Prostate/male GU exam taught by patients not physicians

[sozme]

Hello, I attend an American allopathic (MD) program in the continental United States. We had a lecture and demonstration today on how to do a proper male rectal/prostate exam. I was surprised to learn, however, that not a single physician was involved in the lecture. Additionally, our class has been broken up in 3 seperate groups to practice performing the exam on standardized patients, but no physician is scheduled to be present to give us feedback or anything.

The individual teaching the exam is a standardized patient with a lot of experience being examined. He does not have a medical degree. He is not a PA or an NP.

I was wondering if this is the norm at other schools in the country. I was quite outraged about this, as I pay tens of thousands of dollars in tuition every year.. I also don't know if this is acceptable according to LCME accreditation standards, but I would be absolutely shocked if it is. How is it that at an American medical school, it is acceptable for non-physicians to teach medical students how to perform a rectal exam?

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[DocVapor]

Hello, I attend an American allopathic (MD) program in the continental United States. We had a lecture and demonstration today on how to do a proper male rectal/prostate exam. I was surprised to learn, however, that not a single physician was involved in the lecture. Additionally, our class has been broken up in 3 seperate groups to practice performing the exam on standardized patients, but no physician is scheduled to be present to give us feedback or anything.

The individual teaching the exam is a standardized patient with a lot of experience being examined. He does not have a medical degree. He is not a PA or an NP.

I was wondering if this is the norm at other schools in the country. I was quite outraged about this, as I pay tens of thousands of dollars in tuition every year.. I also don't know if this is acceptable according to LCME accreditation standards, but I would be absolutely shocked if it is. How is it that at an American medical school, it is acceptable for non-physicians to teach medical students how to perform a rectal exam?

Because there's not that much to it, and the physician can't know where you have your finger in there and what you are touching? They've been trained to teach you how to do it, and they are actually the best ones to give you feedback...

 

[Kahreek]

standardized patient!? Oh my

 

[operaman]

Yeah this is pretty standard. It's not rocket science.

 

[redpanda]

Hello, I attend an American allopathic (MD) program in the continental United States. We had a lecture and demonstration today on how to do a proper male rectal/prostate exam. I was surprised to learn, however, that not a single physician was involved in the lecture. Additionally, our class has been broken up in 3 seperate groups to practice performing the exam on standardized patients, but no physician is scheduled to be present to give us feedback or anything.

The individual teaching the exam is a standardized patient with a lot of experience being examined. He does not have a medical degree. He is not a PA or an NP.

I was wondering if this is the norm at other schools in the country. I was quite outraged about this, as I pay tens of thousands of dollars in tuition every year.. I also don't know if this is acceptable according to LCME accreditation standards, but I would be absolutely shocked if it is. How is it that at an American medical school, it is acceptable for non-physicians to teach medical students how to perform a rectal exam?

Sooooo, what feedback do you think that the attending can give you on your technique that the SP can't? Unlike a GYN exam, there's not much question about how to use the tool of choice (examining finger v. finding a cervix).

 

[slopes23]

As others expressed, you can be sure that the SP's originally received a rectal exam from one of the physicians and coached them on what they were doing so they can remember what they felt. The physician cannot see what you are doing with your fingers. Do you expect them to comment on proper stance? Keep legs bent at 15 degrees, bend over at a 30 degree angle, but don't arch your back. Go up on your tippy toes once you reach the prostate.

Relax.

 

[PL198]

screw it sue em

 

[Rendar5]

I learned performing it on a standarized patient, just like pretty much everyone else. I'm not sure how having an attending lecture you would help. Would you need him to instruct you on which hole to stick your finger in?

 

[evilbooyaa]

I learned performing it on a standarized patient, just like pretty much everyone else. I'm not sure how having an attending lecture you would help. Would you need him to instruct you on which hole to stick your finger in?

Especially problematic on a male patient, I imagine.

Regardless, agree with everyone else. We didn't even get a SP for the rectal exam. We got a SP for the testicular exam who went through each step, and a SP for the gyn/cervical exam who went through each step, and could actually guide you on what you were feeling (as she could feel what you were feeling). It was kind of strange having a conversation with a SP in the midst of a speculum and then bimanual exam, but it was enough for pre-clinical years. The real practice came (at least for rectals and GYN exams) came as a MS3.

