This is what I am going for next Halloween. Dr. Bigfinger.
:D:D:D
There is a medical blog site in which doctors reveled that they had to examine prostrates of paid street people that were in nasty health. The bad health actually gave them experience of what diseased prostrates were like. Some of these patients are of sick mental health also and are very vulgar to state it nicely.
When I was a med student we did not practice digital rectal exams on each other. My reaction would be been “No…effing…way.”
Two things to note: 1) the likelihood of finding any significant abnormality in that age group is very low. Prostatic enlargement you can detect that way doesn’t typically occur until the patient is at least in his 40s, and generally later. Ditto for rectal cancers.
2) this particular part of a physical exam is not exactly rocket science. You learn by doing, i.e. on patients who are getting a general physical exam, such as those being admitted to the hospital for whatever reason. If there was reason to think from symptoms/signs that the patient had an elevated risk of some ailment detectable by digital methodology, the resident (or other elevated being) might do his own exam. Which would mean more than one rectal exam for the patient, but that’s what you risk at a teaching hospital.
We did do gyn exams on women paid (hopefully large amounts of money) to be sample patients. That sort of exam is rather more complex.
Nothing to revel about, believe me. 
2nd year med student here-
Last year we covered the Prostate exam in our “introduction to the patient” class- basically we have Standardized patients (Paid Actors who are trained to mimic/simulate real symptoms and histories and such) who teach out how to deal with scenarios and situations everything from basic interviewing techniques, to learning how to listen to the heart, palpating the abdomen and giving a normal physical exam. There are also GSP: Genital Simulated patients- they’ve been SPs for several years, and gotten extra training (and a pay raise) to teach us those situations.
So we basically came in, read up the notes on how to give an exam for males and females, and then went to large groups- watched a video on it (though it mostly focused on the female exam, guys weren’t emphasized more than what the notes had), and then we broke up into small groups of 3-4 students and went to our individual GSPs. There they reviewed the materials with us (the notes and findings and such) and then they told us what to expect, and then we gloved up and gave him an exam- we had to first give a testicular exam, examine the penis, check for hernia, etc, and then we would also do the digital rectal exam and try to feel for his prostate- very surreal experience, but the dude (Mine was like 6’5’’ and a firefighter in real life i believe) basically then told us if we were close or not- he had been trained for 3-4 weeks, and done this several times (as good GSPs are hard to come by, so you keep each one) and well… knew his anatomy well enough until we were correctly around his prostate. We then palpated it, and then pulled out, and let the next person try. Basically 4x in a row he did it. And then he showed us that there’s another way to examine the patient, if they can’t stand or such, and they’re laying down, he assumed the laying down position, and then we did it again. So 8x in a session basically.
And then they called time, and we switched- everyone who had males went to the female GSPs and vice versa- so he still probably had 8 more to do- not my idea of fun. Hopefully he’s compensated well enough. But in the female one it was less invasive, and more of her showing us how to do everything- she basically showed us the anatomy of the area, how to choose out a speculum and use it properly, and to see the cervix, and techniques such as palpating things like ovaries (“they feel like tiny almonds”) and uterus and such. And that was it, again each of us used a speculum, palpated the ovaries and such, and she would use a hand mirror to see what we were doing).
The GU stuff though isn’t tested though for us during the first year- that session is basically a demo learning session, and when we took our ITP exams (where we have to basically give an SP a physical exam) we left out that part of the exam. In our 3rd year, we’ll once again cover the GU system and we’ll be responsible for it then, but until then we were just supposed to use it for a learning experience and try to take away as much as we could from the experience.
I’m so sending this to Dirty Jobs with Mike Rowe.
ToeJam, please change your mind on this right now. Eight people using a speculum, opened wide enough to view the cervix, plus additional exams and palpitations, is BY NO MEANS “less invasive” than eight individual gloved and lubed fingers in a man’s anus. It’s hard to express how repugnant this attitude is - that anything entering a vagina is fine, but anything going up a man’s arse makes you hope “he’s compensated well enough”. It’s a sexist, old-fashioned and nauseating attitude.
They were not talking to the others when they left the examination room, so I guess they didn’t revel in the task.
My apologizes for my wording, obviously both experiences are no less traumatizing than the other, and I fully agree with you on your ideas of it being a terrible attitude.
Though, I know female GSPs are paid more than male (or at least my instructor stated this was the case).
So I hope he’s paid well enough too for his time and efforts. There seems to be a shorter supply of males than females in the field of SPs and I don’t know why.
