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

[Matthew9Thirtyfive]

Interesting. Never had that done on me before.

At MEPS they did make like 20 of us bend over and grab our butt cheeks and spread them and the doctor went down the line looking up our buttholes but I never did know what that was for. Nothing went in though lol.

@Matthew9Thirtyfive any idea what that is to check for?

Hemorrhoids.

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[RNtoMD87]

Hemorrhoids.

Oh. Surprised they were that concerned about hemorrhoids.

The underwear duck walking was fun though.

 

[Matthew9Thirtyfive]

Oh. Surprised they were that concerned about hemorrhoids.

The underwear duck walking was fun though.

They only care if they’re large, symptomatic, or bleeding in the last 60 days prior to examination. They’re also looking for polyps, prolapse, and fissures.

Edit: also, yes, the duck walk was fun. I’m glad they did that though because when I crossed the line, I had to duck walk for like 8 hours straight.

 

[DrRedstone]

Didn't realize this thread was so old. Btw, for all the DO's out there, what's an ischioanal fossa release?

Ischiorectal fossa release is used to enhance lymphatic drainage by loosening fascia, maybe some other things? We didn't learn it at KCU, we just learned of it. Is it actually useful? Who knows. People don't seem to like talking about OMT research other than for low back pain and pneumonia confirmation with one of the anterior Chapman's points.

 

[RNtoMD87]

Oh. Surprised they were that concerned about hemorrhoids.

Except it doesn't, because it's snake oil.

Can't tell if serious.. please show me one non-insane journal which confirms not only do these made-up nodules exist but that they aid in PNA.

thats my question about DO school, the techniques they teach, do they have peer reviewed research backing up the techniques with an adequate sample size?

 

[DrRedstone]

Except it doesn't, because it's snake oil.

Can't tell if serious..

Presence of Chapman reflex points in hospitalized patients with pneumonia. - PubMed - NCBI

I'm just saying someone published research on it (albeit in JAOA) and it is held up as evidence. I made no comment on the validity of the paper (is that because it is poor if present at all?). Will I ever use it to diagnose? No, that's what CXRs are for. Is it possible I might check it for kicks and giggles on patients I round on in rotations? Maybe a few times.

 

[DrRedstone]

thats my question about DO school, the techniques they teach, do they have peer reviewed research backing up the techniques with an adequate sample size?

Here are some non-JAOA articles that I found on pubmed with the search "OMT back pain."

Meta-Analysis: Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. - PubMed - NCBI
RCT: Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. - PubMed - NCBI
Trial of unknown control: The effect of visceral osteopathic manual therapy applications on pain, quality of life and function in patients with chronic nonspecific low back ... - PubMed - NCBI
Trial of unknown control: Changes in biomechanical dysfunction and low back pain reduction with osteopathic manual treatment: results from the OSTEOPATHIC Trial. - PubMed - NCBI

Edit: I looked through a few more pages of articles and found some RCT protocols that have been submitted with larger journals. It should be interesting to see what they come up with.

 

[Crayola227]

Hold up. We have to do rectals on each other in med school?

usually not, they have you do standardized patients for that

 

[Psai]

Interesting. Never had that done on me before.

At MEPS they did make like 20 of us bend over and grab our butt cheeks and spread them and the doctor went down the line looking up our buttholes but I never did know what that was for. Nothing went in though lol.

@Matthew9Thirtyfive any idea what that is to check for?

I dunno but I'm gonna need a reenactment

 

[Black Coffee 24/7]

Presence of Chapman reflex points in hospitalized patients with pneumonia. - PubMed - NCBI

I'm just saying someone published research on it (albeit in JAOA) and it is held up as evidence. I made no comment on the validity of the paper (is that because it is poor if present at all?). Will I ever use it to diagnose? No, that's what CXRs are for. Is it possible I might check it for kicks and giggles on patients I round on in rotations? Maybe a few times.

Pls perform the ischioanal fossa release on your pt during your third yr and report back here

 

[DrRedstone]

Pls perform the ischioanal fossa release on your pt during your third yr and report back here

Sure, but only if you find me some nice peer-reviewed literature endorsing it and it is indicated. I figure I shouldn't change my standard for when and what manipulations I'm willing to use on patients for your entertainment

But this seems to be getting off the original topic. Feel free to shoot me a PM if you want to continue the conversation.

