Does practicing the physical exam on your classmates make you feel uncomfortable

[OncoCaP]

Note that I'm not offering an opinion as to whether it's right or wrong to require this of students, just pointing out that from a big picture perspective it might be better to not rock the boat.

Yes, a great point. A great deal of care and caution is required on anything confrontational like this. Clearly this is a non-trivial issue for the OP or they would have just "gotten over it." The OP needs to decide whether this a battle they want to fight and what the consequences might be.

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[45408]

That calls in to question the strength of the education provided at your school.

I don't know about you, but I'd be a lot more reluctant to turn my head and cough for someone I know personally. My PCP is a graduate of my school, and I think he's great, but I wouldn't see someone that I'm friends with.

 

[erica31]

Since this topic has come up.. I have a question as how I should handle this issue in the next year or so.

I have a both a urostomy and ileostomy-- which = bags on my stomach. When my school (and I know its required) asks the females to wear a sports bra and shorts to do exams on each other-- what should I do?

Should I ask to wear a tank top (while covering my surgical scars and bag up) still will draw attention to me b/c no one else will be wearing a tank top.

Should I make a huge announcment the first day of class? Just get it over with? Or should I tell each of my partners, one by one, about it.

Plus... sometimes you can hear noises (sometimes loud) from the bags, and also while it fills up with fluid (so I can't just drain them and pray they remain "quiet" for the 2 or so hours during class)...

What should I do? I've seen docs for years due to my condition, and have no qualms about my disease and showing it to them, but the future students in my class, (although future docs) are not MY docs... and I'm honestly, just really nervous.

I need advice, please. And not just "talk to prof" but also, how to handle the issue with my future classmates. I know this likely will be many other students first encounters with an ostomy, and a don't want anyone to get 'grossed out' and me to feel bad about myself.

 

[SocialistMD]

But the school should either provide standardized patients for structured practice or should allow students to opt out of being "patients" themselves.

I don't think you can have your cake and eat it, too. If you are going to be palpating on your classmates, you should have to be a guinea pig for them.

... it has to do with the fact that I'd like to be perceived as a (fully clothed) professional by my classmates and professors.

Trust me, it is already too late for this. There is not a single person from my medical school class that I perceive as a professional...

While I don't really have an opinion on this matter, I think it is hypocritical to see it acceptable to practice your exam on unsuspecting patients who may be sick but not to open one's self to the same examination. I never had a problem with being the practice patient for this reason.

 

[45408]

Since this topic has come up.. I have a question as how I should handle this issue in the next year or so.

I have a both a urostomy and ileostomy-- which = bags on my stomach. When my school (and I know its required) asks the females to wear a sports bra and shorts to do exams on each other-- what should I do?

Should I ask to wear a tank top (while covering my surgical scars and bag up) still will draw attention to me b/c no one else will be wearing a tank top.

Should I make a huge announcment the first day of class? Just get it over with? Or should I tell each of my partners, one by one, about it.

Plus... sometimes you can hear noises (sometimes loud) from the bags, and also while it fills up with fluid (so I can't just drain them and pray they remain "quiet" for the 2 or so hours during class)...

What should I do? I've seen docs for years due to my condition, and have no qualms about my disease and showing it to them, but the future students in my class, (although future docs) are not MY docs... and I'm honestly, just really nervous.

I need advice, please. And not just "talk to prof" but also, how to handle the issue with my future classmates. I know this likely will be many other students first encounters with an ostomy, and a don't want anyone to get 'grossed out' and me to feel bad about myself.

Your school should have some kind of dean of students that you could probably discuss this with, which I would definitely recommend.

 

[SocialistMD]

I need advice, please. And not just "talk to prof" but also, how to handle the issue with my future classmates. I know this likely will be many other students first encounters with an ostomy, and a don't want anyone to get 'grossed out' and me to feel bad about myself.

It depends on how you feel about the issue. In the end, everyone in your class will know because med school is like junior high in that regard. If you don't mind everyone knowing, don't do anything diffferent and just show up. If you don't want them to know, you are going to need to talk with the administration. I'm sure they will be more than accommodating. However, if you do agree to be a patient for one classmate, rest assured that the person doing the exam on you will tell one person who will tell one person...