For BFF and SiL, the first three years’ worth of exams were on classmates. It was also not the same ones for every exam. When it was time to practice gynecological examinations, they followed the usual protocol: rectal exam for virgins, vaginal for not.
Part of the idea was “if you can’t stand having it done to you, get the hell out of here.”
For the last three years they did Clinical Rotations, where they got to perform procedures on patients (from taking clinical histories to blood extraction to X-Rays to younameit) under supervision.
The US Army’s Special Operations Combat Medic school has students practice DREs on each other. Also practice NGI Tubes, finger pricks, genital exams, and hundreds of IVs on each other. Fun times. . .
The rumor is that they used to practice Folley Catheters on each other, but the practice was stopped because of infection issues. By my time, we used training aids.
Thank you. I’m sorry if I came across all attack-y! It is interesting. I know in the UK they keep having drives to try to get women to come forward as (paid) volunteers for training doctors and nurses, I think partly because they have such problems with women not going for smear tests as it has a bad rep. However I never see similar drives for male volunteers; I guess maybe they think that there isn’t as much variation in skill level with a rectal exam, or that all men are going to feel similarly about it, or maybe there’s less variation in arseholes than there is in vaginas… who knows. But I wonder if it’s partly that men aren’t encouraged to come forward and do their bit for medical science in quite the same way that leads to a shortage of male volunteers? I don’t know if that’s the same there though. In fact I know very little, so I’ll stop now but thank you for not jumping back down my throat the way I jumped down yours! :o
I’m not sure, it’s very interesting though as the range of SPs ages seem to vary from around 20yo to around 80yo, and it’s a VERY useful teaching tool- many of the people are former health care workers, or they’re actors/musicians/ people who just want to help educate the students. And it does tend to skew towards the female and over 40 crowd, with many of them being retirees, who now use this as a source of supplemental income (this is the SP portion- so they’re paid basically to talk and act like a normal person just giving an interview).
We get to be trained basically on how to talk to people, how to shake hands, how to do all the “little things” that people tend to take for granted when they visit the real doctors (Like, even though you should wash your hands after seeing a patient, the patients prefer if you wash your hands right BEFORE you see them for a physical exam, even if you just used an alcohol wash outside/ Also, patients don’t like it if they have symptoms and you look afraid to shake hands with them :smack:, it’s basically developing the confidence and skills needed to interact with patients, which sometimes isn’t really emphasized in medical school, and often takes a backseat to all the textbook knowledge that comes in the first two years).
And the idea of working on my fellow medical students is just- wow. That doesn’t seem quite that helpful in teaching- here at least we’re basically just practicing on our teachers/instructors. So they know if we’re doing it wrong or if we’re fumbling around in the wrong hole even (there’s always that rumor every year of the poor nervous student who gets it in the wrong one). :eek: Those instructors and the program itself which is constantly self-monitoring and improving itself are def. a valuable thing to have, and they deserve all the credit in the world for taking the time to help us out.
Ideally, guest starring Kari Byron for the female patient too.
Back when I had a tumor and was in the getting everything tested and ready for surgery, and then again post-op the base hospital here in Groton used me to help train a bunch of independent duty corpsmen on various exams for female plumbing as I was available and willing. Well, some of the training was also because what I had was particularly interesting and not normally seen.
I also was a volunteer training aid for the EMT class down at Portsmouth Naval back when mrAru was doing EMT training back in 87. Mast trousers, backboards and water rescue were fun. Then they did a mass catastrophy triage simulation with about 20 volunteer victims that was fabulous, complete with the injury makeups =)
I would really recommend being the mass disaster trauma volunteer for your local disaster relief sometime, it can be a blast, and helps train responders. I have a friend who is going to have me lugged down into a cave and hauled out again a few times for training cave rescue teams [it helps I used to cave, and am not afraid of being hauled out of a pit in a basket 
]
Funny. I never said ‘prostate exam’. They had to examine each other.
Teaching hospitals.
I had NO idea what these two words could possibly mean in this order, and so I looked it up for all us dopes.
could they make a quality “mannequin” emulator for beginners? Especially lots of them, some of them demonstrating the healthy case and some the various sick cases?
Off-topic, but my dentist told me that they learned to do novocaine injections on each other in dental school. She remembers standing in front of the class, bending down to look into her unfortunate colleague’s mouth, while the rest of the students chanted, “SHOT! SHOT! SHOT!”