 

[IM-2019]

I do want to add, I hope that med school students take this professionally. One problem I had in nursing school about it, is classmates would giggle and act stupid when it came to assessing a bare chested individual. Makes me feel like we're back in middle school.

We had a dean mention that a med student gossiped about another students appearance after examining them during a school session, but faculty heard about it and they got written up for professionalism. From what I've seen, everyone is really really professional about it. Even in private, conversations have occasionally been about how it's awkward rather than anything sexual.

For example, perhaps course directors could give students a survey at the beginning of the term that asks if they have a gender preference for physical examination partners, based on potential worries about attraction, religious beliefs or even discrimination. If given the choice, I would probably prefer opposite-sex workshop partners because I am in a same-sex relationship (assuming we should be able to opt out of examining certain people, which I disagree with). But if you believe no one should be coerced into such situations, why is it fairer for me to be in a suboptimal position when the majority gets their preference? Fairness is listening to every individual person about their needs and trying to accommodate everyone, or no one, so the outcome is equal.

The main point I was making with this, though, on the demographics front, is that it shouldn't matter because we are all going to have young, old, male, female, cis, trans, gay, straight, and even asexual patients one day. We should be able to compartmentalize our personal and our professional lives to the extent that we view all peers as patients, view all patients as equally worthy of our respect and attention, and conduct ourselves accordingly in workshops. It primes us for professional relationships in the future with colleagues and patients.

I think having a preference sheet is the best option. You would probably get large groups of men and women preferring the same gender, but also probably a handful of students ok with a co-ed group or an opposite sex homosexual partner or something like that, so that everyone could be matched into a comfortable group as much as possible.

For what it's worth, my school did split us by gender for physical exam practice sessions, but then didn't when we acted as standardized patients for each other. That I think was kinda the worst option, because men wound up having to ask female classmates to displace a breast for a chest exam for the first time while in a timed, simulated encounter rather than in a classroom setting.

You have to shut it off. Co workers and patients should be off limits. I don't even think of them in that way. Attraction isn't solely visual, it's also situational.

There's tons of dating within a med school class, and with other healthcare professionals. Part of why examining classmates is awkward is because they aren't actually off limits the way a patient is.

 

[smoke4joy]

Why should it be uncomfortable? It is practice; every student needs to practice more the better.

 

[deleted480308]

Interesting. Never had that done on me before.

At MEPS they did make like 20 of us bend over and grab our butt cheeks and spread them and the doctor went down the line looking up our buttholes but I never did know what that was for. Nothing went in though lol.

@Matthew9Thirtyfive any idea what that is to check for?

Hemmorhoids/fissures (actual answer)

 

[RNtoMD87]

We had a dean mention that a med student gossiped about another students appearance after examining them during a school session, but faculty heard about it and they got written up for professionalism. From what I've seen, everyone is really really professional about it. Even in private, conversations have occasionally been about how it's awkward rather than anything sexual.



I think having a preference sheet is the best option. You would probably get large groups of men and women preferring the same gender, but also probably a handful of students ok with a co-ed group or an opposite sex homosexual partner or something like that, so that everyone could be matched into a comfortable group as much as possible.

For what it's worth, my school did split us by gender for physical exam practice sessions, but then didn't when we acted as standardized patients for each other. That I think was kinda the worst option, because men wound up having to ask female classmates to displace a breast for a chest exam for the first time while in a timed, simulated encounter rather than in a classroom setting.



There's tons of dating within a med school class, and with other healthcare professionals. Part of why examining classmates is awkward is because they aren't actually off limits the way a patient is.

Seems highly unprofessional to date fellow students to me. Don’t sh where you sleep

 

[Matthew9Thirtyfive]

Hemmorhoids/fissures (actual answer)

Is that different than my actual answer of hemorrhoids/fissures, or did you just not see it lol

 

[Dona Nobis Pacem]

Get over it princess.

