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

[Marcus Brody]

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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.

And you have a "right" to STFU and GTFO if it's that big a deal. No one is making you become a doctor, much less making you attend school A vs school B. 🙄

 

[MilkmanAl]

SOme of us aren't lucky enough to have a choice of which school to attend, you know. I don't see why you should be required to perform a physical on someone if you're not comfortable with it.

 

[MedStudentWanna]

If you wanna be a doctor, you need to be more open-minded than a doorman (no offense to doormen!).

Considering your line didn't make any sense whatsoever, I doubt offense was taken.

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

Ah, so if a student doesn't want to take off her shirt in front of her classmates, it means she's uncomfortable with her body. Perhaps she's just modest. Have you thought of that? Perhaps she doesn't like people touching her unless it's her personal physician, with whom she has a professional relationship. Have you thought of that? Perhaps she has scars or something else she's sensitive about that she doesn't want broadcast to the whole school. Have you thought of that?

Your line about being open-minded comes to mind and it reminds me to call you a big, fat hypocrite! Doctor, heal thyself.

 

[girlofgrace7]

Though we have not yet gotten into physical exams, we seem to have standardized patients (who are really great... we had some actually start crying when we were supposed to be patient interviewing someone who was physically abused) for everything other than venipuncture and vital signs.

Considering how often guys in my class talk about their trips to strip clubs or how they hooked up with a girl in our class, I would be very uncomfortable disrobing in front of them. It is an entirely different matter if it is my personal doctor, and I actually prefer having a male physician; however, I have a rapport with my male classmates and would prefer that they do not perform a physical exam on me. Although everyone should be professional and there are checks in place if professional boundaries are broken, things are going to be awkward if you are placed with someone you are attracted to.

 

[nima123]

Doctor, heal thyself.

😀 Sure, I'll try Virgin Mary.

And since you're so open-minded, I wonder if you've considered joining a monastery instead of medical school.

 

[AlexMorph]

😀 Sure, I'll try Virgin Mary.

And since you're so open-minded, I wonder if you've considered joining a monastery instead of medical school.

what is this...i don't even...where do you get your comebacks from?!?!

 

[DrCJU]

I find it interesting that some posters are saying that we NEED to experience this awkward interaction so that we might be more compassionate doctors... assuming that self conscious people have no idea what if feels like to be self conscious UNTIL they are physically examined by a classmate.

Additionally, our classmates are being given a lot of credit here regarding their professionalism and such intense dedication to perfecting the PE that they're not noticing/judging/ and later commenting on what they've seen. I have keloid burn scars on my chest and shoulders that don't show if I'm wearing a shirt but may peek out from time to time. One of classmates caught a glimpse recently and said, verbatim "EWW!! what is that? what's wrong with you? is it contagious?"🙄 It was a guy and he probably got the shock of his life while trying to sneak a look at my boobs. Needless to say, for the past week or so I've had a lot people asking me about it including people I didn't even know existed...which isn't as bad as the ones who just stare at me without blinking or looking away when I catch them

 

[greatnt249]

I love how many of you preach that this exercise should foster some sort of sensitivity/solidarity toward our future vulnerable patients, yet berate your future colleagues for not wanting to broadcast their business to their peers...bravo, hypocrites, bravo.

I don't need to be manhandled by my classmates (some of whom have yet to rise up to the level of maturity they should be at at this stage of the game) to know what it feels like to be vulnerable. I also find it insulting to my character to basically not be trusted to know what it means to be sensitive to my future patients. You don't need an exercise like this to teach sensitivity, just like we don't need to inundated with what it means to be a professional EVERY clinical skills session we have.

If you don't know what it means to be sensitive, you'll find out quick enough when you get slapped with your first complaint.

 

[musafirah]

I find it interesting that some posters are saying that we NEED to experience this awkward interaction so that we might be more compassionate doctors... assuming that self conscious people have no idea what if feels like to be self conscious UNTIL they are physically examined by a classmate.

Additionally, our classmates are being given a lot of credit here regarding their professionalism and such intense dedication to perfecting the PE that they're not noticing/judging/ and later commenting on what they've seen. I have keloid burn scars on my chest and shoulders that don't show if I'm wearing a shirt but may peek out from time to time. One of classmates caught a glimpse recently and said, verbatim "EWW!! what is that? what's wrong with you? is it contagious?"🙄 It was a guy and he probably got the shock of his life while trying to sneak a look at my boobs. Needless to say, for the past week or so I've had a lot people asking me about it including people I didn't even know existed...which isn't as bad as the ones who just stare at me without blinking or looking away when I catch them

I love how many of you preach that this exercise should foster some sort of sensitivity/solidarity toward our future vulnerable patients, yet berate your future colleagues for not wanting to broadcast their business to their peers...bravo, hypocrites, bravo.

I don't need to be manhandled by my classmates (some of whom have yet to rise up to the level of maturity they should be at at this stage of the game) to know what it feels like to be vulnerable. I also find it insulting to my character to basically not be trusted to know what it means to be sensitive to my future patients. You don't need an exercise like this to teach sensitivity, just like we don't need to inundated with what it means to be a professional EVERY clinical skills session we have.

If you don't know what it means to be sensitive, you'll find out quick enough when you get slapped with your first complaint.