 

[Hurricane95]

I can see why some people would be uncomfortable with this. At my school, we all practice the PE on each other, without regards to gender. We are in groups of 12, and from there we pair off however we want. That being said, there is nothing official about having to formally strip or anything. You just kind of lift your shirt as needed here and there and that's it. Only your partner and sometimes an upper classmen (to make sure you're doing the exam correctly) sees anyway. I mean the most you ever expose is the abdomen anyway and we never feel for femoral pulse, we just announce, "I would now feel the femoral pulse". That's it. I've always seen it as very benign and no big deal and personally have no issues with it. Then again I'm the type of guy who could stand in front of the whole class in boxers and have a line of people poking and prodding me, I really don't give a damn.

 

[dogpython]

I think that what the answers to this post have shown is that there are valid arguements on either side of this issue. We could go round-and-round debating the topic, but when it is as divided as this, I think that a school should always err on the more conservative side and allow students to decide to the extent they would wish to participate in a PE. I personally think that the classmate relationship is different than that of the doctor-patient relationship. And while we may all be trying to be "professional" and approach this in an "asexual" manner, the fact is we are all humans with all the flaws and personal feelings that entails. While some may say we need "put ourselves in the patient's shoes" or we become hypocrites of ourselves, I would say that it's like putting your hand on a burning stove, we know that it is uncomfortable and don't need to actually do it to confirm this fact.

 

[chicklett1]

I think that what the answers to this post have shown is that there are valid arguements on either side of this issue. We could go round-and-round debating the topic, but when it is as divided as this, I think that a school should always err on the more conservative side and allow students to decide to the extent they would wish to participate in a PE. I personally think that the classmate relationship is different than that of the doctor-patient relationship. And while we may all be trying to be "professional" and approach this in an "asexual" manner, the fact is we are all humans with all the flaws and personal feelings that entails. While some may say we need "put ourselves in the patient's shoes" or we become hypocrites of ourselves, I would say that it's like putting your hand on a burning stove, we know that it is uncomfortable and don't need to actually do it to confirm this fact.

Well-stated, dogpython. That's pretty much how I feel about it too.

Erica31, I feel for you, I really do because I think you have every right to keep your medical condition to yourself if that's what you would prefer. As a patient, you are protected by HIPAA, but as a med student, you have no protections.

I was the OP, and what happened to me was that I learned during the cardiovascular exam that I have a mitral valve prolapse--with a classic murmur. We've already talked about how I didn't want to take off my shirt in public in the first place, but then after the MVP was discovered, I became a guinea pig and the instructor invited <i>everyone</i> to come over and have a listen, which was really really not cool with me--it was actually very disempowering.

I think that way before you start learning the physical exam, you should approach whomever is in charge and just ask how they can accommodate you. Don't feel guilty about it--you're just asking to be treated with the same respect that we would treat a patient. Just as a patient is able to decline an exam, you should be able to as well.

 

[thebeatblitz]

This is an interesting topic. Personally, I have no problem with it since I played a college sport and now have no shame. It's really the same thing you see at the gym; some people are all carefree and out-in-the-open, others wear bathing trunks to take a shower (which I don't understand). Subjective comfort zone I guess.

 

[erica31]

Gracias chicklett, your post made me smile.

Well-stated, dogpython. That's pretty much how I feel about it too.

Erica31, I feel for you, I really do because I think you have every right to keep your medical condition to yourself if that's what you would prefer. As a patient, you are protected by HIPAA, but as a med student, you have no protections.

I was the OP, and what happened to me was that I learned during the cardiovascular exam that I have a mitral valve prolapse--with a classic murmur. We've already talked about how I didn't want to take off my shirt in public in the first place, but then after the MVP was discovered, I became a guinea pig and the instructor invited <i>everyone</i> to come over and have a listen, which was really really not cool with me--it was actually very disempowering.

I think that way before you start learning the physical exam, you should approach whomever is in charge and just ask how they can accommodate you. Don't feel guilty about it--you're just asking to be treated with the same respect that we would treat a patient. Just as a patient is able to decline an exam, you should be able to as well.

 

[Yakko]

Frankly I'd be worried I might make some of the other students uncomfortable, especially if it's one of my cute female classmates doing the exam.

 

[45408]

This is an interesting topic. Personally, I have no problem with it since I played a college sport and now have no shame. It's really the same thing you see at the gym; some people are all carefree and out-in-the-open, others wear bathing trunks to take a shower (which I don't understand). Subjective comfort zone I guess.

After passing puberty, I don't think I've seen any guys wear a swimsuit into the public showers, although there have definitely been some that I wish they would.

