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

We learned to draw blood and put in IV’s on each other. Hernia checks, testicular exams, DREs, breast and pelvic exams were learned by practicing on paid instructors - I wouldn’t call them volunteers, since a) they were paid and b) they weren’t just there to be passive subjects but had their own training so as to give useful feedback and guidance. The male patients got a fraction of the pay of the females; something like 25% as I recall. For our exams, we used a prostate simulator with a silicone anus/rectum and swappable healthy/diseased prostates.

We also learned nasogastric tube placement by practicing on each other. Some students did arterial lines on each other, I thought that that was pretty stupid actually.

Intubation can be practiced on mannequins; my wife practiced neonatal intubation on kittens. Surgical techniques can in some cases be practiced on simulators, both physical and computer-based - this is mostly the case for laparoscopic techniques. Others can be taught with living, anesthetized pigs - at the beginning of my residency a group of four residents used one pig to learn chest tubes, vascular cutdowns, suture ligation of bleeding vessels, operation of surgical staplers and other instruments, etc. Those pigs were pretty well used up by the end of the day. I doubt that they still do that kind of training, though. Incisions and suturing can be practiced using pig’s feet or pork bellies or oranges. Orthopods practice new techniques using cadaver parts, like a severed leg for knee procedures.

Many invasive things like central lines, chest tubes, endoscopy, bronchoscopy, etc are learned by doing them on patients: preferably initially in the OR, ICU, or ER on anesthetized patients and under direct supervision. Doing your first invasive procedure on an awake patient without supervision brings a new level of stress to the situation.

You’ve just been waiting for a chance to work that into conversation, haven’t you? :slight_smile:

this is one time when I suggest that we NOT enforce the rule about kitty pics…

When the docs I work for were studying a new sort of injection device used for injecting something into an eye (a tiny, solid item, not a liquid), they got a bunch of fresh pig eyes from a butcher and used those as the testing models. The anatomy and thickness - rather like a decently thick piece of leather, which most people don’t know - is extremely close to a human eye, at least for those purposes.

Folks, the problem of ethics, volunteers and finding abnormal anatomy to practice on has been solved, via the realistic training simulator (as mentioned by brossa).

It comes with interchangeable prostates for a wide-ranging learning experience.

The company name is terrific. Although it might be embarassing to tell people you work there.

How do you become a paid volunteer for pelvic/gyn exams? I’m all for it if you get paid a lot.

I hope the kitties with the NG tube were treated humanely and weren’t in pain. Where did they get the cats? Shelter?

I did too! I’ll never forget the bass guitar on the soundtrack…

There’s paying through the nose, and then there’s paying through the . . .

Robotic rectum may aid prostate cancer diagnosis
by Thomas Angus, Martin Sayers, Kate Wighton
04 July 2016


Furthermore, a computer screen behind the device can display a 3D model of the rectum and prostate, allowing the doctor, with the aid of 3D glasses, to see the anatomy while they perform the examination. The technology can be programmed for different scenarios, allowing the anatomy to be changed each time, explained Dr Alejandro Granados, also from the Department of Surgery and Cancer at Imperial [College, London] and who is leading the development of the robotic rectum.

“We scanned a number of volunteers with an MRI scan and used this to perfect the shape and geometry of the anatomy.”

He added: "We have already asked a number of doctors and nurses – including prostate specialists and cancer surgeons - to trial the technology. They commented on the great advantage of being able to alter the anatomy. The size and shape of the rectum and prostate can vary greatly from person to person, and this technology enables medics to practice their skills in many different virtual patients. They also observed that because these examinations are performed solely by feel, experiencing a realistic sensation is crucial.

Furthermore, the team are continuing to perfect the device, by collecting data from real prostate examinations in patients.

Dr Bello explained: "There is very little research into the exact pressure and trajectory a doctor needs to use for a successful prostate exam. Therefore we are asking doctors to wear a small pressure sensor on their fingertip, underneath their surgical glove, when they are examining real patients.

…the team are now working towards building an affordable prototype for medical schools. Although each device may cost over £10,000, the team say a more affordable option may be to use the finger pressure sensors and 3D software on traditional plastic models, to enhance existing training facilities.

The device is being presented this week at the international Eurohaptics conference at Imperial, taking place 4-7 July.

I always heard that they started off with mannequins and then moved on to the paid volunteers, or patients having unrelated exams or procedures if they consented.

The stories about nurses first learning to give injections with an orange are not an urban legend, either.

I grew up in a city that has a medical school, and did some temp work there many years ago. While I was temping, I heard that the students were going to start learning how to do sutures, and they placed their annual call to a certain ethnic grocery store that would very reliably supply them with pigs’ feet at a reasonable cost.

Band name.

Remember this from a few years ago? Med students were learning to do pelvic exams by practicing on unconscious women who were there for routine surgery without getting permission before hand.

Brobotic rectum?

One of my great aunts went to medical school in the 1930s, she was one of the only female students at the school. The school hired prostitutes for gynecological demonstrations & lectures. I think male subjects were just recruited from the undergrads or charity clinics. The medical students spent a lot of time in the charity clinic getting practical experience.

When I was in pharmacy school, I volunteered at the local free clinic (and still support them financially) and pre-meds were recommended by their advisors to work there too, to see if this was really what they wanted to do. They usually worked as patient guides, who did an intake interview and then kept them company until it was their turn.

I’m also guessing that the prostitutes were not there voluntarily?

Yes, paid volounteers. My wife was a paid volunteer on the payroll at a major university medical school, to teach students from eastern countries to do general exams on female patients. Many medical students from Islamic or Hindu countries have never even talked to women, not even their sisters or their mothers. The idea was for them just get hands-on (literally) experience at touching female bodies, not just gynecological, but all over, and to learn to understand how female patients respond to touch. So she just went and let the med students do whatever they wanted to with her body, in order to explore the territory. (Under supervision of an instructor, of course). She had previously modeled for breast exam videos, so this was not new to her.

She said the most fun was looking at their expressions when she demonstrated her Kegels.

One of my housemates in the late 70’s said they had paid professional patients to teach gynecology, to do a few for-real exams after all the theory, etc. He mentioned the “patient” was trained (probably a nurse or some professional?) and gave a running commentary “now you’re feeling my uterus…” during the exam.

FWIW, a healthy prostate should feel like the tip of your nose. Funny site to see everyone in class with one finger up their buddy’s ass and the other hand feeling their own nose for comparison.

Here are some of the models available. I think they can be pretty expensive, but I have never needed to price them.

Bob

Here is a video showing how to do a proper prostate examination…

More... Search google.com for prostate exam and click on videos.