Quoted for truths.. exactly what i was thinking. how ironic and hypocritical.i think some students are just a little too brianwashed into believing all the schadenfreude (as someone else put it) and all the other BS med school throws at us MUST be good for us..

and i'm really sorry to the OP about the faculty member not even asking permission before having the whole class see you on display to check out your heart murmur.. yikes..

 

[zenlike]

I think practicing your skills on as many different people as possible can only help you to improve. I think helping your classmates improve makes you a better student.

 

[girlofgrace7]

I think practicing your skills on as many different people as possible can only help you to improve. I think helping your classmates improve makes you a better student.

While this is true, I don't think this is the issue at hand. It's not a question of whether or not to practice on classmates; it is an issue of whether you should be required to practice on one another, possibly in front of a large group of your classmates while underclothed. Even though our school does not require us to practice on one another, a lot of the students will practice on their friends after hours either in the student lounge (I watched a bunch of the M2s giving one another neuro exams the other day before their standardized patient encounters) or in the privacy of a simulation exam room. That's very, very different than being made to participate, not choosing your partner, and not wanting to be on display for everyone.

 

[The Poet Sings]

I find it interesting that some posters are saying that we NEED to experience this awkward interaction so that we might be more compassionate doctors... assuming that self conscious people have no idea what if feels like to be self conscious UNTIL they are physically examined by a classmate.

Additionally, our classmates are being given a lot of credit here regarding their professionalism and such intense dedication to perfecting the PE that they're not noticing/judging/ and later commenting on what they've seen. I have keloid burn scars on my chest and shoulders that don't show if I'm wearing a shirt but may peek out from time to time. One of classmates caught a glimpse recently and said, verbatim "EWW!! what is that? what's wrong with you? is it contagious?"🙄 It was a guy and he probably got the shock of his life while trying to sneak a look at my boobs. Needless to say, for the past week or so I've had a lot people asking me about it including people I didn't even know existed...which isn't as bad as the ones who just stare at me without blinking or looking away when I catch them

i would think that by this stage, he would have the sense to ask politely if he wanted to know what your scars were. goodness. whenever i'm about to ask someone something about their health, i preface it with "i hope you don't mind me asking" or "if you don't mind sharing" or something along those lines so they are in control of the situation and don't feel compelled or guilted into telling me about their issue. "eww" and "what's wrong with you" are never appropriate. ever. you should've kicked him in the balls and then when he was hunched over in pain, asked him what was wrong with him hahaha.

 

[greatnt249]

I think practicing your skills on as many different people as possible can only help you to improve. I think helping your classmates improve makes you a better student.

Yeah, well I "think" that forcing medical students to practice physical exams on one another just means the medical school is too cheap to hire standardized patients. There...another opinion that misses the heart of the issue.

 

[zenlike]

Yeah, well I "think" that forcing medical students to practice physical exams on one another just means the medical school is too cheap to hire standardized patients. There...another opinion that misses the heart of the issue.

What am I saying is: in the pre-clinical years, when you're faced with a problem like this, you have to ask "what is the best thing for my (and my classmates) education?" To me, it seems obvious that modesty takes a back seat to the educational opportunity you would be missing out on.

Additionally, schools do have valid fiscal concerns when it comes to the use of standardized patients.

 

[mac_kin]

🙂

 

[mac_kin]

🙂

 

[da8s0859q]

Agreed!

I honestly am bewildered and shocked that someone would consider becoming a medical doctor and refuse to have a classmate palpate for the femoral pulse or draw blood.

I'm sorry you are in the wrong profession. You obviously have no idea about the dehumanization and loss of decency that patients experience when in hospital. And you are afraid to have a classmate palpate around your hip joint??

IMO, people with palpation problems have them because they are having sexuality problems - noone admits it; but the discomfort comes from the fear of sexual arousal or fear of someone who is not your boyfriend/girlfriend touching you. This is shocking. It's not like your classmate is trying to feel you up or stick his penis inside your vagina. If that is your fear, then it is completely YOUR problem that you need to get over. I would hope that people are professional enough to perform these practice exams respectfully, with proper draping etc.

But again: the issue these people all have is body image and sexuality. There's nothing else to it. I'm sorry, if your sexuality problems are so strong that you can't allow a future doctor to touch you, then you don't belong in medicine.

So basically, what you're saying is that it's okay for you to judge who does and does not belong in medicine based on whether they want a classmate to palpate for a femoral pulse.

How do you feel about vaginal exams on classmates? Breast exams? DREs on the guys?

 

[mac_kin]

É)

 

[mac_kin]

🙂

 

[greatnt249]

I'm sorry you are in the wrong profession. You obviously have no idea about the dehumanization and loss of decency that patients experience when in hospital. And you are afraid to have a classmate palpate around your hip joint??

You must have missed my comment about how incredibly arrogant it is to assume that we have no clue what it feels like to be vulnerable. We've all been to the hospital, and the grand majority of us have turned our heads and coughed/had our feet in stirrups. If you seriously think that the goal of manhandling your classmates (SOME OF WHOM AREN'T MATURE ENOUGH TO HANDLE EVEN THAT) is to foster solidarity with your patients, then it is by far one of the more convoluted excuses I've heard for why we must do these things to each other. If I'm paying the equivalent of a mortgage for my medical education, then they should be able to hire standardized patients.

