performing pelvic/pap as a student

[larryj]

How do medical students (esp. male students) get experience with performing pelvic exams and pap smears?

At teaching institutions, is it just expected that students will be performing exams? How about at county hospitals / free care clinics?

My experience, unfortunately, has been with private practice physicians. I have been categorically excluded from performing and even observing pelvic and paps. In private practice I believe physicians feel that their patients would be offended if even asked to have a student perform their sensitive exams.

If a patient is posed the question "Would you like a student to do your pelvic today?", how many really say yes?

How many pelvics and paps does it take to get proficiency/ be comfortable with what feels normal/abnormal? How many have most of you performed by graduation?

As a future primary care (likely FP or IM) physician, I feel that I will definitely need to be able to do these exams. Is it expected that a new PGY1 would be able to do these on July 1 of their first year, without assistance/training?

thanks for any replies.

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[triathlete411]

At my medical school we had a class with volunteers that allowed us to perform the pelvic exam. Then, during my third year OB rotation, I performed a countless number of pelvic exams. If your school doesn't have these kinds of programs, you could consider volunteering at a local planned parenthood, or something similar. I would definitely know how to do a pap before July 1 of your intern year.

 

[Acro Yali]

I get to do a lot of pelvic and Pap during my ob/Gyn rotation as well. So much that during my 3rd day, the "newness" of the exam started to wear off. I even got to do a few during my other primary care rotations.

Its not a very complex manuver and wouldn't take you more than 10-20 to get proficient at it. If you have trouble getting that experience, try volunteering at a community clinic/health department or some equivalent, the physicians and patients populations there are more open to having a student do the examination. And another tip is to go over with the resident/attending about the procedure before you actually do it so the patient won't lie there getting more anxious when she hears you saying "what am I supposed to do with this spectulum?"

 

[hotbovie]

At my school, the very first day of the OB rotation includes an instructional session with nurses pair up and rotate being the teacher and patient. During the rotation, any patient that a student sees in clinic, the student performs the exam with the resident standing by. We were approprately instructed never to perform a breast or pelvic exam without a resident or attending present during the exam. This decree applied to both male and female patients.

The acutal pelvic exam for pap smear isn't very hard, and it doesn't take many to get the hang of it. It's a lot harder to determine the cm of dilation on a laboring patient. However, you really only would need to know how to do that if you do OB or ER, and in those areas you'll get plenty of practice early in internship.

 

[Zhavago]

While most private docs won't let you do pelvics, I was lucky to have 1/2 day with a private doc who is staff at our teaching university. He let me do a pelvic and pap on a patient who was a retired physician. One of the BEST things he did with me and told me to practice myself was playing with the metal speculum ahead of time, ie be able to handle, set, loosen the speculum comfortably without fumbling. My university uses the plastic ones, and I'd had minimal experience with the plastic and no practice with the metal.

Back to my point,
1) you'll probably need 5 to get comfortable with talking the patient through the exam.
2) You'll probably need 10 to get through the exam proficiently yourself.
3) Family Practice is a great potential place for practicing because the forgein medical grads (males) had NEVER done pelvics. Find an upper level family resident, and they likely will let you help or try to do it yourself.
4) on the subject of family practice FMGs, our program does a lecture series for all 1st year family residents. One things they cover for the 1st years are pelvics and paps because they know they might need more practice and/or are forgein and (if male) have never done one. If your family rotation is when the lectures are going on, I bet you could jump in for extra instruction. If you have nice faculty in FP as my school does (and if you could somehow get off a morning or afternoon when the lecture happens if you are on a different rotation at the time), you might be allowed to attend.
5) Look for ob gyns or FP residents with broken/sprained/injured arms, wrists, elbows, shoulders - Hey, it happens. A resident had a casted hand and was happy to let me help and try more procedures.

Hope that gives you a few ideas. Honestly, all of the advice about the clinics is great advice. My town/health dept also has an STD clinic with an awesome nurse practicioner. Local/state health depts handle stds by default and would be a place for lots of practice, too.

 

[OSUdoc08]

How do medical students (esp. male students) get experience with performing pelvic exams and pap smears?

At teaching institutions, is it just expected that students will be performing exams? How about at county hospitals / free care clinics?

My experience, unfortunately, has been with private practice physicians. I have been categorically excluded from performing and even observing pelvic and paps. In private practice I believe physicians feel that their patients would be offended if even asked to have a student perform their sensitive exams.

If a patient is posed the question "Would you like a student to do your pelvic today?", how many really say yes?

How many pelvics and paps does it take to get proficiency/ be comfortable with what feels normal/abnormal? How many have most of you performed by graduation?

As a future primary care (likely FP or IM) physician, I feel that I will definitely need to be able to do these exams. Is it expected that a new PGY1 would be able to do these on July 1 of their first year, without assistance/training?

thanks for any replies.

