Do you think it's important to learn how to do pelvic/genital and rectal exams?

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BeastInfection

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Just curious to hear some thoughts, especially from those who have gone through third and fourth year.

I get that it's part of a thorough physical exam, but from the perspective of a second year student, it seems like kind of an oddly specific thing to learn. Some of us will go into ob/gyn, or family med, or urology, etc., where we will be doing these things regularly. But, the vast majority of us won't be going into these fields and, it seems to me, there is very little chance that we'll be performing pelvic or rectal exams ever again. So why do med schools deem it "essential learning" during second year? Just so we are able to do it third year?

Admittedly, I don't know ****, which is why I'm looking for thoughts on the matter. Perhaps it is a more general and practical tool than it seems to a second year?
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No, its not important. There are no diseases that can be detected in those regions. It is utterly useless and will not help in your education. Give me a break.

(Optometry student here)
 
BeastInfection said:
Just curious to hear some thoughts, especially from those who have gone through third and fourth year.

I get that it's part of a thorough physical exam, but from the perspective of a second year student, it seems like kind of an oddly specific thing to learn. Some of us will go into ob/gyn, or family med, or urology, etc., where we will be doing these things regularly. But, the vast majority of us won't be going into these fields and, it seems to me, there is very little chance that we'll be performing pelvic or rectal exams ever again. So why do med schools deem it "essential learning" during second year? Just so we are able to do it third year?

Admittedly, I don't know ****,which is why I'm looking for thoughts on the matter. Perhaps it is a more general and practical tool than it seems to a second year?
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Obviously.
 
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You'll be doing rectals in surgery, Internal medicine, EM too. Maybe adolescent peds. That brings in a huge chunk of med students. Yeah, the ROAD people don't, but those aren't the majority of med students.

It's the same rationale as "Why do we care about scrubbing into an OR" or "Why do we care about delivering babies", etc. It's the general broad curriculum. Some stuff you might never do or see again, but that's the nature of a general medical education. Plus, you never know when you'll need to utilize certain skills 😉

Besides, people change their minds in 3rd year anyway.
 
KnuxNole said:
You'll be doing rectals in surgery, Internal medicine, EM too. Maybe adolescent peds. That brings in a huge chunk of med students. Yeah, the ROAD people don't, but those aren't the majority of med students.

It's the same rationale as "Why do we care about scrubbing into an OR" or "Why do we care about delivering babies", etc. It's the general broad curriculum. Some stuff you might never do or see again, but that's the nature of a general medical education. Plus, you never know when you'll need to utilize certain skills 😉

Besides, people change their minds in 3rd year anyway.
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Point taken. Are pelvic and male GU exams as broadly useful as rectal?
 
mimelim said:
There are a lot of things to complain about in medical school. Learning how to do a complete physical exam is not one of them.
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I'm aware of that, which is why I was trying to be careful to show that I was genuinely curious how often and in what fields it was used, as opposed to making a thread to complain, which was not the intention behind my question at all...
 
Super important, should be taught earlier than MS2 year IMO. It's a mystery to me why schools make these two exams so mysterious and "special." I wish I had learned them right along with auscultation of the heart.
 
BeastInfection said:
Just curious to hear some thoughts, especially from those who have gone through third and fourth year.

I get that it's part of a thorough physical exam, but from the perspective of a second year student, it seems like kind of an oddly specific thing to learn. Some of us will go into ob/gyn, or family med, or urology, etc., where we will be doing these things regularly. But, the vast majority of us won't be going into these fields and, it seems to me, there is very little chance that we'll be performing pelvic or rectal exams ever again. So why do med schools deem it "essential learning" during second year? Just so we are able to do it third year?

Admittedly, I don't know ****, which is why I'm looking for thoughts on the matter. Perhaps it is a more general and practical tool than it seems to a second year?
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Its oddly specific because most medical students avoid doing them despite their importance in the physical exam.

The rest of what you wrote is no different than someone going into another specialty, i.e. Radiology, wondering why they need to auscultate even though they'll be looking at films all day. Its the vocational school mentality.

It's just the basics. You learn the basics and then if you eventually go into a field where some of it isn't used then whatever.
 