 

[Gabby]

What am I saying is: in the pre-clinical years, when you're faced with a problem like this, you have to ask "what is the best thing for my (and my classmates) education?" To me, it seems obvious that modesty takes a back seat to the educational opportunity you would be missing out on.

I'm sorry, but I see NO benefit in me having to be examined by classmates -- either for my education or for theirs. If they want volunteers, fine. If they not enough people volunteer, then it's the school's responsibility to hire standardized patients. We pay them $30,000 a year in tuition. That isn't so that WE can be the patients to practice on.

 

[Gabby]

Is it purely a "comfort" issue or is it religious sexuality issue (i.e. I'm a catholic virgin waiting until marriage and up until now no man has seen my breats, so it feels weird; I'm muslim and will not allow a female to palpate around the hips or groin area). Both came up in our physical therapy program.

You as a human being are entitled to a comfortable learning environment. However, you picked a "health profession" and are among a group of hopefully professional adults. You will be required to treat and provide life saving care for people in all situations - e.g. removing clothes from an opposite sex patient in an emergency situation; inserting a urinary catheter; performing a prostate or pelvic exam.

Yes, you can later choose to work in an area where you will hardly ever perform these acts. However, IMO, as a medical professional you need to be comfortable providing these acts, and part of this comfort means you yourself need to feel comfortable in receiving and understanding the importance of these acts.

It drove me crazy when the muslim guys in our class refused to allow females to practice on them. Sorry but it's not like we are interested. And you picked a profession where you need to treat all people with respect regardless of religion, sex, sexual orientation etc. If you can't handle that - you are in the wrong field IMO.


My advice: realize for yourself why you are uncomfortable, then get over it.

My advice: read the thread before you put in your two cents. No one on this thread said they were uncomfortable treating their classmates. They said they were uncomfortable undressing and allowing classmates to treat them.

 

[Gabby]

Agreed!

I honestly am bewildered and shocked that someone would consider becoming a medical doctor and refuse to have a classmate palpate for the femoral pulse or draw blood.

Yeah, because part of being a doctor is allowing classmates to palpate a femoral pulse on you. By the way, I don't think anyone here complained about anyone drawing blood.

IMO, people with palpation problems have them because they are having sexuality problems - noone admits it; but the discomfort comes from the fear of sexual arousal or fear of someone who is not your boyfriend/girlfriend touching you. This is shocking. It's not like your classmate is trying to feel you up or stick his penis inside your vagina. If that is your fear, then it is completely YOUR problem that you need to get over. I would hope that people are professional enough to perform these practice exams respectfully, with proper draping etc.

But again: the issue these people all have is body image and sexuality. There's nothing else to it. I'm sorry, if your sexuality problems are so strong that you can't allow a future doctor to touch you, then you don't belong in medicine.

Armchair psychology is the best! Given that everyone denies it, but you know it to be true, I'd say you've been there before yourself, skippy.

 

[Gabby]

You must have missed my comment about how incredibly arrogant it is to assume that we have no clue what it feels like to be vulnerable. We've all been to the hospital, and the grand majority of us have turned our heads and coughed/had our feet in stirrups. If you seriously think that the goal of manhandling your classmates (SOME OF WHOM AREN'T MATURE ENOUGH TO HANDLE EVEN THAT) is to foster solidarity with your patients, then it is by far one of the more convoluted excuses I've heard for why we must do these things to each other. If I'm paying the equivalent of a mortgage for my medical education, then they should be able to hire standardized patients.

He didn't miss your point. He's just compassionately challenged and I'm "SHOCKED and BEWILDERED" that someone like that is going to be a doctor.

 

[mac_kin]

🙂

 

[EmersonAnne]

This has nothing to do with "man-handling". Maybe I'm not at all emberrassed or afraid because I have been on sport team after sport team, had various medical and physical therapy tests on my knees, shoulders, back. I've been lifeguarding since 12 and practicing getting people out of water and landmarking CPR etc. SO maybe personally that's why I could care less that someone wants to palpate my greater trochanter.

I can understand that some people have never been touched by a stranger ...and that's where my problem lies. Someone in their mid to late 20s who has never been touched (non-sexually or sexually) has some unique developmental issues in my opinion. And I really feel that someone who is sexually afraid/emberrassed/uncomfortable has no place in medicine..where you will treat people of all ages, genders, backgrounds.

So really at this point - in medical school - it is time to grow up, suck it up, do the lab and shut up about it. It's one lab for christ's sake, noone here is taking your virginity.

Sorry buddy, but you're so off-base here that I think you'll never find your way back home. First off, it has NOTHING to do with not being touched in the past, either sexually or not sexually. The simple truth of the matter is that these are your classmates, your equals, your colleagues. Perhaps I don't want my colleagues to be feeling for my femoral pulse. That's my right as a human being. I'd be much more comfortable with someone I don't know doing it, but having my classmates do it? No.

Now perhaps you're into letting your friends feel you up in class, but some of us aren't and as a future physician, maybe you should be a little less judgmental and a little more compassionate. Put another way, quit being such a jackass just because your comfort level outstretches everyone else's.

