Send to:

Choose Destination
See comment in PubMed Commons below
Am J Surg. 2011 Jan;201(1):46-53. doi: 10.1016/j.amjsurg.2010.09.004.

Hidden practice revealed: using task analysis and novel simulator design to evaluate the teaching of digital rectal examination.

Author information

  • 1Faculty of Medicine, Imperial College, London, UK.



during traditional teaching of digital rectal examination (DRE), accurate visual demonstration is not possible, because the examining finger is hidden from view. The aim of this study was to identify the steps involved in performing DRE and the ability of teachers to verbalize and demonstrate these steps.


a "cut-away" bench-top DRE simulator (with an integrated camera) was created to allow observation of internal finger movements, with a tripod-mounted camera providing an external view. A 2-stage task analysis involved video and audio data from 20 clinicians.


DRE was deconstructed into 49 procedural steps, many of which were observed but not verbalized. The mean percentage of steps verbalized and/or observed was 54 ± 9.2% (range, 36%-70%). In addition, there were 12 critical decision points considered necessary to direct students to safe practice.


this novel methodology identified the steps involved in performing DRE, including those likely to be omitted during traditional teaching.

2011 Elsevier Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk