Digital Rectal Examination: Perspectives on Current Attitudes, Enablers, and Barriers to Its Performance by Doctors-in-Training

Abstract

Background Digital rectal examination (DRE) is a valuable diagnostic tool for diagnosing multiple conditions, but its use has declined in practice. This study sought to provide perspectives on current attitudes, enablers, and barriers to performing DRE for doctors-in-training (DiTs) and explore strategies to improve and facilitate consistent, efficient, and effective execution of DRE.​​​​​​​ Methodology Self-reported DRE practice among DiTs (n = 1,652) across three metropolitan health service regions in Western Australia was surveyed using a de-identified multiple-response ranking, dichotomous quantitative and qualitative survey. Data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results A total of 452 (27%) DiTs responded to the survey, with an even distribution of key demographics between regions and specialties. The median post-graduate year was 2. Half of DiTs reported being comfortable with performing DRE. Most had training in medical school (71%), while 9.7% had no training in DRE. Chaperone availability, perceived invasiveness, and lack of confidence were key barriers; key enablers were formal training and senior colleague/departmental support. The multivariate logistic regression showed that DiTs who reported being comfortable in performing DRE were significantly and independently associated with being a high-volume practitioner (p < 0.001), confident in diagnosing benign (p < 0.001) or malignant pathology (p < 0.001), perceived adequate DRE training (p < 0.001), prior formal DRE training (p = 0.007), and surgical subspeciality interest (p = 0.030). Conclusions Low levels of confidence and comfort in the performance of DRE among DiTs have resulted in the underutilization of a critical diagnostic tool. Future curriculum and departmental clinical practice interventions should address barriers while promoting enablers.

Can Digital Rectal Examination Identify the Subtype of Dyssynergic Disorders as Well as High Resolution Anorectal Manometry?

“…The Digital Rectal Examination (DRE) stands as a fundamental clinical tool and cornerstone of proctological examinations. However, a notable decline in its utilization is observed [19], primarily due to the misconception of its low diagnostic value and the emergence of increasingly sophisticated complementary examinations. Consequently, DRE is often conducted with limited focus on anorectal function assessment, prompting frequent reliance on additional physiological tests.…”

The Importance of Digital Rectal Examination in Identifying Early-Onset Rectal Malignancies

“…Although most medical students are taught how to properly perform a DRE in their pre-clinical years, there is limited teaching on DRE during the clinical years and in residency [8]. A study in Australia notes that low levels of confidence and comfort in performing rectal exams were the main reasons for underutilization, particularly by doctors-in-training [9]. These doctors reported that formal training in DRE during medical school and adequate support from senior colleagues were key contributors to their comfort level in performing rectal exams [9].…”

“…A study in Australia notes that low levels of confidence and comfort in performing rectal exams were the main reasons for underutilization, particularly by doctors-in-training [9]. These doctors reported that formal training in DRE during medical school and adequate support from senior colleagues were key contributors to their comfort level in performing rectal exams [9]. Furthermore, being comfortable with performing DREs was associated with greater confidence in diagnosing benign or malignant pathology [9].…”

“…These doctors reported that formal training in DRE during medical school and adequate support from senior colleagues were key contributors to their comfort level in performing rectal exams [9]. Furthermore, being comfortable with performing DREs was associated with greater confidence in diagnosing benign or malignant pathology [9]. Medical school preceptors and residency program directors should ensure greater hands-on training in successfully performing a DRE so that doctors-in-training can get more comfortable in this skill and use this skill more often.…”

Perspectives on Current Attitudes, Enablers, and Barriers to Obtaining Surgical Informed Consent for Doctors-in-Training

“…Overall, the response rate for the survey was low at 23%. At the same time, low survey response rates are not uncommon, especially in surveys involving healthcare professionals [ 11 - 13 ]. This may reflect a level of response bias in our results.…”