 

[thebeatblitz]

After passing puberty, I don't think I've seen any guys wear a swimsuit into the public showers, although there have definitely been some that I wish they would.

But those guys are the best, especially when they do the towel between the legs like floss maneuver.

 

[Tired]

I became a guinea pig and the instructor invited <i>everyone</i> to come over and have a listen, which was really really not cool with me--it was actually very disempowering.

And after all, it's really all about you . . .

 

[chicklett1]

And after all, it's really all about you . . .

Well it is my heart, after all.

 

[45408]

But those guys are the best, especially when they do the towel between the legs like floss maneuver.

or as you're walking towards the shower, and they've got their towel thrown over their shoulder, and they decide to stop in front of you and bend over to itch their toes. Barf.

 

[goodoldalky]

One of the first classes we had at my medical school was similar to this. The women wore sports bras and shorts, the men, just shorts. We learned all physical exams except genital, rectal, and breast.

Although the program is being phased out across the country, I believe it is one of the strengths of my education. It's really not about learning how to do an exam, either. It's about gaining a sense of perspective. Too many healthcare providers forget what it's like to strip down and be examined by a physician (sometimes while a student peers over his or her shoulder). No one likes that. It can be a very awkward experience (such is the nature of medicine), and it is important that we, as future providers, learn what that is like on both ends.

At the time, it was awkward, horrible - collectively, we dreaded it everyday. But that doesn't mean it wasn't a valuable experience, and it's something I will recommend stays around.

It comes down to this, which was eloquently stated:

Isn't it important to put yourself in a patient's shoes every once and a while? People hate getting naked in front of strangers, it probably wouldn't hurt physicians in training to be reminded of that.

I would suspect that the physicians who experienced this sort of thing in training are more sensitive to the feelings of their patients, and probably have a stronger sense for what it is really like to be stripped down, poked, prodded, etc.. And for that, some would argue that they provide a higher standard of care. (That isn't to say that if your program does not do this, you will be any less of a physician... )

 

[UnderdogMD]

One of the first classes we had at my medical school was similar to this. The women wore sports bras and shorts, the men, just shorts. We learned all physical exams except genital, rectal, and breast.

Although the program is being phased out across the country, I believe it is one of the strengths of my education. It's really not about learning how to do an exam, either. It's about gaining a sense of perspective. Too many healthcare providers forget what it's like to strip down and be examined by a physician (sometimes while a student peers over his or her shoulder). No one likes that. It can be a very awkward experience (such is the nature of medicine), and it is important that we, as future providers, learn what that is like on both ends.

At the time, it was awkward, horrible - collectively, we dreaded it everyday. But that doesn't mean it wasn't a valuable experience, and it's something I will recommend stays around.

It comes down to this, which was eloquently stated:



I would suspect that the physicians who experienced this sort of thing in training are more sensitive to the feelings of their patients, and probably have a stronger sense for what it is really like to be stripped down, poked, prodded, etc.. And for that, some would argue that they provide a higher standard of care. (That isn't to say that if your program does not do this, you will be any less of a physician... )

I completely disagree with this argument, for reasons already mentioned in this thread. My question is what happens when it stops becoming an issue of awkwardness/uncomfortableness and starts becoming an issue of health/privacy (already mentioned in this thread) or even of religion (hijab/burqa ect.) Anybody go to a school that has run into these issues?

 

[SugarBuster]

By the time I start med school (fall '08) I plan to be on an insulin pump, since pumping insulin is lower-maintenance than multiple daily injections. I specifically made the choice to transition to a pump in order to manage my type 1 diabetes while in med school. I'm not planning to advertise the fact that I'm diabetic to my classmates, but my pump (Omnipod, actually) will be quite obviously stuck to my abdomen. Not sure yet how I'll handle this.

I suppose the upside of having a chronic condition is not having to try very hard to understand the patient's perspective -- the feeling of being a patient is already quite familiar.

 

[Abilene85]

I would suspect that the physicians who experienced this sort of thing in training are more sensitive to the feelings of their patients, and probably have a stronger sense for what it is really like to be stripped down, poked, prodded, etc..

I understand this argument, but you are talking like med students never go to the doctor. I mean, I think my yearly gynecology check-up is more than enough to remind me that baring all to a doctor is a slightly uncomfortable situation. Do I really need to strip down and get poked by my classmates? I don't think that is going to make me any more sympathetic than putting my feet in the stirrups and spreading my legs for my real doctor once a year.