 

[auburnO5]

Sorry buddy, but you're so off-base here that I think you'll never find your way back home. First off, it has NOTHING to do with not being touched in the past, either sexually or not sexually. The simple truth of the matter is that these are your classmates, your equals, your colleagues. Perhaps I don't want my colleagues to be feeling for my femoral pulse. That's my right as a human being. I'd be much more comfortable with someone I don't know doing it, but having my classmates do it? No.

Now perhaps you're into letting your friends feel you up in class, but some of us aren't and as a future physician, maybe you should be a little less judgmental and a little more compassionate. Put another way, quit being such a jackass just because your comfort level outstretches everyone else's.

👍 Preach

That dude is just a straight up douche.

 

[jcmcems]

When I went to Ranger School in the Army. We had to use a latrine that was one large room (probably about 20' x 40') with 4 rows of toilets. No partitions. I found that it wasn't so much the crapping in front of others that was uncomfortable, but it was the process of wiping. It wasn't like we all went at different times either. It always worked out that there was a crowd in there because we were all released from other training events at the same time.

This has nothing to do with the OP. It is only for your mental pleasure.

As long as one of my classmates doesn't have to milk my prostate, I'll be fine.

Prostate milking? Oh yeah? I normally pay extra for that, but you guys are saying there is a slender chance I may get that for free?? Wowzers, medical school sounds great!

 

[ruraldocmom]

Whew! Lots of really touchy nerves here. I'm just going to tell my story that is related to this and why I think that practicing on eacth other is an *awesome* thing.

I volunteered at a free clinc for two years--as a volunteer medic we had an intense 6-month, 6 hours every Saturday/Sunday, plus 5-12 Friday shift. The main things we dealt with were respiratory infections, TB tests, and STD screens.

I come from a super-religious upbringing. I could barely talk about sex with my husband when I was interviewing for the position at this clinic. I was so naive, I asked my husband a few months after we got married, if he could tie his p---- in a knot. Yeah, seriously.

So, I knew I needed to get over my fear, because thats what it is--MY fear, and MY uncomfortableness. How can I expect a patient to feel comfortable discussing sex in front of me if I'm making them uncomfortable by my discomfort talking about it. In the process of working at the clinic, hearing the stories, talking about sex in a comfotable, matter of fact way, you just learn... its just sex. Its not about me and how I feel about it--its about how the patient I'm trying to help feels about it--my job is to make them comfortable.

To me, its the same thing with practicing exams in front of your peers. Its just a body. Its your body, and its great and awesome and all, but everyone has got one. I've got to learn to be comfortable in my own body, and to learn how awkward the first couple times are, so I can learn how to make it more comfortable for my patients--how its better to try to warm my hands up, to be confident, not tenative and unsure when palpating. You don't think about those things until it happens to you.

Anyway--when we were giving each other practice butt-shots and physical exams, was I nervous as hell? Yes. Was I worried about seeing my first non-husband p----? Yes. But you know what? Better practice out that nervousness on someone you know than on someone that is counting on your professionalism.

Do I remember anybody's body that I saw? Even though I volunteered with them for 2 straight years? Um, no. Because by your third or fourth one, they all look the same.

And, honestly, while its been great for my own personal growth and comfort with the subject, the person who really benefits is the patient. I'm not too good, to uncomfortable to put myself in their shoes for a few minutes to learn something. Maybe thats why many med schools require it--as a method of humanizing & helping you consider from a patient's perspective.

I, for one, love it. I wouldn't tell the OP to get over it... but I would say, just think about what you can learn from it (even if you weren't as puritanical-crazy as I was) and how it will benefit the patient. You can read and study about how patients feel all you want, but you don't really know until you acutally put yourself in those shoes. My two cents. 🙂

 

[ButImLETired]

To those who think it's silly to worry about this kind of stuff:

I think what makes it weird is that we KNOW what we don't know. We're not used to looking at a person totally objectively yet, and as someone pointed out, these aren't 70 year old obese patients, these are young healthy people. We see them every day socially and have probably had an inappropriate thought or two about them at some point- it's just totally natural cause they're on our level. Patients aren't "on our level" in that way- we're the experts, they're the patients. I feel like if I were to take my shirt off in front of a classmate, I'd know he's trying like hell to be objective, but I also know how hard I find it to be objective. Does that make sense? When I'm with my doctor, I expect him to see me as his patient because it's the first time we've ever met and I'm just a collection of body parts. When I'm with a classmate, I'm a friend first and a fake patient second. If I can't look at a good-looking classmate shirtless and not think "huh, nice abs" chances are he can't see me shirtless and be totally proper either.

 

[Gabby]

Frankly, I think anyone who's narcassistic enough to believe that anyone who doesn't agree with them has issues and/or is abnormal in some way, is revealing an awful lot about him/herself. And none of it is anything good.

 

[skatertudoroga]

People call me anti-social but I am very enthusiastic about doing physical exams on any girls that I find attractive. If someone does exam on me I might only appear squemish if I haven't worked out in a while or if I just pretend to be squemish so they wouldnt think I am getting turned on. And so u don't think I am a pervert, I don't mind doing an exam on a girlt hat I do not find attractive. But it is still better than doing an exam on someone who is actually sick and nasty. I think for me the order would go something like this:
Hot Girl>normal guy>Hot Girl with some sickness that does not affect the general experience>ugly girl>>>>very sick and nasty person.