 

[deleted480308]

Is that different than my actual answer of hemorrhoids/fissures, or did you just not see it lol

My bad , didn’t see your response. I was trying to show that I wasn’t being sarcastic but I totally get how that probably looked like I was being a tool. Sorry

 

[RNtoMD87]

Get over it princess.

But I need my safe space!

 

[Matthew9Thirtyfive]

My bad , didn’t see your response. I was trying to show that I wasn’t being sarcastic but I totally get how that probably looked like I was being a tool. Sorry

I should have put a /s tag. Was totally joking.

 

[IM-2019]

Seems highly unprofessional to date fellow students to me. Don’t sh where you sleep

Lol what? It's a running joke with med school faculty that a decent chunk of the class will graduate married to a classmate. It's not like med students are supervising each other, so there's actually less issues with power imbalances than most other relationships you could have with other medical professionals. Plus, you spend a decent amount of time with classmates and are in the same life position, dating is pretty normal in that situation.

 

[Matthew9Thirtyfive]

Seems highly unprofessional to date fellow students to me. Don’t sh where you sleep

Were you actually in the military? Lol Maybe it’s just a Navy thing because we’re all crammed like sardines on the ships, but tons of people date and get married within the same crew. When you’re around the same people all the time going through stressful situations, relationships are bound to form. It’s not unprofessional to date a fellow student in your class. There is no power imbalance.

It would be unprofessional if you broke up and made it uncomfortable for that person and everyone else by acting like an ass. But that’s not a given and easily avoidable by not acting that way if it ends.

 

[RNtoMD87]

Were you actually in the military? Lol Maybe it’s just a Navy thing because we’re all crammed like sardines on the ships, but tons of people date and get married within the same crew. When you’re around the same people all the time going through stressful situations, relationships are bound to form. It’s not unprofessional to date a fellow student in your class. There is no power imbalance.

It would be unprofessional if you broke up and made it uncomfortable for that person and everyone else by acting like an ass. But that’s not a given and easily avoidable by not acting that way if it ends.

Oh NCOs were fraternizing constantly. Doesn’t mean it was professional. My PSG was banging half of our privates while married, and eventually we all got called in for questioning because he used to have unit parties at his house where we would be encouraged to get stupid drink and he would tell the girls “strip for me and I’ll give you a dolla”, and tell them things like “I’ll pee in ya butt”. One private claimed he raped her and most of the unit shunned her saying she was lying. Honestly could’ve gone either way in my opinion. This he female privates were having trains run on them. One private who had a civilian husband wanted the unit to run a train on her for her birthday (behind his back). Like 6 of my platoon mates took part. She was nasty.

Another of my platoon mates slept with about a dozen members of the company and turned up pregnant. Two guys used to double team her all the time (and were fresh out of high school) and one was the dad. Took awhile to figure it out. Hated that for him. He ended up re-enlisting to support his kid.

She manipulated him into getting married, and ofcourse it didn’t work out. She ended up marrying another member of our company.

A good friend of mine (mechanic NCO) blew his brains out and I was the first responding MP on scene. Why? Because his wife (an MP) was cheating on him with another MP sergeant and when she went to Kuwait predeployment (same BN, different company), he got drunk while with friends (married mechanic NCOs) and shot himself im front of them.

We wrote it up as an accidental death so there would still be life insurance. What does she do? Buy the NCO she was cheating on him with a new truck.

 

[Matthew9Thirtyfive]

Oh NCOs were fraternizing constantly. Doesn’t mean it was professional. My PSG was banging half of our privates while married, and the female privates were having trains run on them. One private who had a civilian husband wanted the unit to run a train on her for her birthday (behind his back). Like 6 of my platoon mates took part. She was nasty.

Another of my platoon mates slept with about a dozen members of the company and turned up pregnant. Two guys used to double team her all the time (and were fresh out of high school) and one was the dad. Took awhile to figure it out.

She manipulated him into getting married, and ofcourse it didn’t work out. She ended up marrying another member of our company.