 

[SalseraDoctora]

I have to say I agree with this poster. I mean if I were paired up with somebody female I would feel uncomfortable but probably get over it (and I mean both having her examine me and then also examining her). I would definitely feel extremely uncomfortable having a male student practice on me. Mostly this makes me glad that I don't go to whatever school you go to, because I think this policy sucks. How difficult is it just to pair off by gender?

 

[PeepshowJohnny]

By the time I start med school (fall '08) I plan to be on an insulin pump, since pumping insulin is lower-maintenance than multiple daily injections. I specifically made the choice to transition to a pump in order to manage my type 1 diabetes while in med school. I'm not planning to advertise the fact that I'm diabetic to my classmates, but my pump (Omnipod, actually) will be quite obviously stuck to my abdomen. Not sure yet how I'll handle this.

I suppose the upside of having a chronic condition is not having to try very hard to understand the patient's perspective -- the feeling of being a patient is already quite familiar.

Let me give you a little bit of perspective. Diabetics tend to be VERY represented in medical schools and in medicine (I think it's a combination of a learning responsibility at a young age plus having lots of contact with the medical system). I'd be very surprised if you don't find others with diabetes at your school.

Although I understand wish to keep your condition private, I wouldn't worry about sharing your condition. It's going to make your life much easier if you're comfortable enough to not have to check your blood sugar incognito.

I myself am not diabetic, but I'll always remember being on the interview trail and talking with a few other applicants about why we're interested in medicine. One girl in a very matter of fact manner pulled your Insulin pump out from under her clothes to show us. It was both humorous, but also very genuine.

 

[goodoldalky]

How difficult is it just to pair off by gender?

That is a fine idea. While we are at it, let's make sure only male physicians do physical exams on male patients and female physicians only do exams on female patients.

The point of a lot of this is to develop a comfort level in dealing with and examining both sexes in a professional manner.

I understand this argument, but you are talking like med students never go to the doctor. I mean, I think my yearly gynecology check-up is more than enough to remind me that baring all to a doctor is a slightly uncomfortable situation. Do I really need to strip down and get poked by my classmates? I don't think that is going to make me any more sympathetic than putting my feet in the stirrups and spreading my legs for my real doctor once a year.

You may have a good idea what it is like to be in that position. Many medical students do not.

 

[caliboy007]

At my school, we do all of PE except breast, genital, rectal on each other. Groups are assigned with a faculty facilitator (usually 4:1 ratio). The groups are separated by gender, so you only practice on your own gender. However, this does kind of suck b/c at least as a guy, you don't really get to practice on women until you do your practice PE with an SP. They tell us as guys to practice on each other as if we were girls.

 

[SalseraDoctora]

That is a fine idea. While we are at it, let's make sure only male physicians do physical exams on male patients and female physicians only do exams on female patients.

If my partner were a physician I would not feel uncomfortable. You really think patients feel equally comfortable being examined by a second semester med student and an MD? Do you feel equally comfortable discussing your testicular pain with a female classmate of yours as you do with a female physician?

Just because you apparently are perfectly fine having some random person who 10 minutes ago was not any closer to being a doctor than the guy who sold you your coffee this morning prod your groin does not mean that it is irrational for somebody else to find that situation distasteful. Kudos to you that you have a thick skin--I think that is a great quality to have--but how about a little bit of sympathy for somebody who is apparently does not have as thick a skin as you and is currently unhappy.

 

[45408]

That is a fine idea. While we are at it, let's make sure only male physicians do physical exams on male patients and female physicians only do exams on female patients.

You don't suppose that a patient has a choice in whether or not they see a male or female physician on a regular basis, do you?

 

[SalseraDoctora]

And after all, it's really all about you . . .

It is actually. Excellent point.

 

[chicklett1]

If my partner were a physician I would not feel uncomfortable. You really think patients feel equally comfortable being examined by a second semester med student and an MD? Do you feel equally comfortable discussing your testicular pain with a female classmate of yours as you do with a female physician?

Just because you apparently are perfectly fine having some random person who 10 minutes ago was not any closer to being a doctor than the guy who sold you your coffee this morning prod your groin does not mean that it is irrational for somebody else to find that situation distasteful. Kudos to you that you have a thick skin--I think that is a great quality to have--but how about a little bit of sympathy for somebody who is apparently does not have as thick a skin as you and is currently unhappy.