 

[Winged Scapula]

Yep this is standard in the US and Australia.

 

[kami333]

I would have loved that, being able to talk to the SP and getting instant feedback on what I'm feeling/where my finger is, if it's too uncomfortable/painful, if there's anything I can do to improve it, etc.

 

[eefen]

Like others have said, it's most useful to get SP feedback since they are the ones with a finger up their butt and can better tell you what's going on. Most SPs that I've encountered are very knowledgeable about the technique of a given exam maneuver, if not necessarily the detailed medicine behind it. For these sessions, you are there to learn the technique.

The only way I can see getting worthwhile input from a supervising physician is if you practiced the exam on him.

Somehow, I don't think that would go over very well...

 

[mcloaf]

I was quite outraged about this, as I pay tens of thousands of dollars in tuition every year.. I also don't know if this is acceptable according to LCME accreditation standards, but I would be absolutely shocked if it is.

Slow your roll champ. Maybe you should appreciate that someone is willing to let you put your finger in their butt for practice instead of acting like an entitled child.

I would have loved that, being able to talk to the SP and getting instant feedback on what I'm feeling/where my finger is, if it's too uncomfortable/painful, if there's anything I can do to improve it, etc.

Yeah the feedback was helpful, if not a little awkward at times..."really put your back into it."

 

[NotTheBestUSMLE]

Yep, and they do a good job of it, too. They get thoroughly educated on the anatomy and exam.

 

[Jabbed]

Especially problematic on a male patient, I imagine.

Regardless, agree with everyone else. We didn't even get a SP for the rectal exam. We got a SP for the testicular exam who went through each step, and a SP for the gyn/cervical exam who went through each step, and could actually guide you on what you were feeling (as she could feel what you were feeling). It was kind of strange having a conversation with a SP in the midst of a speculum and then bimanual exam, but it was enough for pre-clinical years. The real practice came (at least for rectals and GYN exams) came as a MS3.

"A little to the right.. and that's my cervix."

 

[slopes23]

It just occurred to me. Troll? If so, 6/10

 

[cbrons]

Slow your roll champ. Maybe you should appreciate that someone is willing to let you put your finger in their butt for practice instead of acting like an entitled child.

It doesn't matter how well a standardized patient was trained. Med school costs a fortune. The schools can at least have 1 physician nearby that you can ask practical medical questions. I wouldn't say someone who expects this is an "entitled child" especially when many schools are cutting corners on clinical teaching. At our school we had no physicians for the head to toe exam (all 100+ items) until we were officially graded. We had to figure out everything on our own.

 

[mcloaf]

It doesn't matter how well a standardized patient was trained. Med school costs a fortune. The schools can at least have 1 physician nearby that you can ask practical medical questions. I wouldn't say someone who expects this is an "entitled child" especially when many schools are cutting corners on clinical teaching. At our school we had no physicians for the head to toe exam (all 100+ items) until we were officially graded. We had to figure out everything on our own.

OPs attitude rubbed me the wrong way. There's no need to be "quite outraged" and "absolutely shocked" over something that is standard practice and completely adequate for his level of training.

There are so many places where I agree schools cut corners with clinical teaching, but I don't think having well trained SP's for rectal exams is one of them. I just don't see the value added of having an MD standing in the corner of the room, it's not like we don't have regular access to them for questions the rest of the time.

 

[fab4fan]

Do these SPs get financially compensated? I'm surprised there are people out there who are willing to volunteer to have multiple students perform sensitive exams on their nether regions. Good on them for helping contribute to MS's education.

 

[evilbooyaa]

Do these SPs get financially compensated? I'm surprised there are people out there who are willing to volunteer to have multiple students perform sensitive exams on their nether regions. Good on them for helping contribute to MS's education.

Yes. Quite well from what I understand.

 

[fab4fan]

Yes. Quite well from what I understand.

Must make cocktail conversation veeerrry interesting.

"So Joe, what do you do?

".........."

