How do med students learn to do a digital-rectal exam?

A cousin of mine recently graduated from med school. When I asked him this question, he became really evasive. How do you know what normal or abnormal prostates feel like unless you have felt them? So what do they do? Practice on each other? Recruit volunteers as practice subjects? Pay winos?

Practice on each other, in some cases. I know someone who stressed about this in med school, because she had to practice her partner (a person she was paired with on many assignments) and he had to check her.

I hear that med students do all kinds of invasive and embarassing exams on each other, both to get them over their own squeamishness about nudity and to get them an idea of what their patients go through. And, of course, to learn how to do them.

No cite, just half-remembered conversations.

I was offered a job to work as a simulated patient for gynaecological exams - essentially being the patient that the students practice their techniques on.

It was a ridiculously high paying job, as simulated patients go, but I could not imagine spending my days like that…

I would imagine there is similar for prostate exams…

How would it benefit her partner to do a prostate exam on a woman? That’s not good practice; he wouldn’t feel anything.

ETA: And another thing, this practicing invasive exams on classmates seem weird to me. Yes they have to get over any squeamishness and empathize with their patients, but there is a difference between my doctor seeing me naked, and my classmate/peer. I would have guessed they practice on volunteers, but maybe I’m wrong.

In my day ethical concerns tended not to cross many people’s minds. So, for example, we learned how to do rectal exams on what I’ll call “vegetatively demented” patients. What I mean by that are people who were so demented that they were totally uncommunicative and bed-ridden. There were also “opportunities” when people were under general anesthetic. As I said, ethics weren’t a consideration. And I was just a ‘kid’ - I wasn’t about to question the professors’ directions. AFAIR, none of us complained or refused to participate.

Many years later, med students from my university actually wrote an influential article describing and implicitly condemning this type of thing. It’s free full text here. If you do choose to take a look at it, be sure to open the table.

For female pelvic exams, we had paid volunteers. It was my sense that these were people with agendas and weren’t just in it for the money. Specifically, they wanted to ensure that the guys, in particular, understood what it was like to have a finger or three, or a speculum, inside you (“don’t you ever forget to run the speculum under warm water first!”).

(BTW, I can’t imagine anyone would ever want to practise* rectal or pelvic exams on a classmate, or be practised on. It sure wasn’t part of my training and it still isn’t today at my school.)

*Imperial spelling!

Your link goes only to the table, and I can’t figure out how to get to the article. I’d be interested in reading the whole thing.

When I was married, my (now ex) wife had a fertility work up. I was also examined. It was a teaching hospital. My testicles were thoroughly palpated, as was my prostate. . . by the doctor, two residents, a “fellow” (WTF is that, anyway?) an intern, and a med student. Seriously. And they all, each and everyone, had man hands.

My mum was a nurse and she said when they learned to take blood or give shots they practice on each other. What no gay jokes? My how times have changed :slight_smile:

A ‘fellow’ is a person who has finished medical school, and residency, and is taking advanced training in a subspecialty. So, usually a fully qualified doctor who could be out doing, for example, OB/GYN work, but is getting focussed training in infertility medicine before they set up shop.

If you had 5 OB/GYNs in a area, one might do infertility, one might do high risk delivery, one might do gyn/onc surgery, etc. The fellowship is where they train in the sub-specialization that makes them the go-to person in their field.

In my PCP’s office he has one of those drug-company provided doo-dads which is, in all seriousness, a prostate exam simulator. It can even be set to simulate different degrees of enlargement and disfunction.

While such a device may not be how med students primarily learn, it does exist.

Ignorance fought! Thanks!

Imagine, having had your prostate checked by a bunch of people, each one introduced by the gig cheese. The fellow one cracked me up. “This is Dr Bigfinger. He’s a fellow”. Weird/Surreal.:smiley:

A jolly good one, I trust?

Sorry 'bout that. Here’s the link.

I have always wondered about that. My surgeon is always training fellows and so I have wondered what the term meant.

Not relevant to the OP, but just to add to my first post above, a common way of learning how to intubate a patient (i.e. placing a breathing tube down their windpipe) was to practice on people who had just died despite attempts at CPR. In that situation, there are knowledgeable people around as well as the proper equipment to do the procedure. As I say, this was a very common practice (in my day).

Just noting that the OP did specify prostate checks, but women do get digital-rectal exams too, especially as an occasional part of a gynecological exam.

Pretty sure I’ve seen this film.

Up until the 1980s students at my med school learned to to rectals (and pelvics and breast exams) by doing exams on each other. Some time in the 80s there came along a new course chair for Intro to Clinical Medicine who argued that this was inappropriate and began hiring model patients for students to learn on. So I initially learned the more intimate exams on someone hired specifically for that purpose. But that’s just your first walk-through of the procedure in 2nd year. The next time I did any one of those exams was when I got to 3rd year clerkships and had to examine my patients. For the first few I had an attending looking over my shoulder or repeating the exam to verify my findings but after a while a was on my own.

Not really. Well, not at my school anyway.