Male Gu Exam Video
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- Pulmonary exam: His lungs were clear to auscultation. A screening low-dose CT of the chest demonstrated no pulmonary pathology. Cardiac exam: Heart exam was normal. Regular rhythm. No murmurs or other abnormal heart sounds were noted. His ECG, or...
- He had no evidence of ischemia, and his wall motion was normal in all images. Gastrointestinal exam: He had a normal exam, no masses, no hepatomegaly or splenomegaly. He had a normal optical colonoscopy done in — June of — that...
- But laboratory results summarized: A lipid panel. He had a total cholesterol of Triglycerides of HDL of An LDL cholesterol of And his total cholesterol to HDL ratio is 3. His complete blood count, to include his white blood cell count, his hemoglobin, hematocrit, and platelet count were all normal. His extended metabolic panel, as follows: His fasting blood glucose was His BUN was His creatinine was 0. His hemoglobin A1c was 5 percent. His vitamin D was His PSA was 0. And his thyroid screen with the TSH was 1. He had a urinalysis done that was clear and had no evidence of protein, ketones, glucose, or blood. His past medical history includes hypercholesterolemia and rosacea. His past surgical history: had an appendectomy at age His social history: He has no past or present use of alcohol.
- No past or present use of tobacco. His medications, as follows: He takes Crestor, 10 milligrams daily to lower his cholesterol. He takes aspirin, 81 milligrams daily, for cardiac health. He takes Propecia, 1 milligram daily, for prevention of male-pattern hair loss. He takes Soolantra Cream, as needed, for Rosacea. And he takes a multivitamin each day for health maintenance.
- Immunizations: The President, during his physical exam, had a Prevnar 13 immunization to prevent pneumococcal pneumonia and he had Number 2 dose of his Twinrix to prevent hepatitis A and B. His routine vaccinations, to include his seasonal influenza are all up to date, and all indicated travel vaccinations are up to date. His cardiac performance during his physical exam was very good. He continues to enjoy the significant long-term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol. We discussed diet, exercise, and weight-loss. He would benefit from a diet that is lower in fat and carbohydrates, and from a routine exercise regimen. He has a history of elevated cholesterol and is currently in a low dose of Crestor. In order to further reduce his cholesterol level and further decrease his cardiac risk, we will increase the dose of this particular medication. The President is currently up to date on all recommended preventive medicine and screening tests and exams.
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All clinical data indicates that the President is currently very healthy and that he will remain so for the duration of his presidency. Get our Politics Newsletter. The headlines out of Washington never seem to slow. Subscribe to The D. Brief to make sense of what matters most. Please enter a valid email address. Please attempt to sign up again. Sign Up Now An unexpected error has occurred with your sign up. Please try again later. Check the box if you do not wish to receive promotional offers via email from TIME. You can unsubscribe at any time. By signing up you are agreeing to our Terms of Service and Privacy Policy. Thank you! For your security, we've sent a confirmation email to the address you entered. Click the link to confirm your subscription and begin receiving our newsletters. If you don't get the confirmation within 10 minutes, please check your spam folder. Write to Jamie Ducharme at jamie.- 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.
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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. 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.- Peer Review reports Background Medical students find learning to do intimate clinical examinations challenging [ 1 , 2 ]. Due to the sensitive nature of these examinations for patients as well as the reticence of some students, opportunities to gain skills in this area may not be readily available in the course of current medical school teaching programmes [ 3 , 4 ] Opportunistic learning of first-time intimate examination skills only in clinical settings has long been identified as an inconsistent and ineffective method of ensuring that all students gain the necessary skills in ways that are respectful of patients and feasible for busy clinical staff [ 5 ]. New teaching methods are continuously being explored to decrease student anxiety levels and to provide a safe environment for students to improve performance prior to practicing these examinations on patients in clinical settings.
- The use of audio visual material, mannequins, [ 7 ] tutorials and teaching associates [ 8 — 11 ] are common teaching modalities employed to improve confidence and competence. Internationally there has been a shift towards the use of paid, trained gynaecological teaching associates GTAs especially for learning to examine the female pelvis [ 12 ]. However there have been few studies investigating the effectiveness of female and male genital examination training using Teaching Associates TAs undertaken as part of the same programme [ 8 , 13 ]. Some criteria for evaluating simulation learning programmes have been developed. The combined use of teaching modalities has been shown to be effective. For example, the addition of a standardised patient to a simulation model and use of electronic feedback [ 13 ], the use of standardised patients to teach genital examination prior to using the mechanical simulation, [ 15 ] and the use of an online learning module viewed immediately prior to a simulated class session [ 16 ].
