1. Teaching Female/Male Clinical Exams to First Year Medical Students Ruth Westra DO, MPH Jennifer Pearson MD Stephen Palmquist MS2

2. Current Training Female and Male Lectures Female/Male Exam Videos Task Trainers (Breast, Pelvic, Male Genitalia and Rectal) 1:1 Pelvic Simulator Session 1:1 Female Standardized Patient 1:1 Male Genitalia Exam

3. Task Trainers

4. Female Task Trainers

5. Male Task Trainers

6. Survey Description Purpose: To determine the effectiveness of preparing first year medical students to perform female and male sensitive exams for first year preceptorships and beyond Qualtrics Survey of MS2 (60), MS3 (60), MS4 (60) at the University of Minnesota Medical School, Duluth Campus IRB 1407E52083 University of Minnesota

7. Results 80/180 (44%) surveys completed 37 MS2 (62%), 23 MS3 (38%) and 20 MS4 (33%)

8. Results-Effectiveness Female and Male Lectures 3.72 and 3.59 Female Task Trainers (Breast, Pelvic) 4.04 Male Task Trainers (Male Genitalia/Rectal) 3.73 1:1 Pelvic Simulator Session 4.2 1:1 Female Standardized Patient Breast 4.12 1:1 Female Standardized Patient Pelvic 4.07 1:1 Male Standardized Patient Genitalia Exam 3.98

9. Results-Female Exams Completed First Breast Exam: 76% completed in the first year of medical school (30% in Family Medicine Preceptorship I and 46% in RMSP 1) First Pelvic Exam: 42% completed in the first year of medical school (14% in FMP I and 28% in RMSP 1); majority completed in 3 rd year clerkships 5% of the MS4 respondents did not complete a breast/pelvic exam

10. Results-Male Exams Completed First Male Genitalia Exam: 35% completed in the first year of medical school (11% in FMP I and 14% in RMSP I) First Male Rectal Exam: 22% completed in the first year of medical school (8% in FMP I and 14% in RMSP I); majority completed in 3 rd year clerkships 10% of MS4 students respondents did not complete a male genitalia/rectal exam

11. Student Comments “Very valuable to have the first experience in a controlled setting.” MS4 “ Very important to do a practice exam on a clinical model before an actual patient.” MS4 “It is a tough hurdle a first year to overcome, but the faculty did an excellent job in preparing us.” MS2

12. Student’s Perspective Controlled environment –Taught by teachers with experience –Can ask questions –Okay to make mistakes Gain basic skills before going to clinic –Preceptors know you have exam skill –More likely to be able to perform exam when the opportunity arises

13. What we do well Early training to prepare for the experiences in their preceptorships Well organized experiences in a controlled setting Most complete first female/male exam during the 3-4 year clerkships

14. Areas to improve Room set up and practice with exam table Early training with reinforcements Improved task trainers with male genitalia 1:1 standardized patients for Rectal exams (task trainers but no “real patients”) Faculty (preceptor) development to encourage participation by the students on their preceptorship experiences with female/male exams

15. Questions Why are a substantial number not completing male exam components even as they approach graduation? No required clerkship that includes observation of male exam (Urology is surgical selective). Should a competency check list be created for students in their 3 rd and 4 th year to include female/male exams? Does it make a difference if the preceptor and student are gender matched? How often should you complete a rectal exam for female/male patients? What is the ideal number of pelvic exams for a female volunteer patient to complete? What is the ideal number of male genitalia/rectal exams for a male volunteer patient to complete?

16. References Performing the first pelvic examination: female medical students’ transition to examiners, Patient Education Counseling 2007 Dec;69(1-3):55-62. Experienctial learning in women’s health:medical reflections, Medical Education 2006 Aug;40(8):768-774. Anxiety and feelings of medical students conducting their first gynecological examination, J Psychosom Obstet Gynaecol, 2003 Mar;24(1): 39-44. Can online learning adequately prepare medical students to undertake a first female pelvic examination? J Obstet Gynaecol Can. 2012 Mar;34(30:264-268. Medical students’ self-reported experiences performing pelvic, breast, and male genital examinations and the influence of student gender and physician supervision. Acad Med, 2006 Mar;81(3): 266-269.

17. References Medical students’ experience s learning intimate physical examination skills: a qualitative study, BMC Med Educ.2014 Feb 28:14-39. A survey of digital rectal examination training in Canadian medical schools, Can J Gastroenterol. 2012, Jul: 26(7): 441-444. Pelvic examination skills training with genital teaching associates and a pelvic simulator: does sequence matter? Simul Healthc. 2012 Apr;7(2): 95- 101. Who gets “kicked out” of the exam room? Factors associated with patients declining medical student participation, Teach Learn Med. 2009 Jan- Mar;21(1):1-7. Teaching pelvic examination technique using professional pateints: a controlled study evaluating students’ skills, Acta Obstet Gynecol Scand. 2010 Oct;89(10):1298-1303.