BeastInfection said:
Point taken. Are pelvic and male GU exams as broadly useful as rectal?
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Holy ****. I don't like doing them either but if someone comes in complaining of purulent discharge after a gang bang I'm going to ask them to drop their pants and see what they're talking about.
 
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thepoopologist said:
Its oddly specific because most medical students avoid doing them despite their importance in the physical exam.

The rest of what you wrote is no different than someone going into another specialty, i.e. Radiology, wondering why they need to auscultate even though they'll be looking at films all day. Its the vocational school mentality.

It's just the basics. You learn the basics and then if you eventually go into a field where some of it isn't used then whatever.
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Yeah, I realized as I was making the thread that the same argument could be extended to "why do I need to learn repro when I want to be a cardiologist?" and so on, but was still curious to hear how much these specific exams were used in the daily practice of a physician, as they're being taught alongside other PE skills that are clearly used every day, all day for many.
 
...don't you learn how to do focused exams on all parts of the body?
 
BeastInfection said:
Yeah, I realized as I was making the thread that the same argument could be extended to "why do I need to learn repro when I want to be a cardiologist?" and so on, but was still curious to hear how much these specific exams were used in the daily practice of a physician, as they're being taught alongside other PE skills that are clearly used every day, all day for many.
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Short answer to your opening question - you learn these exams because as a medical student and as a doctor you have basic competencies that you are REQUIRED to know. You're not going into OB/Gyn but you sure as hell should know how to recognize someone having eclamptic seizures or what to do with someone who's having vaginal bleeding. You may not be going into urology but nearly every patient care specialty there are circumstances where you need to do a rectal exam. And above all, you are not a mechanic or a plumber. You're a doctor and therefore have a higher standard expected beyond a vocational education (as someone stated above).

In any case, specialties offhand where I've seen people do gyn exams: EM, OB/Gyn (obviously), IM, FM, Peds, Surgery. Rectal exams I've seen in pretty much every single patient care specialty as stated above.
 
thepoopologist said:
Its oddly specific because most medical students avoid doing them despite their importance in the physical exam.

The rest of what you wrote is no different than someone going into another specialty, i.e. Radiology, wondering why they need to auscultate even though they'll be looking at films all day. Its the vocational school mentality.

It's just the basics. You learn the basics and then if you eventually go into a field where some of it isn't used then whatever.
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Just FYI, radiologists shoot contrast up various orifices for some of their fluoro studies and basically first must do a DRE or insert a speculum. It's not like these aren't basic skills used frequently by most specialties.
 
KnuxNole said:
You'll be doing rectals in surgery, Internal medicine, EM too. Maybe adolescent peds. That brings in a huge chunk of med students. Yeah, the ROAD people don't, but those aren't the majority of med students.
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The ROAD people don't?

Radiologists might be doing contrast enemas, VCUGs, HSGs, etc. Dermatologists have to look at 100% of a patient's skin for a complete physical exam, and if you have inguinal lymphadenopathy that turns out to be melanoma with an unknown primary, you have to do an anorectal exam as well.

They're "special" exams because they have to pay people more to allow you to do them, so they make a special workshop for it. We would do heart/lung exams on every $8/hr standardized patient that came through, but the pelvic exam patients got something like $100/hr.

You need to expose students to it all, because even med students don't seem to know as much as I would think. Some of the girls in my group were pretty clueless when it came to seeing a naked old man. Let's just say that they didn't realize the toll that age and obesity take on a man's manhood, and they would have probably documented him as having anomalous anatomy...
 
JJMrK said:
Super important, should be taught earlier than MS2 year IMO. It's a mystery to me why schools make these two exams so mysterious and "special." I wish I had learned them right along with auscultation of the heart.
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Yes. We didn't do the male GU/rectal and pelvic until second year. When learned in the "safe" environment, we got a grand total of 1 exam. Same for the pelvic. Why they don't send us to OB/GYN clinic and uro clinic once or twice a semester in years one and two is beyond me.
 
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BeastInfection said:
Just curious to hear some thoughts, especially from those who have gone through third and fourth year.

