Turn your head and cough…

So, quick, tell me what you think of when you see this picture:


Yep, we did the genital and rectal examinations this week.  Now, I’m going to be pretty vague about the experience – because professionalism – but it’s something I really wanted to talk about.  No matter how grown up and mature we are, I think most of us – and I know at least my group – felt a bit awkward going into this session.  Med school is all about simulation – simulated patients in simulated scenarios.  As such, we don’t ‘touch’ patients as much as learn about them.  Added to that, although the prostate and penis exams are medical exams that are no more sexual than a cardiac or GI exam, there still exists a layer of subconscious meaning with them that is hard to shake.  Society has rules about these things, and as members of society we follow the unspoken rules of not pulling out our genitals for strangers to view and examine.  I felt that way, to a lesser degree, when I first started seeing women get checked for dilation, or birth, even though that’s the field I’m really interested in, and I am a woman.  I think this is because crossing over that unspoken societal line is, naturally, a strange if not somewhat taboo experience, and this isn’t helped by being a med student, where you are so afraid of “doing it wrong.”

So that, in a nutshell – I honestly didn’t intend for that to be a pun – was my mental state before going into the session;

Image and video hosting by TinyPicFor those visual learners 😉

How did it turn out?

Image and video hosting by TinyPic

Honestly, although I wouldn’t call the experience ‘fun,’ it was actually an excellent learning experience.  The session was just the tutor and 2 students (splitting our normal groups of 4) and there was no doctor – the tutor taught the session and then acted as the simulated patient, and whom we performed the genital and digital rectal exam on.  And I cannot say enough good things about how the session was set up – we were taught in the first hour how take the specific history and do the exam, and then in the 2nd hour we each took a history – rectal or genital – and then did both exams.  The way it was set up – the patient as the tutor, only 2 students – really made it a safe learning experience, and it was the farthest thing from awkward.  You just got into it, and then it was just like any other medical exam – I just wanted to do it right, and which part of the body I was actually examining was the last thing on my mind.  It was also a great session in that I really took a lot of knowledge out of it; despite it being a session I had 2 days before my exam, it was so well explained I could probably do a pretty though exam now without any review, which isn’t something I’ve ever been able to say for the previous physical exams.

So, final verdict on the digital rectal and genital exams? Not something I intend to make a future practice of, but definitely a good learning experience.

Doesn’t mean I didn’t take the opportunity to text my dad – who prefers to think of me as his innocent little Shirley Temple (I was a curly haired baby) – and torture him a little bit about ‘examining a man’s genitals at school today.’

Maybe I’m not that grown up after all 😉

4 thoughts on “Turn your head and cough…

  1. A medical student who refused to do a gynecological examination was forced to quit medical school. This should be debated because a future psychiatrist or radiologist doesn’t need to experience doing REALLY invasive procedures. On the other hand, I see the other side. A medical school that accepts 10% or less of applicants can FORCE students to put up or shut up. Having heard both sides, I believe it should be at least debated.

    • I totally agree with your position that there are some specialities that will never need these skills. I think the third side, or problem to that view, is that medical school isn’t really attempting to train psychiatrists or radiologists: residency is for that. Medical school is here to make family physicians, and so they throw the broad approach out not only to try and train family doctors, but to also keep doors open for students. Most of my classmates don’t know what kind of doctor they want to be when they come into medical school, and even ones that think they do change their minds when they get to clerkship. So if medical school didn’t teach something like a pap smear to a student because they were sure they wanted to be a radiologist, for example, but the they got to the wards and fell in love with gynaecological oncology, then that would be it’s own problem.

      That said, it is something that I think should be dealt with more delicacy than forcing the student to leave, which I think isn’t just being good people but also good business, as they put lots of money into these students. So that’s my two cents, and thanks for commenting and sharing your opinion!

  2. Please don’t get angry if I play devil’s advocate. What if the student REFUSES even after you tried the ‘delicate’ approach? Now what? Does she get forced out of medical school? One other point is worth exploring. Since some PA-C {physician assistant} programs are specific ie Pediatrics PA, Pathology PA, Anesthesiology Assistant, should the medical profession re-think the generalist approach?

    • Oh I’m not angry: I love a good debate 🙂 And I agree, it’s a tough area. I personally think that the school is responsible for having that student do that procedure. There are even more grey areas like, if it is a religious exception, but I would hope there would be some way to work through it without resorting to expulsion. Perform the procedure on a simulation robot perhaps? I think the focussed PA approach works very well for physician assistants, but I do wonder about it for medical school. I’d say more than 50% of my class isn’t sure what residency they want to do yet, so making medical school more specialized would be difficult I think: closing doors prematurely and the like. Still, it is a discussion worth having for sure! Thanks for having it with me 🙂

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