- Strategies for teaching genital examination previously included opportunistic teaching in various clinical settings, the use of mannequins female examination only , and scheduled teaching of speculum examination and smear taking in a family planning clinic. There was no programmed male genital examination teaching. The WSHS is a direct-access specialist service based in the community, staffed by sexual health physicians and clinical nurse specialists. The programme was first implemented in This paper reports on the design of the teaching programme and the pre and post questionnaire evaluation results. Methods Population The study population included all 84 medical students in year five of a six year undergraduate degree programme at the University of Otago, Wellington in The programme The genital examination teaching programme consists of an introductory session followed by a practical session several days later for all 5th year medical students.
- The programme ensures that all students successfully undertake both a female and male examination. The learning takes place as part of one of several General Practice modules within the six year medical degree. See Fig. Preparatory material is available about genital examination processes and procedures on a secure online learning platform, including appropriate video-recordings. Students are expected to familiarise themselves with these resources before the day of the practical session. Each 3—4 h practical session can accommodate up to 16 medical students at a time by running four parallel streams of dedicated clinic rooms two for male, two for female examination , each using Teaching Associates TAs and clinical tutors. Half the student group undertake the female-specific preparatory learning activities and the female clinical examination first, then follow with the male-specific preparatory learning activities and male examination. The other half group undertake their learning in reverse order.
- The organisation of 16 students, up to eight TAs, four clinical tutors, and TA and tutor reserves in any one practical session is complex but runs smoothly with efficient administration. During the teaching sessions the program convenor and administrator are available to circulate, assist with logistics and discuss and answer any questions the students may have. The TA role is to be a real life patient so students can practice a genital not breast or rectum examination, and to provide patient feedback. Following an expression of interest, potential TAs are invited to a one-hour training session run by experienced WSHS staff. Following the session attendees are asked to indicate if they still want to be involved. Those who want to participate are then rostered to each of the practical sessions. TAs are paid for their services at the same rate as other simulated patients. Tutors from all disciplines initially met together and agreed on the intended learning outcomes and the format for the sessions.
- On the day of the practical session, students first prepare by working together in pairs to re-review a video recording of the examination they are about to undertake, and in turn practice the examination procedure on fabricated models. Prior to the female examination, students practice speculum insertion and bimanual examination. Prior to male examination, students practice testicular examination and view swab testing kits. Individual students then immediately proceed to an appropriately equipped clinical examination room with a trained TA and a clinical tutor.
- Each student undertakes the examination, talking appropriately to the TA and guided throughout by the clinical tutor. During the female examination, the student is expected to correctly use a speculum to visualise the cervix, and undertake a bimanual examination. During the male examination, students undertake examination of the genital area, including testicular examination. Feedback, and testing for sexually transmitted infections is discussed but swabs are not taken. Constructive feedback is given and discussed by both the tutor and TA. Staff are available to assist students with debrief if required, although this has rarely proved necessary. Programme evaluation The evaluation was undertaken using a mixed methods approach. Students were asked to complete pre and post teaching programme questionnaires. Following the programme successive groups of students were also invited to participate in focus groups.
- Focus groups were also undertaken with two cohorts of students in their final clinical year year 6 , one cohort who had not been part of the programme and a subsequent cohort who had participated in the programme. Focus group results will be reported separately. Each student in the cohort was asked to complete pre and post programme questionnaires. Finally there was a free text field where students could include comments on both the pre and post questionnaires.
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The post programme questionnaire differed slightly in that questions six, seven and eight were asked about the current teaching intervention, rather than past experience See Table 1. The questionnaires are also available as Additional files 1 and 2. Table 1 Standardised student evaluation form questions Full size table Questionnaires were linked by a unique, non-identifiable number. Students were asked to use the last six digits of their mobile phone number.- Students were given the option of omitting the code on the post questionnaire if they objected to their pre and post data being matched. For linkable questionnaires Wilcoxon signed-rank tests were used to compare pre and post scores for all questions and P values were reported. We also analysed scores by student gender. The difference in overall means for Questions 1 to 8 by student gender were analysed using a Wilcoxon rank-sum test.
- Differences in how students rated their pre programme skill level for male and female examinations were analysed using Wilcoxon signed-rank tests. The difference between pre and post responses for Questions 9 through to 11 were also analysed by the gender of the student. A Wilcoxon rank-sum test was performed on the difference in test scores. Free text comments were reviewed by 3 investigators and grouped into obvious themes. Questionnaires were unable to be matched if participants had either declined consent by not submitting a code or had illegible codes.
- Students considered themselves less skilful, confident and comfortable at performing male genital exams compared to female exams prior to the teaching intervention. Following the teaching programme skill, confidence and comfort had improved for both female and male exams, but improved more for male exams. Table 2 Students self-rated skill, confidence and comfort level for male and female genital examination pre and post programme Full size table Completion of a simple gender analysis identified there were differences between male and female students.