 

[alpinism]

OPs attitude rubbed me the wrong way. There's no need to be "quite outraged" and "absolutely shocked" over something that is standard practice and completely adequate for his level of training.

There are so many places where I agree schools cut corners with clinical teaching, but I don't think having well trained SP's for rectal exams is one of them. I just don't see the value added of having an MD standing in the corner of the room, it's not like we don't have regular access to them for questions the rest of the time.

The ironic thing is that while I generally despise SPs, if there is anytime to use them, its for rectal exams.

At the same time we had them for learning pelvic exams during M2. Absolutely horrible.

Besides making the whole ordeal extremely awkward and uncomfortable, they taught the exact opposite of what we ended up doing on my OB/GYN clerkship and what most patients preferred.

In any event, there's no substitute for learning from real patients.

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all. - William Osler

 

[PL198]

screw SPs, students should just do rectal exams on each other

 

[GomersGoToGround]

For rectals? Nah.

Too easy. Drop the patient's pants, and place them on the chair, next to yours.

Before moderators come in, obviously a poor-taste joke.

And that was a terrible pun. Butt as others have said, it's nice learning from patients. Generally a few guidelines such as what to look for, etc. Then, the patient can express what is considered "normal" comfort for that particular exam.

 

[chronicidal]

Must make cocktail conversation veeerrry interesting.

"So Joe, what do you do?

".........."

usually SPs have other jobs, especially acting.

 

[JP2740]

Because there's not that much to it, and the physician can't know where you have your finger in there and what you are touching? They've been trained to teach you how to do it, and they are actually the best ones to give you feedback...

Really? At my school the doc put his finger in with me and we would sweep around describing the structures to each other. I don't get how else you could learn it and know what you're feeling around for.

 

[evilbooyaa]

Really? At my school the doc put his finger in with me and we would sweep around describing the structures to each other. I don't get how else you could learn it and know what you're feeling around for.

At the same time? Impressive. That SP is more compensated than most, I'm sure.

 

[Rendar5]

It doesn't matter how well a standardized patient was trained. Med school costs a fortune. The schools can at least have 1 physician nearby that you can ask practical medical questions. I wouldn't say someone who expects this is an "entitled child" especially when many schools are cutting corners on clinical teaching. At our school we had no physicians for the head to toe exam (all 100+ items) until we were officially graded. We had to figure out everything on our own.

If you pay me $200, I'll happily come by so I can sit there and you can ask me pertinent questions about all the things you should expect to find on the exam. "yes the prostate feels like the person described it", "yes, the 2nd digit is preferred to the 3rd digit." "no, I don't recommend sticking your entire fist in there". "The strangest thing I've seen placed in a rectum? probably an aerosol can. No I've never seen a hamster in there"

 

[Redpancreas]

Hello, I attend an American allopathic (MD) program in the continental United States. We had a lecture and demonstration today on how to do a proper male rectal/prostate exam. I was surprised to learn, however, that not a single physician was involved in the lecture. Additionally, our class has been broken up in 3 seperate groups to practice performing the exam on standardized patients, but no physician is scheduled to be present to give us feedback or anything.

The individual teaching the exam is a standardized patient with a lot of experience being examined. He does not have a medical degree. He is not a PA or an NP.

I was wondering if this is the norm at other schools in the country. I was quite outraged about this, as I pay tens of thousands of dollars in tuition every year.. I also don't know if this is acceptable according to LCME accreditation standards, but I would be absolutely shocked if it is. How is it that at an American medical school, it is acceptable for non-physicians to teach medical students how to perform a rectal exam?

Bro, calm down. In the beginning, I'm sure all M.Ds learned just as we did. Think about it in terms of efficiency. Whomever this person is that's teaching you to do the exam has probably become an expert. Why waste a physician's time for something like that. Our nutrition course, for example, is taught by a nutritionist which I've heard some complain about...but then the last time I heard nutritional advice from an MD, he told someone to watch their fat intake so that they can lose weight. Forget a nutritionist whose job it is to keep up with latest trends in nutrition. Better nutritional advice has been espoused on bodybuilding.com. M.D.s aren't gods of everything.