Thank you for saying this. I appreciate your sensitivity.

 

[SalseraDoctora]

My pleasure.

 

[Cranial Gavage]

Perhaps this Physical Exam class should require that we practice venipuncture on our partners to further satisfy the schadenfreude of our superiors.


[/sarcasm]

 

[deuist]

We do venipuncture on each other...

 

[Cranial Gavage]

Perhaps this Physical Exam class should require that we practice venipuncture on our partners to further satisfy the schadenfreude of our superiors.

[/sarcasm]

We do venipuncture on each other...

On second thought, that doesn't surprise me (and doesn't seem too unreasonable.)

By the way, I'd be interested in hearing med students' opinions concerning the presence or absence of schadenfreude in medical education. (The German word translates as "damage pleasure," or taking pleasure in other's misfortune.)

Are the hardships of medical school (physical diagnosis discomfort, cramming minutiae for anatomy, lack of sleep, etc) just inherent to the system, or is there a mean-spirited element on the part of the professors?


[EDIT] New thread created for this topic so this one doesn't get hijacked:

http://forums.studentdoctor.net/showthread.php?t=488685

 

[Trisomy 8]

deleted

 

[OncoCaP]

On second thought, that doesn't surprise me (and doesn't seem too unreasonable.)

By the way, I'd be interested in hearing med students' opinions concerning the presence or absence of schadenfreude in medical education. (The German word translates as "damage pleasure," or the joy of inflicting discomfort on others. Sorry to be esoteric.)

Are the hardships of medical school (physical diagnosis discomfort, cramming minutiae for anatomy, lack of sleep, etc) just inherent to the system, or is there a mean-spirited element on the part of the professors?

Ok, now I'll be quiet and go back to pre-allo...

In the early basic sciences I find hardship totally absent (other than watching some classmates suffer, which I wish they didn't have to). Some of my friends say it gets better because they find the later material (and clinics) much more interesting and others hate being in the hospital all the time. Whether it gets better or worse ... I'm not worried about it. I'll look for ways to enjoy the experience and learn as much as possible. Most students are doing ok and you have this distribution on the joy curve. Hardships are not inherent in the system. Many of the people who seem to suffer the most hardship worry about things like grades, ranking, or impressing people like their friends or professors. Other don't get help when they face a crisis and suffer mostly alone unnecessarily.

If you have no fear of being wrong sometimes (or even often), enjoy learning stuff that might help you diagnose and treat a patient someday, you find a happy life to be had (depends on the school to some extent probably). Yes, the hours are long, so don't even think about medicine if you're looking for a 9-5 thing unless you never had to study in your life and made straight A's. If you don't worry and just do your best (and look for things you enjoy), spend time with people you like, realize that the worst thing they can do to you is kick you out so you can find something else that's a lot of fun (extremely rare to get kicked out unless you don't study or don't take care of life's problems early enough), you can really enjoy it. Of course, that's really the hard part ... letting go of the mania that too many of us have been raised with so we can actually enjoy life.

More to the point of this thread, our HX/PE stuff has been totally professional. If I don't feel comfortable checking the femoral pulse of my classmate, I will simply say I'm not going to and move on or check it through the clothing. Most of the preceptors and faculty are very nice and have great ideas and workarounds for most any situation. They make me feel comfortable and I like learning these useful skills.

 

[Cranial Gavage]

OncoCaP- great response. Thanks for the advice.

For others interested in discussing the schadenfreude topic, I created a new thread in pre-Allo so as not to hijack:

http://forums.studentdoctor.net/showthread.php?t=488685

 

[mac_kin]

I love the way we do things here in PT school, which is very similar to medicine. As a physio, your job revolves around touching/feeling/moving people's body parts. A good doctor, in order to perform a thorough diagnosis has to do the same.

Noone here in a class of 100 has any problems. The handful of girls with religious issues simply always pair up and go behind the curtains if disrobing to a sports bra is needed...they're ok with the shorts though.

Our profs say, in practice, you will have any patient walk in off the street. Every human body is different, joints are looser or tighter, skin/tissue feels different, ranges of motion are different. Therefore, we are rotated in a different group each lab session so that we get to feel as many body types as possible. This is what the school stresses and I believe they are right. I would feel more uncomfortable and worried going to a PT or doc who was too shy to feel different body types.

