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Barriers Preventing Medical Students From Performing Pelvic Examinations During Obstetrics and Gynaecology Clinical Clerkship Rotations

Published:February 22, 2019DOI:https://doi.org/10.1016/j.jogc.2018.12.023

      Abstract

      Objective

      This study sought to identify barriers that prevent medical students from performing pelvic examinations in their obstetrics and gynaecology (Ob/Gyn) clinical clerkship rotations and to compare the perspectives of faculty, residents, nurses, and students regarding perceived barriers.

      Methods

      An electronic survey was distributed to third-year Dalhousie University (Halifax, NS) medical students on completion of their Ob/Gyn clerkship rotations in the 2015-2016 academic year and to Ob/Gyn nursing staff, faculty, and residents (Canadian Task Force Classification III).

      Results

      There were 82 responses, giving an overall response rate of 28%. Students reported performing an average of 9.2 speculum examinations, 3.8 cervical checks, and 2.8 bimanual examinations during their 6-week rotations. They reported being declined the opportunity to perform an examination an average of 7.1 times. Students perceived themselves to be more competent performing these examinations compared with staff perception of student competency. Students perceived resident interest in teaching, resident and staff time constraints, and patient willingness to have a medical student involved in their examination as frequent barriers. Faculty, residents, and nurses perceived student gender, patient willingness, difficulty of examination, and resident time constraints to be significant barriers.

      Conclusion

      This study is the first to examine multidisciplinary perspectives on perceived barriers to medical students performing pelvic examinations. Staff and students have different perceptions of a student's competence performing these examinations. Existing barriers are likely multifactorial.

      Résumé

      Objectif

      Cette étude visait à définir les obstacles qui empêchent les étudiants en médecine d'effectuer des examens pelviens durant leurs stages cliniques en obstétrique-gynécologie et à comparer les points de vue des professeurs, des résidents, des infirmières et des étudiants quant aux obstacles perçus.

      Méthodologie

      Au cours de l'année universitaire 2015-2016, un sondage électronique a été distribué aux étudiants en troisième année de médecine à l'Université Dalhousie d'Halifax (N.-É.) qui terminaient leurs stages en obstétrique-gynécologie. Il a également été envoyé aux infirmières, aux professeurs et aux résidents en obstétrique-gynécologie (classification III du Groupe d'étude canadien).

      Résultats

      Au total, 82 personnes ont répondu au sondage, ce qui donne un taux de réponse de 28 %. Les étudiants ont déclaré effectuer en moyenne 9,2 examens au spéculum, 3,8 examens du col utérin et 2,8 examens bimanuels au cours de leurs stages de six semaines. Ils ont également dit s'être fait refuser la possibilité d'effectuer un examen 7,1 fois en moyenne. Les étudiants avaient une meilleure perception de leur aptitude à réaliser ces examens que le personnel. Parmi les obstacles à la réalisation des examens fréquemment nommés par les étudiants, notons l'intérêt des résidents quant à l'enseignement, les contraintes de temps des résidents et du personnel ainsi que l'ouverture des patientes à l'idée qu'un étudiant effectue l'examen. Selon les professeurs, les résidents et les infirmières, les obstacles importants étaient le genre des étudiants, l'ouverture des patientes, les difficultés liées à l'examen et les contraintes de temps des résidents.

      Conclusion

      Cette étude est la première à s'intéresser aux points de vue multidisciplinaires relatifs à la perception des obstacles empêchant les étudiants en médecine de réaliser des examens pelviens. Le personnel et les étudiants ne voient pas du même œil l'aptitude des étudiants à effectuer ces examens. Les obstacles existants sont probablement multifactoriels.

      Key Words

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      REFERENCES

        • Liu KE
        • Shapiro J
        • Robertson D
        • et al.
        Pelvic examinations by medical students.
        J Obstet Gynaecol Can. 2010; 32: 872-874
        • Wearn AM
        • Roberts HE
        • Bhoopatkar H
        • et al.
        Evaluation of an “unannounced” CDROM to help undergraduate medical students to learn female pelvic examination.
        Focus Health Prof Educ. 2010; 11: 22-32
        • Buchwald J
        The first pelvic examination: helping students cope with their emotional reactions.
        J Med Educ. 1979; 54: 725-728
        • Chang J
        • Odrobina M
        • McIntyre-Seltman K
        The effect of student gender on obstetrics and gynaecology clerkship experience.
        J Womens Health. 2010; 19: 87-92
        • Higman J
        • Steer PJ
        Gender gap in undergraduate experience and performance in obstetrics and gynaecology: analysis of clinical experience logs.
        BMJ. 2004; 328: 142-143
        • O'Flynn N
        • Rymer J
        Women's attitudes to the sex of medical students in a gynaecology clinic: cross sectional survey.
        BMJ. 2002; 325: 683-684
        • Akkad A
        • Bonas S
        • Stark P
        Gender differences in final year medical students’ experience of teaching of intimate examinations: a questionnaire study.
        BJOG. 2008; 115: 625-632
        • Broadmore J
        • Hutton JD
        • Langdana F
        Medical students’ experience of vaginal examinations of anaesthetised women.
        BJOG. 2009; 116: 731-733
        • van den Einden L
        • te Kolste M
        • Lagro-Janssen A
        • et al.
        Medical students’ perceptions of the physicians’ role in not allowing them to perform gynecological examinations.
        Acad Med. 2014; 89: 77-83
        • Mavis B
        • Vasilenko P
        • Schnuth R
        • et al.
        Medical students’ involvement in outpatient clinical encounters: a survey of patients and their obstetricians-gynecologists.
        Acad Med. 2006; 81: 290-296
        • Bhoopatkar H
        • Wearn A
        • Vnuk A
        Medical students’ experience of performing female pelvic examinations: opportunities and barriers.
        Aust N Z J Obstet Gynaecol. 2017; 57: 514-519
        • Nulty D
        The adequacy of response rates to online and paper surveys: what can be done?.
        Assess Eval High Educ. 2008; 33: 301-314