So I suggest when you are dealing with patients you'll wish you were dealing with fellow students.

 

[Gabby]

People call me anti-social but I am very enthusiastic about doing physical exams on any girls that I find attractive. If someone does exam on me I might only appear squemish if I haven't worked out in a while or if I just pretend to be squemish so they wouldnt think I am getting turned on. And so u don't think I am a pervert, I don't mind doing an exam on a girlt hat I do not find attractive. But it is still better than doing an exam on someone who is actually sick and nasty. I think for me the order would go something like this:
Hot Girl>normal guy>Hot Girl with some sickness that does not affect the general experience>ugly girl>>>>very sick and nasty person.

So I suggest when you are dealing with patients you'll wish you were dealing with fellow students.

Thanks for adding credence to the position of posters uncomfortable with having classmates perform physical exams on them.

 

[auburnO5]

People call me anti-social but I am very enthusiastic about doing physical exams on any girls that I find attractive. If someone does exam on me I might only appear squemish if I haven't worked out in a while or if I just pretend to be squemish so they wouldnt think I am getting turned on. And so u don't think I am a pervert, I don't mind doing an exam on a girlt hat I do not find attractive. But it is still better than doing an exam on someone who is actually sick and nasty. I think for me the order would go something like this:
Hot Girl>normal guy>Hot Girl with some sickness that does not affect the general experience>ugly girl>>>>very sick and nasty person.

So I suggest when you are dealing with patients you'll wish you were dealing with fellow students.

 

[skatertudoroga]

I come from a super-religious upbringing. I could barely talk about sex with my husband when I was interviewing for the position at this clinic. I was so naive, I asked my husband a few months after we got married, if he could tie his p---- in a knot. Yeah, seriously.

I can tell you that to tie something pliable into a knot you need 3 layers. To bend something in half the length must be pi times greater than the cross-section. To bend in 4 it must be pi squared. So to tie a knot the length should be about 6-7times greater than the cross-section. You can try it with a computer cable. You will find out that indeed your husband would have to have what is commonly known as a pencil dick to make it happen.
In this chart: http://bp1.blogger.com/_G3gOTRwttos...3RJ0/s1600-h/penis_size_preference_chart2.jpg
On the y-axis you should divide the value by pi to get the cross-section. So to get the correct ratio you would indeed end up in the lower right quadrant. It might not even work because the values in that chart are for erect penis. When flaccid and pliable it is always shorter and fatter.

For further info:
http://en.wikipedia.org/wiki/Britney_Gallivan

 

[da8s0859q]

I can tell you that to tie something pliable into a knot you need 3 layers. To bend something in half the length must be pi times greater than the cross-section. To bend in 4 it must be pi squared. So to tie a knot the length should be about 6-7times greater than the cross-section. You can try it with a computer cable. You will find out that indeed your husband would have to have what is commonly known as a pencil dick to make it happen.

So glad you're here to explain cock-tying for us laymen while wanting to feel up your classmates.

 

[ruraldocmom]

Hmm... thanks for the analysis. Let me just say that I didn't get in based on the strengths of my physics grades.

 

[d1ony5u5]

Just to add a thought to this threat:

I think another aspect that is being neglected, and that seems to me to be important, is one of the essential truths of medical education: as medical students, we learn from people.

The principal reason why med schools used or still use this type of activity might be different, but I think you could justify the practice from this perspective.

All the medical knowledge we have amassed, and that which we're still gathering comes from studying people, from doing things to some of them that they find uncomfortable... I think it is very humbling, and necessary too, to understand the not so glamorous realities of how medicine has become what it is now, and how it keeps advancing. By becoming a learning instrument for your classmates you get this opportunity that would otherwise be very hard to obtain. And obviously, you also help them learn PE skills... One thing that is defensible about a medical student becoming a "guinea pig" for another, is that it makes us a lot more aware of the unavoidable and unpleasant realities of how medicine is learned. And this is something that concerns ALL medical students.

My argument is, in short, a rehash of what Atul Gawande wrote in "Complications." It is naive to expect perfection without practice. And in many senses, what better place to start practicing than on ourselves (I.E. in people who are almost identical to ourselves by virtue of having exactly the same level of knowledge, experience, skill, etc?). That skill will only come from practice, and that practice has to be done on another person. At least at one point in our training we should experience being the person on whom other students will practice. Sure it will be awkward, but what we learn and what they learn from it is well worth the price in my opinion.

I don't really buy that this can be simply understood without experiencing it first hand, as some have expressed regarding a related point earlier in the thread. I think it is somewhat similar to why you have labs in science classes. You have to experience it personally to really learn it, and to understand its ramifications. Just having a theoretical understanding is insufficient.

If some students think that their hang ups about being touched or being seen by their fellow students (excluding the genital, rectal and breast parts) take precedence over this, and the other more obvious benefits of practicing PE skills on each other, I think there are some serious issues. I totally understand feeling uncomfortable and awkward in these situations, but the gain is so much bigger in comparison!