I know people have talked about separating sexuality and practice. I don't find this an issue personally. I can assume a professional mind set and do what I need in lab (eg. feeling some cute guys ischial tuberosity). It's all practice and if I want to flirt I leave it for the parties/get together's after class. This issue of feeling sexual or fear that some guy/girl is thinking sexually of you should NOT be an issue at all. We're all in our 20's and should be professional adults. Stop worrying about sex. For all you know, your own doctor may be thinking sexually of you when you go to see him/her. You don't know what people are thinking, so forget about it and keep your own mind on track.

For the issue of wanting to feel professional in front of classmates/profs, this is the career you have chosen. Your profs know that you need to practice, as they have once done too. Your 40 year old profs, with his own teens at home, is not thinking unprofessionally or sexually about you. He's there to facilitate your learning.

I think people need to get over it. I think bringing it up and making a big deal of all this just makes it much more awkward than it needs to be.

 

[SalseraDoctora]

I think the point of this poster was just that when she signed up to be a medical student she didn't know she was going to sign up to be a guinea pig too. It is one thing to volunteer to let somebody practice on you, and it is another thing to have the task assigned to you. And yes, if she wanted to make a big scene and opt out she could, but then she would look bad.

You can say that perhaps she should have known when she enrolled in that med school that this practice was normal, but based on what I have seen in my own med school their practices and policies seem to change on a semesterly basis, and we get very little warning. Also the policies do vary school to school. It does seem insensitive to me of the faculty of that school to oblige students to be practice patients. Many med schools do not have that policy (including mine thank goodness), and I haven't noticed any huge problem recruiting true volunteers for us to practice on. To me it just seems insensitive of the faculty at whatever school the poster attends.

 

[deuist]

I think the point of this poster was just that when she signed up to be a medical student she didn't know she was going to sign up to be a guinea pig too.

She is hardly being asked to be a human guinea pig. That term is reserved for those men and women who are experimented upon without their knowledge or consent. She is merely being asked to allow other medical students listen to her heart and lungs---not such a difficult proposal if you ask me.

Whenever I give tours to applicants I always make a point of telling them that our medical school has the students practice on each other. Some of them seem a bit put off by this method at first, but most usually nod their head in agreement when they realize that we aren't going to do anything that involves the pelvis or the breast.

 

[Abilene85]

She is hardly being asked to be a human guinea pig. That term is reserved for those men and women who are experimented upon without their knowledge or consent. She is merely being asked to allow other medical students listen to her heart and lungs---not such a difficult proposal if you ask me.

Asking the OP to simply take part in the physical exam practice like every other student is one thing. But then using her (I'm just going to assume the OP is female) as the example murmur heart and inviting all the students to listen without her consent (because it doesn't seem that the instructor asked her permission) seems to border on guinea pig to me. Okay, it's not "experimentation," but it is still inappropriate. In this setting, we aren't the patients, we are just acting. We still have a right to our privacy - if you had an embarassing skin condition discovered by one of your classmates during the mock exam, would you want the other 28 coming up to study it? Probably not.

 

[Crixivan]

We're all in our 20's and should be professional adults.

Should be, yes, but in my experience, the school accepts the students with the best numbers and then tries to somehow "teach" them professinalism.

Some students may want to be a guinea pig so that others could learn, but if the students are still so immature that they stigmatize individuals with disease, then I can see how the experience would be uncomfortable.

If you're somebody who normally wouldn't mind the exam but feel creeped out by the behavior of specific classmates or don't think that they'd respect confidentiality, then the school has basically screwed up picking its class. If you generally just don't want somebody practicing non-invasive exam skills on you because you're too shy, use the experience as a lesson in how patients might feel the same way about you examining them.

 

[goodoldalky]

If my partner were a physician I would not feel uncomfortable. You really think patients feel equally comfortable being examined by a second semester med student and an MD?

No, I do not. That is my point. There are hundreds of patients being examined by medical students at your medical center's hospital EVERY DAY. It is important for you to also know what it is like to be examined by someone who is learning.
It is also important that you and your partner learn about the professionalism and behavior that would be appropriate in these types of settings. You both ought to be acting like physicians at this point.

Do you feel equally comfortable discussing your testicular pain with a female classmate of yours as you do with a female physician?

I think you have taken the practicing of physical exam techniques one step further. The answer is no, but I do not know of any program that does that.

Just because you apparently are perfectly fine having some random person who 10 minutes ago was not any closer to being a doctor than the guy who sold you your coffee this morning prod your groin does not mean that it is irrational for somebody else to find that situation distasteful.

For one thing, it is important to note that patients are "practiced" on regularly and quite often have a problem with it. It is not uncommon for people to request that even residents be restricted from participating in their care, much less medical students, because it makes them uncomfortable. It is this idea that society wants to be treated only by impeccably trained doctors and not be subject to training physicians in any way. You may be better able to deal with these attitudes and more understanding in the resolution of problems and the development of compromise if you have a clear, recent understanding of what it is like. [Even if only with regards to PE skills (which, let me remind you, are insignificant compared to what techniques are "taught" on patients)].

Kudos to you that you have a thick skin--I think that is a great quality to have--but how about a little bit of sympathy for somebody who is apparently does not have as thick a skin as you and is currently unhappy.

Understandable. My point is that it is valuable experience for physicians in training to know what it is like to be a patient (at a teaching hospital, no less). Additionally, in large part, this experience is not about you. It is about your partner, who is learning, and about the patients you will see in the next four years (who will be thankful that you at least have some sense what it is like to be "practiced" on).

 

[Hoo\/er]

I did talk to the program director at my school, and her response was basically that it was my problem and I needed to deal with it because school policy isn't going to change. I disagree with that decision, but it seems that I am in the minority, so I guess I will do just that--deal with it.

Damn it, never just "deal with it." If you're uncomfortable doing something with your body, don't just give in because you are in the minority.

Don't be scared of the medical school administration. You have rights.

As mentioned in a previous post, you won't get kicked out of school and it is highly unlikely that they could do anything to punish you for refusing to consent to participation. The lawsuit you'd have would be worth millions - not to mention the bad publicity for the medical school in general.

It's a can of worms they certainly don't want to open, so rock that boat for all it's worth.

 

[goodoldalky]

Damn it, never just "deal with it." If you're uncomfortable doing something with your body, don't just give in because you are in the minority.

Don't be scared of the medical school administration. You have rights.

As mentioned in a previous post, you won't get kicked out of school and it is highly unlikely that they could do anything to punish you for refusing to consent to participation. The lawsuit you'd have would be worth millions - not to mention the bad publicity for the medical school in general.

It's a can of worms they certainly don't want to open, so rock that boat for all it's worth.

Theoretically, I agree with Hoover, in most situations. Personally, if I were in that situation, I would be very hesitant to rock the boat. Medicine is a small, tight-knit group, and burning bridges can really come back to get you. I would avoid pissing off any person of importance until you are out of their reach, so to speak.

Not that I am implying that an administration or a person of power would ever do anything to hinder your career, but I've heard stranger things. I have heard stories of people in power in the profession exerting some influence in a negative manner over another's career... I'd just realize you may be taking a risk if you choose to pick that bone. Protect your rights, certainly, but be careful about stirring up lawsuits and bad publicity "for all it's worth". Consider talking to a lawyer in advance to ensure you make a safe, defensible decision if it is a big issue to you.

 

[loveboatdoc]

I read through this old thread, and figured I'd toss in another .02.

At our small (82 in graduating class) DO school, nobody had to participate if they felt uncomfortable, but I don't recall anyone sitting out. Some who were overweight wore t-shirts, and it wasn't a big deal. Girls had halter tops; most wore shorts but a few wore longer leotard-type leggings. There was no pressure to participate. We were told we could practice at home on family members, or after-hours if we needed more privacy.

The advantage of practicing (Not rectal, genital, or breast) PE's and OMM was we had a wide range of body types to learn on. One guy had fantastic musculature, and didn't mind the rest of us referring to him. It was not uncommon to discover skin problems / nevi (esp on backs), and folks could get it taken care of. My belly was so skinny back then, you could see my aorta pulsate when I layed flat on my back, and I didn't mind having my classmates listen/palpate. (the prof even had me get an u/s to r/o anuerysm).

One of our profs wore an insulin pump, and he taught us about it while raising his shirt. I respected him for that, and he explained how it enabled him to perform his job better, etc.

Now, we are all old and grey, and we see each other at conferences, etc. We are a VERY close class! Maybe DO's are just more touchy-feely in general, but I always look forward to seeing my old classmates and hugging...heck, we even have OMM tables set up at meetings and work on each other's headaches or backaches. There is a spirit of comraderie and caring for each other...all kept on a professional level.

