Male genital examination in the medical curricula: an exploration of medical students’ experience

INTRODUCTION: One of the challenges regarding the teaching and learning of the male genital examination as part of the undergraduate medical curriculum relates to the extent of practice opportunities with patients in the clinical setting. OBJECTIVES: To quantify how many male genital examinations have been performed on real patients by medical students at the point of graduation, and to explore the context of performing the examination with patients. METHODS: A self-completed, online, anonymous questionnaire was developed and deployed as part of a two-centre study. Data were collected from final-year medical students in the period just after graduation from the medical programmes at the Universities of Auckland and Flinders in late 2013. RESULTS: The combined response rate was 42.9% (134/312). The median for the number of male genital examinations performed was 2-3. A total of 16% of medical students had never performed a male genital examination. Self-reported opportunities for performing the male genital examination were strongly related to the setting (e.g. urology and paediatrics/neonates). The largest self-reported barrier was related to patients being uncomfortable being examined by female students. CONCLUSIONS: For some students, their only experience of performing male genital examinations is on a model in simulation. Opportunities to perform the male genital examinations that students feel comfortable with are rare. The delivery of medical curricula needs to address this issue

Medical students' experience of performing female pelvic examinations: Opportunities and barriers

Background: Teaching and learning female pelvic examination within the undergraduate medical curriculum offers some potential challenges. One such is the extent to which students are provided practice opportunities with patients in the clinical setting. Aims: To quantify how many pelvic examinations, on real patients, have been performed by medical students at the point of graduation, and to explore opportunities and barriers to performing these examinations. Materials and methods: A retrospective study using a self-completed, anonymous, electronic survey was developed as part of a multi-centre study. Data were collected in the immediate period after graduation from the medical programs at the University of Auckland and Flinders University in 2013. An ordinal set of range categories was used for recording numbers of examinations. Results: The combined response rate for the survey was 42.9% (134/312). The median range category for the number of pelvic examinations performed in patients who were not in labour was 6–9 and in labour was 2–3. Thirty-three percent of medical students had never performed a pelvic examination in labour. Male medical students performed significantly fewer pelvic examinations compared with female students. Self-reported barriers to performing the pelvic exam include: gender of the student, ‘gate-keeping’ by other health professionals, lack of confidence and patient factors. Conclusions: The majority of medical students have performed several pelvic examinations on real patients at graduation. Male gender and access being limited by midwives were the main barriers to performing female pelvic examinations. Medical curricula need to address these issues in the learning environment

Audit and exploration of graduating medical students' opportunities to perform digital rectal examinations as part of their learning

[Extract] Dear Editor, There appears to be a trend indicating a decrease in the number of digital rectal examinations (DREs) performed by medical students over the last few decades.1, 2 Reasons why opportunities to practise have fallen include ethical concerns3 and deterrents such as being told not to by medical staff, embarrassment, refusal by patients and lack of a chaperon

Evaluation of the effect of hand hygiene reminder signs on the use of antimicrobial hand gel in a clinical skills center

Summary: Hand hygiene is a critical element of patient care, which needs to be learned and reinforced to become an autonomous behavior. Previous studies have explored aspects of hand hygiene behavior in the clinical workplace, but not in controlled learning environments with health professional students. Development of good hand hygiene behavior requires a multi-faceted approach, including education, reinforcement, feedback and audit. Our study aimed to identify the effect of unannounced hand hygiene reminder signs on the use of antimicrobial hand gel in a clinical skills center. Year 2 MBChB students received practical learning regarding hand hygiene in their clinical skills sessions. Baseline hand gel use was measured using before and after weighing of the bottles. An A5 sign was created to remind the students to hand cleanse and was used as an unannounced intervention. In semester 2 (2012), the student groups were randomly allocated as intervention (signs) or control (no signs). Hand gel use at all sessions was measured. Data were compared between groups and over time. In total, 237 students attended the skills sessions twice during the study. Hand gel use was not significantly different between the two study arms. Overall use was low, typically 1–2 hand gel pumps per student per session. In addition, hand gel use fell over time. A visual reminder to cleanse hands did not appear to have any effect on behavior. These findings may have implications for their value in a clinical setting. Low overall use of hand gel may be context-dependent. Students are in a simulated environment and examine ‘healthy’ peers or actors. There may have been inconsistent tutor role-modeling or problems with the educational approach to the skill. Analysis at the level of the group, and not the individual, may have also limited our study. Keywords: Hand hygiene, Human factors, Medical students, Evaluatio

Australian and New Zealand Medical Students\u27 Attitudes and Confidence Towards Providing Nutrition Care in Practice

The prevalence of lifestyle-related chronic disease is increasing. Doctors in primary care are ideally placed to support patient nutrition care, but recent reviews show education is still lacking. This study aimed to identify medical students’ attitudes towards the role of nutrition in health, nutrition knowledge, and perceptions of nutrition education, in postgraduate (Australia) and undergraduate (New Zealand) programs in order to identify gaps in nutrition knowledge and skills to better inform future education. Second-year graduate and third-year undergraduate students participated in semi-structured focus groups and interviews. A general inductive approach was used to investigate students’ 1) attitudes toward the role of nutrition in health, 2) nutrition knowledge based on nutrition-specific competencies and 3) perceived adequacy of nutrition education received. Interviews (nine) and focus groups (seven) identified four common themes: 1) role of medical practitioners in nutrition care, 2) barriers to nutrition education, 3) nutrition knowledge, and 4) nutrition-related skills. Students perceive that doctors are well-placed to provide some level of nutrition care, but poor translation of nutrition knowledge to clinical contexts is a key limitation in nutrition education. In summary, nutrition education may be insufficient to support the nutrition-related competency development of the undergraduate and postgraduate student participants in this study. Focusing on the integration of these skills into the curriculum may be a priority