 

[EagerToBeMD]

I don't really buy that this can be simply understood without experiencing it first hand, as some have expressed regarding a related point earlier in the thread. I think it is somewhat similar to why you have labs in science classes. You have to experience it personally to really learn it, and to understand its ramifications. Just having a theoretical understanding is insufficient.

And yet, not one person has explained what the person being used as the patient is learning. Why? Because they're not learning anything. So you guys can muddy the waters with the above all you want, but it's a bunch of BS and nothing more. People don't sign up for med school to be patients. They sign up to be trained to treat. You don't have to be the guinea pig to learn that.

If some students think that their hang ups about being touched or being seen by their fellow students (excluding the genital, rectal and breast parts) take precedence over this, and the other more obvious benefits of practicing PE skills on each other, I think there are some serious issues.

I think the students who can't understand why some students might refuse to do this (and have every right to), have issues. We're in the practice of respecting patients' privacy, especially when it comes to health. If I've had an abortion and I don't want my classmates to see my scar during an abdominal exam, it's my right as a human being. That trumps Johnny Joe's "right" to do the abdominal exam. And if you can't grasp that concept, perhaps you need to go back to Medical Ethics 101 and learn more about boundaries, even in medical school.

 

[silverhorse84]

Even though I doubt it'll make anyone think differently, I'm going to add my $0.02. I go to a school that's very good at making sure everyone feels okay about the physical exam being performed on them (making sure girls can work with other girls and boys with boys if that makes them comfortable) - I never really thought about it until we got to the heart part of the exam.

I was already partnered with a male, and I am a female who is very well endowed in the chest area. I had never felt uncomfortable with physicians listening to my heart or anything, but having a classmate do it, while I was sitting in a bra was extremely uncomfortable, especially when we got to the part of feeling for the PMI. Its obviously difficult to feel on me and I had to ask him to stop because I was getting more and more uncomfortable. He had no problem with that, and he found someone else to find it on so he had the experience and we moved on. It wasn't a big deal in the end, but it does make me aware of what others go through.

I don't need a fellow student performing an exam on me to know what it feels like - I've known what a physical exam is since I was a child. We've all been to doctors, so we've all been through a physical exam as a patient. I know there are things that we do in school that may have never been done (like the PMI), but I still don't believe it has to be done on me by a colleague just so I know "what it feels like." We all have imaginations, so we can all figure it out for ourselves. I feel very lucky that I had a very respectful partner - and I was respectful of him when it came to things like feeling for the femoral artery. I already knew him from our semester of interviewing (we stayed in the same groups), but if I had been in a new group I probably would have just asked to be with another female.

If a male (or a female with smaller breasts) ever wants to try to tell me that I shouldn't feel uncomfortable, and it's a "good experience for me to go through," my response is going to be: "You've never been in my shoes and you never will, therefore who the f are you to tell me how I feel?"

Again, just my experience and my $0.02 so take it with a grain of salt.

 

[da8s0859q]

I don't need a fellow student performing an exam on me to know what it feels like - I've known what a physical exam is since I was a child. ... If a male (or a female with smaller breasts) ever wants to try to tell me that I shouldn't feel uncomfortable, and it's a "good experience for me to go through," my response is going to be: "You've never been in my shoes and you never will, therefore who the f are you to tell me how I feel?"

Thank you. This whole thing about "you're going to be a DOCTOR, you should know how it FEELS" is ridiculous. Doctor-patient is not the same thing as medical student-medical student.

 

[d1ony5u5]

Let me clarify a couple of things:

1st, I completely understand and agree that it can feel uncomfortable and awkward. I feel this uneasiness myself. 2nd, I don't deny the fact that you can opt out of the exercise, if you want. After all, it is med school, not a nazi death camp.

Now, when weighing the pros and cons of opting out vs. participating, I think you deny yourself an important learning opportunity, and do the same for your fellow students. So what I'm saying is: uncomfortableness<<<learning from the experience.

I'll be a little more clear about what I think the person being practiced on gains from the situation, as what the person practicing the PE gains is more obvious. From the perspective that I'm arguing, it is not that you learn how patients feel when a PE is performed on them. What I argue is that you learn what it feels to be practiced on by someone with very limited training (about the same as your own). I didn't want to go into more detail about this because I'm just basically repeating points from Gawande's book, but I'll rephrase a few. If the point were exclusively to learn how to perform PEs, it would certainly be less awkward to get an SP or volunteers who have no qualms about being touched/seen by peers. But by not becoming yourself the object on which others at your same stage of training practice, you would be missing several things: an appreciation of what it is to become the lab rat on which medical students, residents, etc learn; an accurate reflection of what you are doing to others during the PE feels like, from which you can modify and improve your technique... There certainly are others, but I will just focus on these.

As Gawande eloquently put it, our medical education system is based on a paradox. On an individual basis, those who need care would benefit a lot more by obtaining it exclusively from providers who are very experienced. But as a whole, society suffers because no new doctors are receiving needed training. It is crucial for us, as medical students, to understand this fact, as our whole medical education (~7 years worth, if not more) is based on this fragile condition. There is a tension between these two competing interests, and YOUR education and my education depends entirely on people agreeing to be "guinea pigs" on which we will practice. This by itself seems to me to justify the necessity of letting fellow students practice on you at least once in your training... but then there are more practical benefits as well.