I think it is so important to touch our patients, but tell them what we need to do before we touch them. I think the hundreds of hours in OMM / PE classes during school made this 2nd nature, and improved our diagnostic skills significantly.

OK, time to blast me for posting on an old thread....get out the fireballs and thumbs down!

 

[Lacheln]

I find it totally fascinating that this thread was started just 2 years ago, and yet in this thread from earlier this year people were in utter disbelief that any school used fellow students for physical exams.

Like I said, VERY recently schools had students perform FULL physical exams on each other, including the full monty. Yes, you can opt-out, but the peer-pressure to allow it is intense.

 

[KeyzerSoze]

I find it totally fascinating that this thread was started just 2 years ago, and yet in this thread from earlier this year people were in utter disbelief that any school used fellow students for physical exams.

Like I said, VERY recently schools had students perform FULL physical exams on each other, including the full monty. Yes, you can opt-out, but the peer-pressure to allow it is intense.

No, people in that thread are shocked that schools had students perform breast, pelvic, and prostate exams on each other.

As a random data point, my school has students practice physical exam skills (except breast, pelvic, and prostate of course) on each other in pairs. You get to pick your own partners, so you don't have a big group of people staring at you, and you can avoid having the exam done by a student of the opposite sex if that makes you uncomfortable.

 

[nima123]

This thing can only be a big deal in the US.
I don't understand what the problem is with doing physicals (except breast and genitalia) in a very professional environment. I actually think it's part of developing a professional attitude towards patients as you move from your pre-clinical to clinical years. If you wanna be a doctor, you need to be more open-minded than a doorman (no offense to doormen!).

We did our breast an genitalia exams with professional actors that our school had hired. This was done in small group setting and everybody got hands-on training during the session.

In my opinion, the OP is just not comfortable with her body. The whole thing about [pervert?] male students touching her is an excuse.

 

[nlax30]

I definitely don't agree with using classmates for breast, pelvic, genital exams, but no problem with the rest. I'm at a DO school so we were already used to workig with classmates during OMM lab and that sort of personal contact was never an issue. I think it was kind of nice, in general our class became pretty comfortable with each other, there were all sorts of body types represented and it was nice to be able to take a study break and go to the lab to have your study partner work on some back/neck pain you developed from hours of hunched over reading.

For physical exam modules, including the "invasive" exams, the school brought in actors/standardized patients. I think that's the way to do it. Sometimes you just feel too comfortable with a classmate and may not approach the physical exam in a different manner and say things you wouldn't necessarilly say to a patient in a professional setting. Have an actor you don't know kind of helped simulate the actual experience of learning how to approach a stranger and explain what you are about to do, even if it might be very personal and a little invasive. On our time it certianly was encouraged to practice basic skills on classmates and family, but the initial introduction to the exam components was with the actors.

 

[RiskyFugu]

We practice on each other at my school. Two of my classmates---one male and one female---have even trust their hands down my pants in search of a femoral pulse. We use model patients for genital/rectal, similar to your school. Otherwise, everything is done on each other without complaint.

You are going to going to perform much worse exams on your patients---and they're going to be uncomfortable, too.

The pre-med was right: you need to get over it.

Pardon me, but what the hell does “much worse exams on your patients and they’re going to be uncomfortable too” have to do with being examined by your own classmates? They are two unrelated events, but you seem to think that one justifies the other.

I’m a guy and I hate being “examined” for learning purposes. If they’re doing something simple like testing reflexes or doing an HEENT, fine, I can tolerate that. But anything more “personal” than that is uncomfortable for me. And if it were a female student, I simply wouldn’t allow it.

It’s not that I have anything to be embarrassed about. I have no problem whatsoever walking on the beach without a shirt, and I certainly have no problem with being examined by a doctor. I just don’t want to be touched by classmates or anyone else who is not helping me in some capacity. And I sure as hell don’t want to use my anatomy to help anyone else learn. Maybe it’s selfish, but it’s my right. Moreover, I am a relatively private person and I don’t want my classmates knowing anything about my health....even if there’s nothing to know. If my BP were slightly high or if I had a speck of lint in my belly button, it’s none of my classmates’ beeswax. I have a right to keep it that way.

So, for you to tell the original poster to “get over it” is incredibly insensitive on your part. It suggests that you consider your own logic and opinions to be the general rule, and any views contrary to them can be trivialized and summarily dismissed.