- For questions one to eight the median overall male student self-assessment score was slightly higher than the female students median 2, interquartile range 2—3, versus 2, 1. We also examined changes from the pre to post score means according to student gender, but none of the differences in student gender were significant. The grouped themes illustrated with quotes from these comments are outlined in Table 3. Of the 62 linked questionnaires, 22 students included comments in the pre questionnaire and 33 in the post questionnaire. The pre teaching themes were largely based around lack of opportunity to participate in genital examinations on real patients, particularly male. The post teaching comments were largely positive, with a few helpful suggestions for improvement. Table 3 Themes from free text field of questionnaire 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. 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. 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 ]. 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.
Patient Preferences For Physician Gender In The Male Genital/rectal Exam
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.
- 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.
- She Received One Anyway. Ashley Weitz, who received an unauthorized pelvic exam in , on the grounds of the Utah State Capitol. Last year she testified before the Utah Senate in favor of a bill requiring express consent for the procedure. Medical schools and students are grappling with an unsettling practice: Performing pelvic exams on unconscious, non-consenting patients. Before the procedure, she told her physician that she did not want medical students to be directly involved. But after the operation, Janine said, as the anesthesia wore off, a resident came by to inform her that she had gotten her period; the resident had noticed while conducting a pelvic exam.
- Distressed, she tried to piece together what had happened while she was unconscious. Why had her sexual organs been inspected during an abdominal operation, by someone other than her surgeon? Later, she said, her physician explained that the operating team had seen she was due for a Pap smear. Janine burst into tears. The hospital declined to comment on its policies regarding informed consent for pelvic exams. The exams are typically conducted while the patient is awake and consenting at a gynecologist visit, to screen for certain cancers, infections and other reproductive health issues.
- But across many U. Sometimes the exams are conducted — by doctors or doctors-in-training — while women are under anesthesia for gynecological and other operations. Often the exams are deemed medically necessary, but in some cases they are done solely for the educational benefit of medical trainees. At some hospitals, physicians discuss the procedure with patients beforehand or detail its specifics in consent forms, but at others the women are left unaware. There are no numbers to indicate how many pelvic exams have been performed nationwide without consent, but regional surveys suggest that the practice is not uncommon. A survey at the University of Oklahoma found that a majority of medical students had performed pelvic exams on unconscious patients, and in nearly 3 of 4 instances they thought informed consent had not been obtained. Phoebe Friesen, a biomedical ethicist at McGill University, drew attention to the issue in with articles in Bioethics and Slate , which elicited stories from other women with the hashtag MeTooPelvic.
- She wondered how an operation performed through incisions in her abdomen could have affected her sexual organs, and concluded that either a uterine manipulator was used or a pelvic exam was conducted without her knowledge. Wright said. In most states, it is legal for a medical student to perform a pelvic exam on a woman who is under anesthesia; Ms.
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Wright believes this happened to her during a surgery in Because if so, you should have your surgery somewhere else. Wright testified before the Wisconsin legislature in favor of a bill on informed consent. In , the School of Medicine and Public Health adopted a new policy requiring doctors to obtain informed consent before allowing students to perform sensitive exams, which must be related to routine care, on anesthetized patients.- Last year, the United States saw a wave of bills banning unauthorized pelvic exams in 11 states. Maryland, Utah, New York and Delaware passed laws mandating informed consent, joining six states with prior regulations on the books. A number of medical institutions have their own policies in place. Nearly three decades ago, Dr. Ari Silver-Isenstadt was a medical student at the University of Pennsylvania. Just before his gynecological clerkship, a friend cautioned him that he would probably be asked to perform pelvic exams on unconscious female patients.
- Completing a gynecological clerkship, he found, was associated with a reduced appreciation of the importance of consent for the procedure. As Dr. Although the practice has broadly persisted, a number of states passed laws banning it, some citing his paper: California in , Illinois in , Virginia in , Oregon in , Hawaii in and Iowa in Silver-Isenstadt said. On one side of the street was a pearly white high-rise serving patients with private insurance, Penn Medicine Washington Square. At the private insurance clinic, Mr. At Ludmir, the quality of care was high, but Mr. He recalled anxiously maneuvering his hands as he looked to the resident for guidance.
- But for the patients, the scars can run deeper, sometimes rupturing their sense of trust in health care providers. She was given an ultrasound and blood work, the standard approach; her attending physician ran through a list of possible ailments. Then he asked if he could run a test for sexually transmitted infections. Weitz declined, explaining that she was celibate and a childhood abuse survivor, and that she preferred to forgo the exam. The doctor gave her Phenergan, a sedative. Later, she returned to consciousness with her feet in metal stirrups and a speculum inside of her, cold and foreign. Weitz cried out in discomfort. Weitz, 36, said. My next memory is looking over and he was bagging the swabs he had collected without my permission. It was the absence of consent that made this a trauma. Weitz testified before the Utah legislature in favor of an informed consent bill, which was signed into law last year.