A good friend of mine (mechanic NCO) blew his brains out and I was the first responding MP on scene. Why? Because his wife (an MP) was cheating on him with another MP sergeant and when she went to Kuwait predeployment (same BN, different company), he got drunk while with friends (married mechanic NCOs) and shot himself im front of them.

We wrote it up as an accidental death so there would still be life insurance. What does she do? Buy the NCO she was cheating on him with a new truck.

None of this has anything to do with my post. Dating a peer is not even remotely the same as a woman sleeping with a bunch of guys at a command. That happens in the Navy too, and sometimes they get in trouble (ie, when one of the men is married).

When two E-5s in different departments on the ship start dating, it is not unprofessional if they don’t make it unprofessional. There were many relationships at my last command. Only one of them was remotely unprofessional, and that’s only because it was a deployment booty call that involved alcohol (neither of them were married). All the others were just people dating their co-workers.

It is kind of disturbing that you can’t separate a normal, professional relationship from adultery and promiscuous fraternizing with children as consequences.

 

[RNtoMD87]

I standby that it’s unprofessional. I haven’t seen many people completely amicably split up. There’s always tension on some level or another, and it detracts from readiness. Or if they’re together there is at least perceived favoritism between them.

Case in point. We had two married NCOs in my company (an MP female and supply Sgt male). On deployment in Iraq they were able to room together, and there was a lot of tension because everyone knew they were getting laid whenever, but everyone else would be punished for sleeping with anyone in a combat zone. Really hurt unit morale. People still did (with Iraqi interpreters, Navy sailors stationed with us, fellow soldiers, and in one case, a female national guard we called “waffle butt” because she was banging detainees through the hurricane fencing, and everyone ostracized her and belittled her.
Really interesting situations.

And DIFFERENT units is the key. If you’re dating a med student in a completely different section or whatever I can see that. Like a nursing student dating a nursing student at a different school or year. I’m talking about in your class, or group. A speech our bn commander gave us resonated with me. “What kind of inbred trash are you?! Sleeping with your brothers and sisters in arms?! You are family!”

And I was addressing “were you even in the military?”

 

[Matthew9Thirtyfive]

I standby that it’s unprofessional. I haven’t seen many people completely amicably split up. There’s always tension on some level or another, and it detracts from readiness. Or if they’re together there is at least perceived favoritism between them.

Breaking up badly and acting unprofessional is unprofessional. That doesn’t make dating unprofessional. It may make it unwise if you want to avoid drama or tension, but that doesn’t make a peer relationship unprofessional. As I’ve already pointed out, it is obviously possible to have perfectly professional relationships in a close tight-knit group.

Case in point. We had two married NCOs in my company (an MP female and supply Sgt male). On deployment in Iraq they were able to room together, and there was a lot of tension because everyone knew they were getting laid whenever, but everyone else would be punished for sleeping with anyone in a combat zone. Really hurt unit morale.

Again, this is irrelevant. You are arguing against a straw man. No one is saying that adultery is professional. Two single people dating =!= two married people cheating on their spouses. I’m not sure why you seem unable to see the difference.

And DIFFERENT units is the key. If you’re dating a med student in a completely different section or whatever I can see that. Like a nursing student dating a nursing student at a different school or year. I’m talking about in your class, or group.

We don’t really have units in the surface Navy. We have different divisions and departments, but they are all part of the same crew and are together on the same ship.

And I was addressing “were you even in the military?”

That part wasn’t really the point. My point was that you can have a professional relationship between classmates or coworkers if you behave like adults. But you seemed to be implying that the military doesn’t allow peer relationships, which at least in the Navy isn’t true.

 

[RNtoMD87]

Breaking up badly and acting unprofessional is unprofessional. That doesn’t make dating unprofessional. It may make it unwise if you want to avoid drama or tension, but that doesn’t make a peer relationship unprofessional. As I’ve already pointed out, it is obviously possible to have perfectly professional relationships in a close tight-knit group.




Again, this is irrelevant. You are arguing against a straw man. No one is saying that adultery is professional. Two single people dating =!= two married people cheating on their spouses. I’m not sure why you seem unable to see the difference.



We don’t really have units in the surface Navy. We have different divisions and departments, but they are all part of the same crew and are together on the same ship.