We did pelvics on live patient models during our clinical skills class, and they allow me to do pelvic/paps whenever I'm doing clinicals in the ER.

 

[lattimer13]

At my medical school we had a class with volunteers that allowed us to perform the pelvic exam. Then, during my third year OB rotation, I performed a countless number of pelvic exams. If your school doesn't have these kinds of programs, you could consider volunteering at a local planned parenthood, or something similar. I would definitely know how to do a pap before July 1 of your intern year.

someone dug this thread up from the archives...2002?

anyways, i'd just like to point out that these people are NOT volunteering their time for this...they do get compensated fairly well. how do i know, you ask? i used to work as a standardized patient at a medical school prior to going to med school. got paid $20/hr to play the part of a young male w/ a sprained ankle while playing hoops. they offered me $40/hr for med students to stick their finger up my butt to practice their rectals/prostate exams...needless to say i wasn't that desparate for money at the time. the women doing the pelvic/paps got $50/hr. not a bad part-time gig i must say.

 

[excalibur]

To the OP, have you had your OB/GYN rotation yet? Most of your practice should come from there

 

[AF_PedsBoy]

Apart from the clinical session I did "0" pelvics my first three years, espcecially since Ob/Gyn at AGH the patient said, "No" every time (surprise surprise - "Would you like my clumsy male med student to do your exam?") Then fourth year I did my ER rotation at AGH and did like 6 of them. So the best place is ER rotations where A) No one really wants to do it; and, B) The patient doesn't really have too much of a choice. Not very surprising that I did like a million testicular exams, though, as usually the patient says, "I want a male doctor," and the nurses gleefully hand it off to you...

 

[(nicedream)]

To the OP, have you had your OB/GYN rotation yet? Most of your practice should come from there

I'd hope so, they should be a PGY2 now. So, Larry, if you're still around - did you ever learn how to do a pelvic?

 

[berkeleyboy]

Apart from the clinical session I did "0" pelvics my first three years, espcecially since Ob/Gyn at AGH the patient said, "No" every time (surprise surprise - "Would you like my clumsy male med student to do your exam?")

I actually had the same experience during my OB rotation. I did like 5 pelvics/paps and 1 breast exam in resident clinic total thruout the rotation. IT sucks but I always got kicked out the room before I even got a chance to introduce myself to the patient just because I am male. This is a teaching hospital with a free public resident clinic, male students are denied the chance to learn.

 

[jennyboo]

You can catch up, to a certain extent, during your OB rotation.

It goes both ways. As a girl, I have done NOT ONE testicular or hernia exam.

But, I wouldn't sweat it. If you go into a field that requires you to do them regularly, you will get good at them. You don't need to learn it all now or bust. You'll get your chance.

Or, if you don't ever get your chance, you don't need to.

 

[OSUdoc08]

You can catch up, to a certain extent, during your OB rotation.

It goes both ways. As a girl, I have done NOT ONE testicular or hernia exam.

But, I wouldn't sweat it. If you go into a field that requires you to do them regularly, you will get good at them. You don't need to learn it all now or bust. You'll get your chance.

Or, if you don't ever get your chance, you don't need to.

What year are you in school?

We were required to do testicular/hernia exams on live patient models during the first semester of our second year, along with pelvic/breast exams.

 

[jennyboo]

What year are you in school?

We were required to do testicular/hernia exams on live patient models during the first semester of our second year, along with pelvic/breast exams.

I'm a four.

Yes, of course we did them on standardized patients too.

It's the real patients that come AFTER the hired standardized patients that vary depending on whether you're male or female, whether your supervising doc is male or female, and whether the patients are insured or uninsured.

But... I still wouldn't sweat not being able to do lots of them as a student. There's plenty more later on as well.

 

[LO281OK]

My private practice shadowees insisted that I see everything (kudos to them).

HOW TO GET TO SEE/DO A PELVIC AS A PREMED:

1. Be willing and eager (not obnoxious) to take part in anything that goes on during your shadow sessions. They'll let you know where the line is, but if you don't show interest they won't offer. I did a history my first time after seeing it once (scarier than Wake-up Wednesday at Navy OCS).

2. Prebrief the procedure.

3. Have the docs phrase the question as if the affirmative answer is assumed. "This is Tim/Mr. Mann/Dr. Hooker/my med student/our red cross volunteer and he's going to assist me." (mothers are much less likely to object than those who haven't had children).

4. Don't look like you're nervous. Or you've never seen one/done this. Instead of asking (in front of the patient), "what do I do with this _____?," say, "Do I put this here, etc.?"

5. Get a debrief afterward and ask questions or get clarification. I.e. show you are interested (assuming you truly are).