 

[Doctor Bob]

In light of the topic of this thread... your avatar amuses me.

 

[PL198]

Bro, calm down. In the beginning, I'm sure all M.Ds learned just as we did. Think about it in terms of efficiency. Whomever this person is that's teaching you to do the exam has probably become an expert. Why waste a physician's time for something like that. Our nutrition course, for example, is taught by a nutritionist which I've heard some complain about...but then the last time I heard nutritional advice from an MD, he told someone to watch their fat intake so that they can lose weight. Forget a nutritionist whose job it is to keep up with latest trends in nutrition. Better nutritional advice has been espoused on bodybuilding.com. M.D.s aren't gods of everything.

I truly agree with this and it's sad. The avg basement dwelling douche on BBing.com knows more about nutrition than the avg physician.

 

[cbrons]

Also this digital rectal exam... how do we not have better tests developed in 2015? We're still stuck sticking a finger up someone's butt? Seems barbaric and rudimentary...

 

[PL198]

Also this digital rectal exam... how do we not have better tests developed in 2015? We're still stuck sticking a finger up someone's butt? Seems barbaric and rudimentary...

how is it any more barbaric than any other form of palpation

 

[evilbooyaa]

Also this digital rectal exam... how do we not have better tests developed in 2015? We're still stuck sticking a finger up someone's butt? Seems barbaric and rudimentary...

There are better exams. Most ways generally involve something larger going up the rectum (flex sig, colonoscopy, TRUS).

 

[seminoma]

Also this digital rectal exam... how do we not have better tests developed in 2015? We're still stuck sticking a finger up someone's butt? Seems barbaric and rudimentary...

It's to improve the MD-patient relationship. Patients have complained that MDs and med students are too impersonal, detached, even robotic. Can't get much closer to another person than literally being inside of them.

 

[Jabbed]

Do these SPs get financially compensated? I'm surprised there are people out there who are willing to volunteer to have multiple students perform sensitive exams on their nether regions. Good on them for helping contribute to MS's education.

I've always wondered how much they're compensated, but I'm afraid that if they tell me I might decide to become a standardized patient myself..

 

[Doctor Bob]

I've always wondered how much they're compensated, but I'm afraid that if they tell me I might decide to become a standardized patient myself..

The standardized patient I asked said they got paid $25 per student. So it can add up pretty quick over the course of the day.
They had a group (~10 men and women) who went around from med school to med school doing these standardized exams. So they were rather knowledgeable.

"Nope, you're doing that wrong."
"Nuh uh... how do you know?"
"Because I get 200 rectal exams a week and yours feels wrong. Plus you're using 4 fingers. And your hand is sideways. And you forgot a glove."

 

[Ismet]

Also this digital rectal exam... how do we not have better tests developed in 2015? We're still stuck sticking a finger up someone's butt? Seems barbaric and rudimentary...

It's a screening exam, it's not invasive, and it doesn't add to costs like a more invasive test would. Sorry the prostate is located where it is.

I'd prefer doing a digital rectal exam over a manual disimpaction any day.

 

[touchpause13]

Also this digital rectal exam... how do we not have better tests developed in 2015? We're still stuck sticking a finger up someone's butt? Seems barbaric and rudimentary...

It's fast, cheap, and effective. There's no reason to develop another test.

Also i fail to see how it's more "barbaric" than say a pelvic.

 

[PL198]

The standardized patient I asked said they got paid $25 per student. So it can add up pretty quick over the course of the day.
They had a group (~10 men and women) who went around from med school to med school doing these standardized exams. So they were rather knowledgeable.

"Nope, you're doing that wrong."
"Nuh uh... how do you know?"
"Because I get 200 rectal exams a week and yours feels wrong. Plus you're using 4 fingers. And your hand is sideways. And you forgot a glove."

is it a per finger rate, ie is a physician + student tag team a reimbursement of $50 or what

 

[Ismet]

It's fast, cheap, and effective. There's no reason to develop another test.

Also i fail to see how it's more "barbaric" than say a pelvic.

Or a bimanual...

 

[sonofva]

I'm pretty sure my school hired homeless men from Fort Lauderdale beach