- Wilson interviewed medical faculty members in more than a dozen states to gauge the opposition to informed consent policies. She found that doctors often argued that patients implicitly consented to being enlisted in medical teaching when visiting a teaching hospital, or that consent for one gynecological procedure encompassed consent for any additional, related exams. Image Ms. Jennifer Goedken, an obstetrician-gynecologist at Emory University, said working in a teaching hospital showed her the importance of giving students hands-on experience with pelvic exams and she initially worried that legislative debates could stigmatize the procedure. Goedken said. Deborah Bartz. Many hospitals now work with gynecological teaching associates, or G. Examining conscious patients teaches them to listen and respond to feedback; with anesthetized patients, the muscles are relaxed, which makes it easier to feel the ovaries and uterus. Last year, Ms. Weitz felt dizzy. Health care providers are not exempt from that ethical obligation to have obtained consent.
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Created with Sketch. For Yukiko Asaki, it started with finding an appropriate outfit. Not too formal, but something conservative and professional. She hadn't really been looking forward to this Saturday morning experience, but accepting that there would be "certain level of awkwardness that could not be removed," she put on a button-down blouse, got into her doctor mode, and headed to the empty clinic at her medical school in New York City, where she would learn how to examine an unavoidable part of the human body: the privates. Yukiko's medical school, like many in the country, participates in a unique way of teaching medical students the genitourinary exam. Instead of allowing students to practice on anesthetized women after a surgery, as is often done in other countries, the school hires Genitourinary Teaching Associates, or GUTAs, who instruct students on how to perform this sensitive examination using their own bodies.- And chances are it was one of the most nerve wrecking experiences of your doctor's training. But Yukiko, who was 24 years old that spring morning of her second year of medical school, wasn't nervous yet. I wanted to do it sensitively, and conscientiously. She took note of such tips like telling the patient, "I am now going to examine your breasts," instead of saying "I am now going to look at your breasts," a statement that could easily make a woman uncomfortable. For almost 30 minutes, she paid attention in that warm, crowded examination room, trying to remember the steps of the examination as it was being demonstrated. It was noticeably warm in the room, but now, faced with her instructor -- a tall, "stick thin" woman in her mids with short brown hair and an aversion to shaving -- it was Yukiko's turn to pretend to be a physician. With no windows for a breeze, the door shut, her heavy white coat, and the naked women in stirrups scolding her, Yukiko's first encounter with female private parts was what she calls, "the single most awkward day of medical school.
- I've never wanted to leave a situation more than I've wanted to leave this one. Mercifully, it was over at some point. But the very act of touching the body, the bread and butter of medicine, is something that many medical students are uncomfortable with at the time they learn the genitourinary exam, which is usually before students start working on the wards. The ease with private parts is not acquired overnight, and between her sweat and her nerves, Yukiko's experience may very well be the norm. Steven Cole, 54, it was more of a natural progression. I didn't know what the structure was. We had to instruct on ourselves and turn it over to student one, and then student two, and then student three, the whole way down the line," said Cole, who had prior experience teaching theater to aspiring actors.
- Over time, however, he viewed himself more as a medical educator helping train future doctors, than a naked man standing in front of nervous students. Later in the day, when Yukiko was called to learn and perform the male genitourinary exam, practicing on a naked man in his mids wearing a blue hospital gown and white tube socks wasn't nearly as distressing. Although it is not part of the male examination, he made each student perform a male breast exam on him. I guess the easy answer is 'Oh, it was weird,' but it wasn't that weird. Asking fresh medical students to push aside all former notions about private parts and to view them professionally is the expectation in medical school, and studies have repeatedly shown that using the GUTA has helped to not only demystify the exam, but also to teach students greater awareness of their word choice.
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The GUTA also carries the added bonus of preventing hoards of medical students from poking at every unwitting patient who enters the hospital, something that patients and students alike can appreciate. And for Yukiko, who will be starting her pediatrics residency this summer, the experience with her GUTA will always remain one of the most memorable, albeit sweaty, steps toward doctorhood. I mean, I think it's a good approach. I can get over a little awkwardness.Bates Physical Examination Videos | Strauss Health Sciences Library
Photo credit: Sleeping Venus by Vladimir Nagournov Prepare yourselves for some shocking news: the Mister sleeps in the nude. No undies. No socks. Totally bucky. I get too cold for such things. But I do walk naked from the shower up to our bedroom in the morning to help minimize the Towering Tower of Towels that tend to collect up there.
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