Creating a more positive patient experience of pelvic examination

Carter, Sherry; Rad, Manzar; Schwarz, Barry E.; Sell, Sharon Van; Marshall, P. David

doi:10.1111/1745-7599.12020

Cited by 13 publications

(15 citation statements)

References 27 publications

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“…With the discovery of the Pap-test and its uptake for cervical cancer screening in the 1940s, PEs became a routine part of care for those assigned female at birth (Carter et al, 2013).…”

Section: B Sex Workers 'Models' and Marginalized Groupsmentioning

confidence: 99%

‘Poorly relaxed women’: A situational analysis of pelvic examination learning materials for medical students

Towle

2022

Medical Education

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I. Historical Review………………………………………………………. p. a. The invention of the speculum: Lucy, Anarcha, and Betsey…… p. b. Sex workers, 'models,' and marginalized groups………………. p. c. The introduction of the anesthetized PE………………………... p. d. 'Our bodies, ourselves:' Gynaecological teaching associates…... p. II. Contemporary Review…………………………………………………. p. a. Patients' experiences of the PE…………………………………. p. b. Medical student perspectives on the PE……………………….... p. c. Medical school culture and #MeTooPelvic……………………... p. d. Medical education curricula…………………………………….. p. e. Screening guidelines and DIY cervical swabs………………….. p. f. Patient-centred improvements…………………………………... p.

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“…With the discovery of the Pap-test and its uptake for cervical cancer screening in the 1940s, PEs became a routine part of care for those assigned female at birth (Carter et al, 2013).…”

Section: B Sex Workers 'Models' and Marginalized Groupsmentioning

confidence: 99%

‘Poorly relaxed women’: A situational analysis of pelvic examination learning materials for medical students

Towle

2022

Medical Education

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“…When the patient feels like she is being communicated with effectively and is more in control of what is happening to her body, it can decrease anxiety and discomfort for both the patient and the practitioner (Domar, 1986;Kapsalis, 1997). Involving the patient in the bimanual exam by requesting that she tighten and relax her Kegel (vaginal) muscles can not only assist the practitioner in assessing the integrity of the pelvic floor, but also give the patient a sense of control, thereby reducing her stress and anxiety (Carter, Rad, Schwarz, Van Sell, & Marshall, 2013;Linden, 2005).…”

Section: New Approach To Training Of Physiciansmentioning

confidence: 99%

“…Selection of the speculum without assessment of vaginal length and orientation of the cervix within the vaginal vault can lead to unnecessary patient discomfort. A study performed by Carter et al, (2013) suggests that the "Rad technique," performing a bimanual examination prior to insertion of the speculum, can lead to selection of the most appropriate size of speculum and easier visualization of the cervix. This can provide for a quicker exam and less discomfort for the patient (Carter et al, 2013).…”

Section: New Approach To Training Of Physiciansmentioning

confidence: 99%

“…The Rad technique corrects for three misconceptions of conventional practice in performing pelvic examination that lead to patient discomfort. These include performing of the speculum exam prior to the bimanual exam, using of a large speculum for multiparous women, and positioning the table and patient at a 30 degree incline (Carter et al, 2013).…”

Section: New Approach To Training Of Physiciansmentioning

confidence: 99%

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Improving the Pelvic Exam Experience: A Human-Centered Design Study

2017

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Many women are traumatized by pelvic examinations, causing them to experience increased anxiety or avoid these exams completely. Use of a vaginal speculum is necessary during the majority of pelvic examinations. The traditional speculum design is uncomfortable for most patients and lacks considerations for the health care provider. Incorporating Human-Centered Design methodology into the resolution of this problem allows for the consideration of the patient and doctor experiences when making design decisions. Interviews and observation can provide valuable insight for improvements to the design and user experience. Through empathic design, it is possible to develop an instrument that is functional and ergonomic for the health care provider while also promoting the physical and emotional comfort of the patient being examined. This paper challenges current medical standards and provides a novel approach to pelvic examination using a new vaginal speculum.

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“…8,9 The patient experience during a pelvic exam is often dependent on the style and practice of the health care provider. [10][11][12] As such, performing a pelvic exam has been deemed an important competency for graduating medical students, regardless of their specialty choice. 13 However, many students do not feel comfortable performing these exams.…”

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confidence: 99%

Improving Medical Student Comfort and Competence in Performing Gynecological Exams: A Systematic Review

Kirubarajan

Got

et al. 2021

Academic Medicine

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PurposePerforming a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams. MethodThe authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments. ResultsThe search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams. ConclusionsThe literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.

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Creating a more positive patient experience of pelvic examination

Abstract: Changing from the conventional pelvic examination to the Rad technique may create a more positive patient experience and thereby engage more women in recommended in gynecological health care.

Cited by 13 publications

References 27 publications

‘Poorly relaxed women’: A situational analysis of pelvic examination learning materials for medical students

‘Poorly relaxed women’: A situational analysis of pelvic examination learning materials for medical students

Improving the Pelvic Exam Experience: A Human-Centered Design Study

Improving Medical Student Comfort and Competence in Performing Gynecological Exams: A Systematic Review

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