Assessing the Genitalia and Rectum
Assessing the Genitalia and Rectum
Abstract
Background
Learning to undertake intimate female and male examinations is an important part of medical student training but opportunities to participate in practical, supervised learning in a safe environment can be limited. A collaborative, integrated training programme to provide such learning was developed by two university teaching departments and a specialist sexual health service, utilising teaching associates trained for intimate examinations in a simulated clinical educational setting. The objective of this research was to determine changes in senior medical students’ self- reported experience and confidence in performing male and female genital examinations, before and after participating in a new clinical teaching programme. Assessing the Genitalia and Rectum
Methods
A quasi-experimental mixed methods design, using pre and post programme questionnaires and focus groups, was used to assess the effectiveness of the programme.
Results
The students reported greatly improved skill, confidence and comfort levels for both male and female genital examination following the teaching programme. Skill, confidence and comfort regarding male examinations were rated particularly low on the pre-teaching programme self- assessment, but post-programme was rated at similar levels to the female examination.
Conclusions
This integrated female–male teaching programme (utilising trained teaching associates as simulated patients in a supervised clinical teaching environment) was successful in increasing senior medical students’ skills and levels of confidence in performing genital examinations. There were differences between female and male medical students in their learning. Suggestions for improvement included providing more detailed instruction to some clinical supervisors about their facilitation role in the session. Assessing the Genitalia and Rectum
ORDER A PLAGIARISM – FREE PAPER NOW
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-016-0822-y) contains supplementary material, which is available to authorized users.
Keywords: Medical student, Intimate physical examination, Genital teaching associate, Simulation training, Teaching techniques Assessing the Genitalia and Rectum
Discussion
Main findings
This cohort of senior medical students reported greatly improved skill, confidence and comfort levels for both male and female genital examination following the teaching programme. Skill, confidence and comfort regarding male examinations were rated particularly low on the pre-teaching programme self- assessment, but post-programme was rated at similar improved levels to the female examination. Student gender analysis revealed that male students rated themselves slightly higher than female students in both pre and post programme scores. Interestingly males felt less skilled examining males than they did females in the pre-programme scores, although this was not statistically significant.
The teaching programme also had a positive impact on how students rated factors such as the adequacy of their education/instruction, preparedness for examination, opportunities for observation of and participation in examination, and the level of supervision and feedback from instructors.
Themes from the free text comments fields indicate that prior to the new teaching programme being introduced students had limited opportunistic or no opportunities for genital examinations, particularly male examinations. Comments about the teaching programme centred around what a positive experience it was. However, the quality of the individual tutor had a big impact on the experience and there was a perceived need by some students for more instruction/demonstration prior to completing their first intimate examination. Assessing the Genitalia and Rectum Assessing the Genitalia and Rectum
Strengths and limitations
The strengths of the programme were the integration of both male and female genital examination education and the use of a variety of teaching methods. Many medical schools offer opportunities for female genital examination but the use of simulated patients for the teaching of male genital examination is less common. An integrated programme of learning including both male and female genital examination in a simulated educational setting has been rarely reported [17, 18].
In the study, the overall response rate for matched pre and post results was favourably comparable with similar studies [16]. However, not all of the students’ pre and post questionnaires were able to be matched (26%), and it is not known whether this is due to students not wishing to participate or an error on the student’s part when completing the questionnaires. However 74% of eligible students did fully participate. While it was possible to undertake a simple gender analysis, it was not possible to further analyse data by ethnic group due to small numbers. Although this study was limited to student self-assessment, perceived increase in confidence and competence is an important first step in any skills learning process [19, 20] and is particularly important when learning genital examination skills in both genders. This was a point in time survey and another question to be addressed is how long the effects lasted.
Implications
Previous systematic reviews have identified improved short term outcomes for student learning with the addition of a standardised patient [8, 13], however evidence of longer term impact is still limited [8]. Further research assessing doctors in the first year of practice may be useful.
Only two other studies have included teaching programmes with both male and female genital examination together in the same programme (pelvic, rectal, breast and testicular), [17, 18] with most studies focusing on either male or female anatomy separately. The undertaking of both male and female examinations as part of an integrated programme also has important connotations for both male and female medical students. All examine a TA of the opposite, and the same, gender as themselves. This helps to minimise any perception that either gender is more important, and as an aside, may also on occasion (especially for younger students) act as a valuable learning experience about aspects of their own anatomy and sexual health. Assessing the Genitalia and Rectum
The findings from the evaluation have enabled ongoing development of the teaching programme in subsequent years. Clinical tutors have now been given more directed guidance on their role in the session. One unanswered question is how much formal teaching is required or if the guided learning is enough to enable students to have the confidence to enhance their skills as clinical situations present in subsequent training or practice. Formal feedback from the TAs and clinical tutors may also be useful in programme development. In some medical teaching settings the teaching is undertaken by the TA without a tutor. This may be worth exploring.
Conclusions
With the student demographic profile becoming increasingly diverse, and better reflecting the general New Zealand population (including ethnic mix, cultural norms and gender balance) it is important to try new approaches to genital examination training which provide a safe, supported and relaxed environment for approaching this sensitive area of learning and appropriate focus on both male and female anatomy. This teaching programme, utilising teaching associates in a simulated clinical environment, was successful in providing senior medical students with increased skill, confidence and comfort in performing genital examinations for both males and females as part of their clinically-based rotations. Suggestions for improvement included giving more detailed instruction to clinical supervisors about their role in the examination process and having a demonstration of the exam on male and female patients prior to students undertaking their first examination. Future analysis and work will include looking at the more longitudinal benefits of the program for the students and also seeking more formal feedback from the tutors and TA’s. Assessing the Genitalia and Rectum