That part wasn’t really the point. My point was that you can have a professional relationship between classmates or coworkers if you behave like adults. But you seemed to be implying that the military doesn’t allow peer relationships, which at least in the Navy isn’t true.

It wasn’t forbidden as long as it was private-specialist, NCOs, or two officers in non conflicting chains of command, but it was strongly discouraged.

Usually the females got moved to other units because of “bullying” or harassment from all of the males calling her names akin to skank or most often “clearing barrel”


I just personally find relationships with close coworkers or students in your immediate group unprofessional. I’ll just have to agree to disagree. I mean where I work nurses are married to or date nurses on other floors or other specialties on other floors. I feel that’s fine. But I would never date or sleep with someone I work with often.

Even if there’s no actual professional wrong doing, like we used to say- “perception is a mfer”

 

[Matthew9Thirtyfive]

It wasn’t forbidden as long as it was private-specialist, NCOs, or two officers in non conflicting chains of command, but it was strongly discouraged.

Usually the females got moved to other units because of “bullying” or harassment from all of the males calling her names akin to skank or *****.


I just personally find relationships with close coworkers or students in your immediate group unprofessional. I’ll just have to agree to disagree. I mean where I work nurses are married to or date nurses on other floors or other specialties on other floors. I feel that’s fine. But I would never date or sleep with someone I work with often.

That’s your choice. You’re conflating “unprofessional” with “unwise” or “ill-advised.” They aren’t the same. Personally, I would never date someone at my command or in my class either because I feel like it would be distracting. But I’m not about to call a relationship between two consenting adults in which there are no power imbalances or infidelity or anything unprofessional just because I wouldn’t do the same.

But we’re just arguing semantics at this point. *shrug*

 

[deleted480308]

Oh NCOs were fraternizing constantly. Doesn’t mean it was professional. My PSG was banging half of our privates while married, and eventually we all got called in for questioning because he used to have unit parties at his house where we would be encouraged to get stupid drink and he would tell the girls “strip for me and I’ll give you a dolla”, and tell them things like “I’ll pee in ya butt”. One private claimed he raped her and most of the unit shunned her saying she was lying. Honestly could’ve gone either way in my opinion. This he female privates were having trains run on them. One private who had a civilian husband wanted the unit to run a train on her for her birthday (behind his back). Like 6 of my platoon mates took part. She was nasty.

Another of my platoon mates slept with about a dozen members of the company and turned up pregnant. Two guys used to double team her all the time (and were fresh out of high school) and one was the dad. Took awhile to figure it out. Hated that for him. He ended up re-enlisting to support his kid.

She manipulated him into getting married, and ofcourse it didn’t work out. She ended up marrying another member of our company.

A good friend of mine (mechanic NCO) blew his brains out and I was the first responding MP on scene. Why? Because his wife (an MP) was cheating on him with another MP sergeant and when she went to Kuwait predeployment (same BN, different company), he got drunk while with friends (married mechanic NCOs) and shot himself im front of them.

We wrote it up as an accidental death so there would still be life insurance. What does she do? Buy the NCO she was cheating on him with a new truck.

You wrote a clear suicide up as accidental for benefit fraud?

 

[Matthew9Thirtyfive]

You wrote a clear suicide up as accidental for benefit fraud?

I actually skipped that part. Yeesh.

 

[RNtoMD87]

I didn’t write anything except what I saw upon entering the room. That was all above my paygrade and I heard about it later. You don’t speculate on a police report.

Also, they said he was laughing and joking before he did it saying “if y’all fk in my bed... imma shoot y’all... like this”. The wife witness just kept sobbing saying “why did he do it?!” And the male very calmly called top and explained the situation. Much more calmer than I would’ve.

So it wasn’t 100% clear. But most of us felt like it was probably suicide because he was having a very rough time. (I honestly wondered if there was a motive for murder because of how calm the male was, but you don’t say something like that in an MP unit unless you want a lot of enemies, and I had no other reason to think so except the gun was so far from the body, and both witnesses claimed to not have touched it.

It wasn’t investigated nearly to my satisfaction, but I was a specialist. Who cares what I think?