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Med Educ. 2020 Feb 11. doi: 10.1111/medu.14126. [Epub ahead of print]

Differences in teaching female and male intimate examinations. A qualitative study.

Author information

1
The Department of Thematic Studies - Technology and Social Change, Linköping University, Linköping, Sweden.
2
The Department of Obstetrics and Gynaecology, and the Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.

Abstract

OBJECTIVES:

Teaching intimate examinations to medical students has been recognized as difficult because of the anxious feelings that the students may experience. For their professional development, previously incorporated understandings need to be relearned: how to transgress boundaries that regulate intimacy and physical closeness, learning to examine and touch other peoples' bodies, and talking about things that are otherwise taboo. This paper compares how students learn to perform two intimate examinations - the digital rectal exam of the prostate (DRE) and the bimanual pelvic exam (PE) - and analyses how norms and expectations affect how students learn to approach them.

METHODS:

This study is based on ethnographic work: in-depth qualitative interviews with two urologists and nine medical students in semesters 4, 8 and 11 of a medical education programme in Sweden, observations of three learning sessions where 16 students performed the PE on professional patients, and two days of observations at a urology out-patient clinic.

RESULTS:

The educational approach to the PE and DRE differ. The PE is taught as sensitive and to be handled with care, using a well-documented learning concept including interpersonal and technical skills. The patient's exposed position in the gynaecological chair, possible previous negative experiences of PE or sexual exploitation are taken into account. In contrast, there is no educational concept for teaching the DRE. The students perform their first DRE on a clinical patient. The DRE is also handled with care, but with less sensitivity. The patients' possible previous negative experiences are not discussed and are thus made invisible.

CONCLUSIONS:

Well-established routines in performing the PE help doctors and students to be attentive to patients' emotions and previous experiences, and remind them to perceive the examination as sensitive. Aligning the teaching of the DRE with that of the PE will improve how the male prostate patient is approached.

KEYWORDS:

Gynaecolocal Teaching Associates/GTA; digital rectal examination; learning; medical education; pelvic examination; professional approach; professional patients; prostate

PMID:
32043635
DOI:
10.1111/medu.14126

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