When a fellow student who has almost identical examination skills practices on you, I think you can definitely judge better what they are doing well, and notice what they don't do so well. You can then transpose that to your own technique and appropriate what works and modify things that&#8211;because you experienced it 1st hand from someone you should relate very well level-of-training wise&#8211; you know don't feel too good/aren't very effective...

I think Silverhorse84 mentioned something important in her post: when she felt increasingly uncomfortable at one point in the PE, she voiced it and the person performing the PE acknowledged it and took action. In her description she implies that this made her more aware and more considerate when it was her turn and a similarly uncomfortable point of the PE came up. I think this argues for the value of being practiced on. Not to say that she wouldn't have been sensitive otherwise, but going through the experience certainly reinforced that, according to her narrative. Another minor point is that this is not an all-or-nothing. By participating you don't automatically relinquish your prerogative for stopping when you get overwhelmingly uneasy. You can do just as she did, and continue on to parts that you feel more comfortable with.

So, yes, individual students can decline to participate because they feel awkward about having someone they have social ties with touch them semi-intimately and see them half-undressed. Does that outweigh the potential benefit both students would gain? No. In medicine we only learn from others. This implies the need for those others to allow us to learn from them, usually in ways that they find very uncomfortable. It seems exceedingly exploitative/inconsiderate/selfish to only want to learn, but not allow others in your same position (your fellow students) the same opportunity. To me this is counter to the very foundations of medicine...

I think Gawande does do a better job of explaining this, although in a different context. I would recommend reading at least that 1st essay in his book. It is titled "Education of a knife."

 

[EagerToBeMD]

Let me clarify a couple of things:

1st, I completely understand and agree that it can feel uncomfortable and awkward. I feel this uneasiness myself. 2nd, I don't deny the fact that you can opt out of the exercise, if you want. After all, it is med school, not a nazi death camp.

Now, when weighing the pros and cons of opting out vs. participating, I think you deny yourself an important learning opportunity, and do the same for your fellow students. So what I'm saying is: uncomfortableness<<<learning from the experience.

I'll be a little more clear about what I think the person being practiced on gains from the situation, as what the person practicing the PE gains is more obvious. From the perspective that I'm arguing, it is not that you learn how patients feel when a PE is performed on them. What I argue is that you learn what it feels to be practiced on by someone with very limited training (about the same as your own). I didn't want to go into more detail about this because I'm just basically repeating points from Gawande's book, but I'll rephrase a few. If the point were exclusively to learn how to perform PEs, it would certainly be less awkward to get an SP or volunteers who have no qualms about being touched/seen by peers. But by not becoming yourself the object on which others at your same stage of training practice, you would be missing several things: an appreciation of what it is to become the lab rat on which medical students, residents, etc learn; an accurate reflection of what you are doing to others during the PE feels like, from which you can modify and improve your technique... There certainly are others, but I will just focus on these.

As Gawande eloquently put it, our medical education system is based on a paradox. On an individual basis, those who need care would benefit a lot more by obtaining it exclusively from providers who are very experienced. But as a whole, society suffers because no new doctors are receiving needed training. It is crucial for us, as medical students, to understand this fact, as our whole medical education (~7 years worth, if not more) is based on this fragile condition. There is a tension between these two competing interests, and YOUR education and my education depends entirely on people agreeing to be "guinea pigs" on which we will practice. This by itself seems to me to justify the necessity of letting fellow students practice on you at least once in your training... but then there are more practical benefits as well.

When a fellow student who has almost identical examination skills practices on you, I think you can definitely judge better what they are doing well, and notice what they don't do so well. You can then transpose that to your own technique and appropriate what works and modify things that–because you experienced it 1st hand from someone you should relate very well level-of-training wise– you know don't feel too good/aren't very effective...

I think Silverhorse84 mentioned something important in her post: when she felt increasingly uncomfortable at one point in the PE, she voiced it and the person performing the PE acknowledged it and took action. In her description she implies that this made her more aware and more considerate when it was her turn and a similarly uncomfortable point of the PE came up. I think this argues for the value of being practiced on. Not to say that she wouldn't have been sensitive otherwise, but going through the experience certainly reinforced that, according to her narrative. Another minor point is that this is not an all-or-nothing. By participating you don't automatically relinquish your prerogative for stopping when you get overwhelmingly uneasy. You can do just as she did, and continue on to parts that you feel more comfortable with.

So, yes, individual students can decline to participate because they feel awkward about having someone they have social ties with touch them semi-intimately and see them half-undressed. Does that outweigh the potential benefit both students would gain? No. In medicine we only learn from others. This implies the need for those others to allow us to learn from them, usually in ways that they find very uncomfortable. It seems exceedingly exploitative/inconsiderate/selfish to only want to learn, but not allow others in your same position (your fellow students) the same opportunity. To me this is counter to the very foundations of medicine...

I think Gawande does do a better job of explaining this, although in a different context. I would recommend reading at least that 1st essay in his book. It is titled "Education of a knife."

I think this entire post is a bunch of crap. As a first or second year medical student with next to nothing in the way of real medicine, you don't know jack about how your classmates are doing. You're not a patient, so you don't know jack about how patients feel. The whole exercise is done for one reason and one reason only -- to save the school money on standardized patients. All this BS is just that -- BS to excuse it.