I get that it's part of a thorough physical exam, but from the perspective of a second year student, it seems like kind of an oddly specific thing to learn. Some of us will go into ob/gyn, or family med, or urology, etc., where we will be doing these things regularly. But, the vast majority of us won't be going into these fields and, it seems to me, there is very little chance that we'll be performing pelvic or rectal exams ever again. So why do med schools deem it "essential learning" during second year? Just so we are able to do it third year?

Admittedly, I don't know ****, which is why I'm looking for thoughts on the matter. Perhaps it is a more general and practical tool than it seems to a second year?
Click to expand...


Absolutely important. Anyone can get UTIs and STDs. Many men get prostate and testicular cancer. Women can get breast cancer or cervix cancer. A lot of people get anal cancer. You'll see these patients not only in specialized setting but also in primary care setting who have these symptoms. Unless you go into ortho or ENT you'll likely have to do a pelvic exam at some point. You'll want to be as comfortable at it as possible since patients get a little nervous if they see a doctor reaching doing there without knowing what he/she is doing down there.
 
Gheorgia said:
Absolutely important. Anyone can get UTIs and STDs. Many men get prostate and testicular cancer. Women can get breast cancer or cervix cancer. A lot of people get anal cancer. You'll see these patients not only in specialized setting but also in primary care setting who have these symptoms. Unless you go into ortho or ENT you'll likely have to do a pelvic exam at some point. You'll want to be as comfortable at it as possible since patients get a little nervous if they see a doctor reaching doing there without knowing what he/she is doing down there.
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lol can't see ophtho or path doing many pelvic exams to add to that list
 
calvnandhobbs68 said:
lol can't see ophtho or path doing many pelvic exams to add to that list
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You can add almost every specialty outside of FM and OB/Gyn. Just because you won't perform the exam doesn't mean that you shouldn't know how to do one and have a basic understanding of the principles behind it. Knowing the raw steps isn't important if you aren't going to be doing them.
 
Plus in residency "nearly" every specialty will at least require you to rotate through a service during intern year where you will be doing a genital/rectal exam.

Even psychiatry residents rotate through a month or two of medicine, its better to be clueless as a student than as a resident imo.
 
link2swim06 said:
Plus in residency "nearly" every specialty will at least require you to rotate through a service during intern year where you will be doing a genital/rectal exam.

Even psychiatry residents rotate through a month or two of medicine, its better to be clueless as a student than as a resident imo.
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I don't think 99% of GS, ortho, ENT, plastics, vascular etc. will ever do a pelvic exam. Now they will all do rectals on every trauma patient...
 
mimelim said:
There are a lot of things to complain about in medical school. Learning how to do a complete physical exam is not one of them.
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👍

Well put.

Learn it, do it once, and you may be able to skate out of doing it in the future.

I did 3 rectals while I was on my IM rotation. Haven't done a pelvic yet, but also haven't done the OB/GYN rotation yet. GU exam in pediatrics and on every newborn is mandatory. If you do an ER rotation you'll be doing GU exams for STDs for sure. Learn it, at least the basics. You may be rusty but at least you'll have the basic stuff somewhere in your brain.
 
Sure, you may never have to do it again in your life. Regardless, part of being an MD is having a minimal knowledge base of general medicine. The didactic portion of medical school is to familiarize you with concepts and human pathophysiology to prepare you for any field you wish to choose. Similarly, the clinical rotations are meant to give you a fundamental skill set to drop you off at any residency program and make you sufficiently prepared to go from there. Part of the minimal skill set for an being an MD is a complete and/or focused H&P including neuro, cardiac, pulmonary, abdominal, gu, reprodutive, rectal and msk exams. You should know how to draw blood, deliver a baby, perhaps even start an IV or intubate someone.

No one is expecting you to be the best at any of these things yet. Take your turn, learn from it, and try to enjoy your time in a supervised environment. When you're on your own and need to do it again (or for the first time), you'll be happy you were given the opportunity to learn it before.
 
In GS, you may not do pelvic exams often, but they are indicated at times:

-rectovaginal fistula
-perineal or genital trauma
-abscesses/nec fasc/soft tissue infections

Keep in mind also that some plastic surgeons do reconstruction on gyn-onc patients as well (i.e. s/p vulvectomies, etc.).
 
so only internal medicine, family medicine, Obgyn, general surgery, EM, Dermatology, plastic surgery and few others needs to know how to do it? what a waste of time.
 
