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

E-learning for self-management support: Introducing blended learning for graduate students - A cohort study 13 Education 1303 Specialist Studies in Education 11 Medical and Health Sciences 1117 Public Health and Health Services

Background: E-learning allows delivery of education in many diverse settings and researchers have demonstrated it can be as effective as learning conducted in traditional face-to-face settings. However, there are particular practices and skills needed in the area of providing patient self-management support (SMS), that may not be achievable online. The aim of this study was to compare three approaches in the training of university students regarding the preparation of a Chronic Condition Self-Management Care Plan: 1) traditional face-to-face delivery of SMS training, 2) an e-learning approach and 3) a blended approach (combining e-learning and face-to-face teaching). Methods: Graduate entry physiotherapy students and medical students at Flinders University were recruited. Depending on the cohort, students were either exposed to traditional face-to-face training, e-learning or a blended model. Outcomes were compared between the three groups. We measured adherence to care plan processes in the preparation of an assessment piece using the Flinders Program Chronic Care Self Management tools. A total of 183 care plans were included (102 traditional, 52 blended, 29 e-learning,). All students submitted the Flinders Program Chronic Care Plan for university assessment and these were later assessed for quality by researchers. The submission was also assigned a consumer engagement score and a global competence score as these are integral to successful delivery of SMS and represent the patient perspective. Results: The blended group performed significantly better than the traditional group in quality use of the Flinders Program tools: Problem and Goals (P < 0.0001). They also performed significantly better in the total care plan score (P < 0.0001) and engagement score (P < 0.0001). There was no significant difference between the groups for the Partners in Health tool. Conclusions: In this pilot study, the blended learning model was a more effective method for teaching self-management skills than the traditional group, as assessed in the development of a chronic condition self-management care plan. We anticipate that future research with identical groups of students would yield similar results but in the meantime, academics can have confidence that blended learning is at least as effective as traditional learning methods

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

Distribution of male and female procedural and surgical specialists in Australia

Objective: This study examined the distribution of the sexes across Australian medical procedural specialties in 2017 and investigated the proportion of currently registered female specialists based on their graduation date from 1969 to 2008. Methods. A cross-sectional analysis of current Australian procedural and surgical specialists registered with the Australian Health Practitioner Registration Agency as of January 2017 was undertaken. Participants included 4851 surgical specialists (594 female, 4257 male) and 14 948 specialists in specialties with high levels of procedural clinical work (4418 female, 10 530 male). The number of male and female specialists across each procedural specialty and the medical school graduation date of current female specialists were analysed. Results. In 2017, female fellows represented only one in 10 surgeons and three in 10 procedural specialists. All surgical specialties are underrepresented by female specialists. Cardiology is least represented by female practitioners (one in 10), followed by intensive care and ophthalmology (two in 10). General surgery, otolaryngology and urology saw more female specialists with graduation dates between 1983 and 2003 compared with the other surgical specialties. Conclusion. The number of female practitioners registered as specialists is increasing, but they continue to be underrepresented at specialist level across many procedural and surgical specialties

The influence of students' gender on equity in Peer Physical Examination: a qualitative study

Peer Physical Examination (PPE) is an educational tool used globally for learning early clinical skills and anatomy. In quantitative research, there are differences in students’ preferences and actual participation in PPE by gender. This novel study qualitatively explores the effect that gender has on medical students’ experiences of learning physical examination through PPE. We employ an interpretative approach to uncover the PPE experiences of students from a European, graduate-entry medical school. Volunteers participated in either individual or group interviews. The data were transcribed, de-identified and analysed using thematic analysis. There was evidence of gender inequity in PPE, with students describing significant imbalances in participation. Male students adopted roles that generated significant personal discomfort and led to fewer experiences as examiners. Assumptions were made by tutors and students about gender roles: male students’ ready acceptance of exposure to be examined and female students’ need to be protected from particular examinations. In contrast with the first assumption, male students did feel coerced or obliged to be examined. Students described their experiences of taking action to break down the gender barrier. Importantly, students reported that tutors played a role in perpetuating inequities. These findings, whilst relating to one university, have implications for all settings where PPE is used. Educators should be vigilant about gender issues and the effect that they may have on students’ participation in PPE to ensure that students are not disadvantaged in their learning