 

[d1ony5u5]

I think this entire post is a bunch of crap. As a first or second year medical student with next to nothing in the way of real medicine, you don't know jack about how your classmates are doing. You're not a patient, so you don't know jack about how patients feel. The whole exercise is done for one reason and one reason only -- to save the school money on standardized patients. All this BS is just that -- BS to excuse it.

Eagertobemd,

The fact that you are blind doesn't mean nothing exists beyond your eyes.

You don't get it, and I've gone through about as much as I am willing to make you understand. Don't project your ignorance on the rest of us and dismiss explanations just because they are clearly beyond your capacities.

I am a 1st year, and with my limited experience, I do get it. You don't with however much or however little experience you have. Too bad for you.

 

[da8s0859q]

Eagertobemd,

The fact that you are blind doesn't mean nothing exists beyond your eyes.

You don't get it, and I've gone through about as much as I am willing to make you understand. Don't project your ignorance on the rest of us and dismiss explanations just because they are clearly beyond your capacities.

I am a 1st year, and with my limited experience, I do get it. You don't with however much or however little experience you have. Too bad for you.

This little post of yours is pretty much the definition of "insufferable." Your opinion is precisely that -- your opinion. You are in no position to tell other people that they "don't get it" because they disagree with your highly idealized two cents on what it means to learn medicine from others.

This is not a "get it" kind of thing. Integrals in calculus are "get it" things. Cardiac physiology is a "get it" thing. The mechanism of vancomycin is a "get it" thing. Your Gawande-ian post is well thought out and well spoken, but now you're just being ridiculous.

 

[EagerToBeMD]

This little post of yours is pretty much the definition of "insufferable." Your opinion is precisely that -- your opinion. You are in no position to tell other people that they "don't get it" because they disagree with your highly idealized two cents on what it means to learn medicine from others.

This is not a "get it" kind of thing. Integrals in calculus are "get it" things. Cardiac physiology is a "get it" thing. The mechanism of vancomycin is a "get it" thing. Your Gawande-ian post is well thought out and well spoken, but now you're just being ridiculous.

Precisely. This "I'm right, you're wrong and if you disagree, there must be something wrong with you" attitude prevalent on this thread is exactly what's wrong with medical students. Anyone not open to differing opinions and compassionate to the comfort zone of others has no business preaching about what will or won't make anyone else a good doctor. They're the ones with a lot to learn.

And by the way, d1ony5u5, the fact that you're a first-year doesn't surprise me. You have that superior "I know all" attitude that dominates the pre-allo forum. Not to say all first years or pre-meds are like that, but you're one of the ones who perpetuates that stereotype.

 

[45408]

I think this entire post is a bunch of crap. As a first or second year medical student with next to nothing in the way of real medicine, you don't know jack about how your classmates are doing. You're not a patient, so you don't know jack about how patients feel. The whole exercise is done for one reason and one reason only -- to save the school money on standardized patients. All this BS is just that -- BS to excuse it.

If you're willing to pay more tuition, have at it. It's nice to see that they're still saving money once in a while.

 

[VenusinFurs]

Honestly, I think this whole argument is pretty stupid. I can't imagine a school requiring you to practice physical exam on a same-sex partner if you told them you had an objection to it. If you have an issue with being unclothed in a large group of people, I imagine they'd let you sit it out. Different people have different levels of body modesty and this has to be respected even in a clinical setting, so why would a school exercise be any different.

 

[Narmerguy]

If you're willing to pay more tuition, have at it. It's nice to see that they're still saving money once in a while.

Taking shortcuts while masquerading them as "experience" is not the answer. If the cost of a proper medical school education should include the cost of including standardized patients for a PE then that cost should be accounted for.

It's hilarious that some here are suggesting that the only way a future doctor can know what it's like to be examined by a doctor is to be examined by...a student.

Part of why the doctor-patient relationship works so well is that the patient need only put away their pride and insecurities while in the doctor's office. The physical exam doesn't come home with them, their doctor doesn't see them for lunch the next day, and quite frankly they'll never think about it seriously again until their in the doctor's office again. With medical students this is very clearly not the case. After you're done with an exam, if performed by another student, you can't just walk away and not have to think or deal with it again. You see that student over and over and over again. This in NO way resembles the doctor patient relationship and I happily call BS on anyone trying to pass this off as such.

You want students to know what patients feel like being examined by a doctor, why not actually replicate the experience instead of this "ok, you pretend I'm your doctor and you've never seen me before and we're not about to go to class after this" that they want students to believe.

 

[d1ony5u5]

Hmm.

I guess my opinion is not well received by most of the latest posters. I can live with that...

One thing that I would like to make clear is that I'm not imposing my opinion on anyone. I'm simply stating it and not apologizing for it. If you want to refute it, mention what part you disagree with, and why, not an easy "your post sucks man, bc it, like, sucks!"

Might I be wrong? Sure, I really don't claim to be the owner of the truth. Am I an idealist? Perhaps. But if the most eloquent rebuttal you can muster is a "your whole post is crap" and then make a foggy claim for your superiority because you try to give the impression you are some years ahead, I really don't take you seriously.

Come at me with arguments, not with this "this is a matter of opinion..."

Or else realize that you are just arguing from sentiment and STFU.