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mimelim said:
I don't think 99% of GS, ortho, ENT, plastics, vascular etc. will ever do a pelvic exam. Now they will all do rectals on every trauma patient...
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Like Smurfette said, rectovaginal fistulas? Trauma patients?
 
BeastInfection said:
Just curious to hear some thoughts, especially from those who have gone through third and fourth year.

I get that it's part of a thorough physical exam, but from the perspective of a second year student, it seems like kind of an oddly specific thing to learn. Some of us will go into ob/gyn, or family med, or urology, etc., where we will be doing these things regularly. But, the vast majority of us won't be going into these fields and, it seems to me, there is very little chance that we'll be performing pelvic or rectal exams ever again. So why do med schools deem it "essential learning" during second year? Just so we are able to do it third year?

Admittedly, I don't know ****, which is why I'm looking for thoughts on the matter. Perhaps it is a more general and practical tool than it seems to a second year?
Click to expand...

You can bet your ass the vast majority of us are going to go into family med and internal. It's not a matter of opinion-it's statistics. Better get your basic clinical skills down pat because when joe smith comes in with frequent urination and a 400-pack year smoking history...and you don't know how to do a prostate exam-you're going to look mighty stupid.
 
TheProwler said:
Like Smurfette said, rectovaginal fistulas? Trauma patients?
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I haven't seen the standard pelvic exam taught to MS2s used by GS residents or attendings. I'm relatively early in my training, but came from a trauma heavy hospital. My views may also be heavily influenced by always being in a major hospital system with gyn surg and gyn onc always on call and things were turfed to them in the trauma setting.

And I've never taken care of a rectovaginal fistula (not yet at least), so something to learn 🙂
 
TheProwler said:
Like Smurfette said, rectovaginal fistulas? Trauma patients?
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Also many surgery attendings at community hospitals have a dim view of other specialty residents, so if eg a SICU patient needs a pelvic culture in the middle of the night, there's a good chance the GS attending is going to say to his intern, just do it.
 
BeastInfection said:
Just curious to hear some thoughts, especially from those who have gone through third and fourth year.

I get that it's part of a thorough physical exam, but from the perspective of a second year student, it seems like kind of an oddly specific thing to learn. Some of us will go into ob/gyn, or family med, or urology, etc., where we will be doing these things regularly. But, the vast majority of us won't be going into these fields and, it seems to me, there is very little chance that we'll be performing pelvic or rectal exams ever again. So why do med schools deem it "essential learning" during second year? Just so we are able to do it third year?

Admittedly, I don't know ****, which is why I'm looking for thoughts on the matter. Perhaps it is a more general and practical tool than it seems to a second year?
Click to expand...

When I receive an ovarian mass for diagnosis and the note says "palpable adnexal mass identified by pelvic exam", that process is not a mystery to me. I can thank my M2-M3 experiences doing pelvic exams for that. Just because you may not use some technique or procedure yourself in practice does not mean the exposure to it has no value. A big part of being able to practice any specialty involves some understanding of what other providers are doing. Otherwise it's just a race toward ignorance.
 
To the original point, not sure how you could even complete med school rotations without doing a few of these exams. You'd fail all your EM, FM, and Ob/Gyn rotations
 
Gut Shot said:
A big part of being able to practice any specialty involves some understanding of what other providers are doing. Otherwise it's just a race toward ignorance.
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This cannot be overstated. I had a perfect example this week. Super sick guy with a terrible malignancy, who then had a huge stroke. Oncologist says he won't tolerate chemo, but he wants us to do a huge operation. If the oncologist had any SICU experience, he would never be making such ridiculous suggestions.

Knowing what you're referring someone for is quite important.
 
There are a lot of specialists who don't do these exams as often as they should. If they're incompetent at them or grow atrophied it limits their practice.

Most importantly though these are a portion of the basic knowledge everyone with a medical degree is supposed to know. Just because someone thinks they are bound for a specialty where they are not done isn't a good argument. There are lots of people who end up in other specialties for lots of reasons. We wouldn't support someone opting out of anatomy because they intend to be a psychiatrist.
 
"Abdominal" pain in a man often requires a quick GU exam. Takes 5 seconds to check for an inguinal hernia.
 
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