilized for each sensitive examination (60% of all schools, 95% CI 55%-65%), whether as the sole teaching method or in combination with other methods. The next most common technique was teaching associates (49% of schools, 95% CI 44%-54%). The female breast and pelvis sensitive examinations used the teaching associate program more frequently than the male genital examination and female and male rectal examination. Regardless of teaching method, most schools believed their graduating students were confident. Stress management teaching was used in most schools, in conjunction with teaching associate sessions. Conclusion: Manikins were the most commonly used teaching component of a teaching programme on sensitive examinations. Irrespective of teaching method, most schools believed their students were confident upon graduation.

Keywords

International; Sensitive; Examinations; Teaching

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Posner, G. (2010) “Sensitive” examination workshop for medical clerkship students. MedEdPORTAL. https://www.mededportal.org/publication/7936
[2]	Broadmore, J., Hutton, J.D. and Langdana, F. (2009) Medical students’ experience of vaginal examinations of anaesthetized women. BJOG: An International Journal of Obstetrics & Gynaecology, 116,731-733.
[3]	Turner, K.J. and Brewster, S.F. (2000) Rectal examination and urethral catheterisation by medical students and house officers. Taught but not used. British Journal of Urology, 86, 422-426. http://dx.doi.org/10.1046/j.1464-410X.2000.00859.x
[4]	Akkad, A., Bonas, S. and Stark, P. (2008) Gender differences in final year medical students’ experience of teaching of the intimate examinations: A questionnaire study. BJOG: An International Journal of Obstetrics & Gynaecology, 115, 625-632.
[5]	Siebeck, M., Schwald, B., Frey, C., Roding, S., Stegmann, K. and Fischer, F. (2011) Teaching the rectal examination with simulations: Effects on knowledge acquisition and inhibition. Medical Education, 45, 1025-1031. http://dx.doi.org/10.1111/j.1365-2923.2011.04005.x
[6]	Naylor, R.A., Hollett, L.A. and Valentine, J. (2009) Can medical students achieve skills proficiency through simulation training? The American Journal of Surgery, 198, 277-282. http://dx.doi.org/10.1016/j.amjsurg.2008.11.036
[7]	Bokken, L., Linssen, T., Scherpbier, A., Van Der Vleuten, C. and Rethans, J. (2009) Feedback by simulated patients in undergraduate medical education: A systematic review of the literature. Medical Education, 43, 202-210. http://dx.doi.org/10.1111/j.1365-2923.2008.03268.x
[8]	Popadiuk, C., Pottle, M. and Curran, V. (2002) Teaching digital rectal examinations to medical students: An evaluation study of teaching methods. Academic Medicine, 77, 1140-1146. http://dx.doi.org/10.1097/00001888-200211000-00017
[9]	Bokken, L., Rethans, J. and Van Heurn, L. (2009) Students’ views on the use of real patients and simulated patients in undergraduate medical education. Academic Medicine, 84, 958-963. http://dx.doi.org/10.1097/ACM.0b013e3181a814a3
[10]	Behrens, A., Barnes, V.H. and Gerber, W.L. (1979) A model for teaching sophomore medical students the essentials of the male genital-rectal examination. Journal of Medical Education, 54, 585-587.
[11]	Fang, W.L., Hillard, P.J. and Lindsay, R.W. (1984) Evaluation of students’ clinical and communication skills in performing a gynaecological examination. J Med Educ, 59, 758-760.
[12]	Wallis, L.A., Tardiff, K., Deane, K. (1984) Teaching associates and the male genitorectal exam. Journal of the American Medical Women’s Association, 39, 57-62.
[13]	Marsland, C., Larsen, P., Segal, R., Hunter, S., Morris, J., Mezzavia, P., et al. (2010) Proficient manipulation of fibreoptic bronchoscope to carina by novices on first clinical attempt after specialized bench practice. British Journal of Anaesthesia, 104, 375-381. http://dx.doi.org/10.1093/bja/aeq005
[14]	Coldicott, Y., Pope, C. and Roberts, C. (2003) The ethics of intimate examinations-teaching tomorrow’s doctors. British Medical Journal, 326, 97-101.
[15]	Chang, E.H. and Power, D.V. (2002) Are medical students comfortable practicing physical examinations on each other? Academic Medicine, 75, 4, 84-89.
[16]	Power, D.V. and Center, B.A. (2005) Examining the medical student body: peer physical exams and genital, rectal or breast exams. Teaching and Learning in Medicine, 17, 337-343. http://dx.doi.org/10.1207/s15328015tlm1704_5
[17]	Rees, C., Wearn, A. and Vnuk, A. (2009) Don’t want to show fellow students my naughty bits: Medical students’ anxieties about peer examination of intimate body regions at six schools across UK, Australasia and Far-East Asia. Medical Teacher, 31, 921-927. http://dx.doi.org/10.3109/01421590802578244
[18]	O’Neill, P.A., Larcombe, C. and Duffy, K. (1998) Medical students willingness and reactions to learning basic skills through examining fellow students. Medical Teacher, 20, 433-436. http://dx.doi.org/10.1080/01421599880526
[19]	Howley, L.D. and Dickerson, K. (2003) Medical students’ first male urogenital examination: Investigating the effects of instruction and gender on anxiety. Medical Education, 8, 14. http://www.med-ed-online.org http://dx.doi.org/10.3402/meo.v8i.4336
[20]	Powell, H., Bridge, J. and Eskesen, S. (2006) Medical students’ self-reported experiences performing pelvic, breast and male genital examinations and the influence of student gender and physician supervision. Academic Medicine, 81, 286-289. http://dx.doi.org/10.1097/00001888-200603000-00022
[21]	Olson, L.G., Hill, S.R. and Newby, D.A. (2005) Barriers to student access to patients in a group of teaching hospitals. Medical Education, 183, 461-463.
[22]	Pugh, C.M. and Salud, L.H. (2007) Fear of missing a lesion: Use of simulated breast models to decrease student anxiety when learning clinical breast examinations. The American Journal of Surgery, 193, 766-770. http://dx.doi.org/10.1016/j.amjsurg.2006.12.033
[23]	Siwe, L., Wijma, K. and Stjernquist, M. (2007) Medical students learning the pelvic examination: Comparison of outcome in terms of skills between a professional patient and a clinical model. Patient Education and Counseling, 68, 211-217. http://dx.doi.org/10.1016/j.pec.2007.05.007
[24]	Wanggren, K., Patterson, G. and Csemiczky, G. (2005) Teaching medical students gynaecological examination using professional patients—Evaluation of students’ skills and feelings. Medical Teacher, 27, 130-135. http://dx.doi.org/10.1080/01421590500046379
[25]	Abrahams, S., Chapman, M. and Taylor, A. (2003) Anxiety and feelings of medical students conducting their first gynaecological examination. Journal of Psychosomatic Obstetrics and Gynaecology, 24, 39-44. http://dx.doi.org/10.3109/01674820309042799
[26]	Carr, S.E. and Carmody, D. (2004) Outcomes of teaching medical students core skills for women’s health: The pelvic examination education program. American Journal of Obstetrics & Gynecology, 190, 1382-1387. http://dx.doi.org/10.1016/j.ajog.2003.10.697