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 student wellbeing - a consensus statement from Australia and New Zealand

Abstract Background Medical student wellbeing – a consensus statement from Australia and New Zealand outlines recommendations for optimising medical student wellbeing within medical schools in our region. Worldwide, medical schools have responsibilities to respond to concerns about student psychological, social and physical wellbeing, but guidance for medical schools is limited. To address this gap, this statement clarifies key concepts and issues related to wellbeing and provides recommendations for educational program design to promote both learning and student wellbeing. The recommendations focus on student selection; learning, teaching and assessment; learning environment; and staff development. Examples of educational initiatives from the evidence-base are provided, emphasising proactive and preventive approaches to student wellbeing. Main recommendations The consensus statement provides specific recommendations for medical schools to consider at all stages of program design and implementation. These are:Design curricula that promote peer support and progressive levels of challenge to students.Employ strategies to promote positive outcomes from stress and to help others in need.Design assessment tasks to foster wellbeing as well as learning.Provide mental health promotion and suicide prevention initiatives.Provide physical health promotion initiatives.Ensure safe and health-promoting cultures for learning in on-campus and clinical settings.Train staff on student wellbeing and how to manage wellbeing concerns. Conclusion A broad integrated approach to improving student wellbeing within medical school programs is recommended. Medical schools should work cooperatively with student and trainee groups, and partner with clinical services and other training bodies to foster safe practices and cultures. Initiatives should aim to assist students to develop adaptive responses to stressful situations so that graduates are prepared for the realities of the workplace. Multi-institutional, longitudinal collaborative research in Australia and New Zealand is needed to close critical gaps in the evidence needed by medical schools in our region

Pandora's electronic box: GPs reflect upon email communication with their patients

Background Global access to information technology has increased dramatically in the past decade, with electronic health care changing medical practice. One example for general practitioners (GPs) is communication with patients via electronic mail (email). GPs face issues regarding e-communication with patients, including how and when it should it be used. Objective The study aims were to assess the extent that GPs communicate with patients by email and explore their attitudes to this mode of communication. Methods Design: telephone interview survey. Setting: primary care, largest urban and suburban area in New Zealand (NZ). Subjects: randomly selected GPs from the Auckland region. Main outcome measure: description of email use; analysis of issues by telephone survey. Data analysed using SPSS-12 and by thematic content analysis. Results At data saturation, 80 GPs had been interviewed. The majority (68%) had not used email with patients. Only 4% used it regularly. However, there was strong interest in this method. Perceived advantages were the ability to communicate at a distance and time convenient to both doctor and patient; communication where disability affected traditional methods; information-giving (for example, web links); passing on normal results. Identified problems involved inequity of access; linking of electronic data; security; unsuitability for some topics; medico-legal concerns; time; remuneration. Conclusion Study sample closely mirrored current NZ GP population. Although few GPs emailed with patients, many might once barriers are addressed. GPs had a collective view of the appropriate boundaries for email communication, routine tasks and the transmission of information. GPs would encourage professional debate regarding guidelines for good practice, managing demand and remuneration

Using global remote camera data of a solitary species complex to evaluate the drivers of group formation

We would like to thank Megan Whatton, Belden Giman, Hongliang Bu, Dajun Wang, Fang Wang, Roland Kays, Jillian Kilborn, and New Hampshire Fish and Game for their roles in contributing data that was used in this analysis. Any use of trade, product, or firm names is for descriptive purposes only and does not imply endorsement by the US Government.Peer reviewe

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

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

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