Abstract

Teaching intimate physical examinations: an innovative program of instruction and reflection for medical students

Author(s): Julie Taylor, Shmuel Reis, Paul George, Hedy Wald, Jeffrey Borkan

Objectives: To design, implement and evaluate an efficient yet comprehensive and effective curriculum that introduces medical students to and fosters competency with intimate physical examinations (IPE).

Design: As part of the ‘Doctoring’ course, each second-year student at Alpert Medical School of Brown University (AMS) attends two evening training sessions to be introduced to intimate physical exams of both male and female patients. Students work in pairs with trained intimate examination teaching associates under the supervision of senior medical students. Each second-year student then completes a single reflective writing assignment about their experience and receives individualized written feedback from two course faculty.

Setting: Doctoring is a required preclinical course at AMS. The course combines instruction and assessment in medical interviewing, physical examination, cultural competency and professionalism.

Outcome measures: (1) Anonymous, summative written course evaluations, including quantitative questions using a 6-point Likert scale and qualitative, open-ended comments gathered from 187 students over two academic years. (2) Written student reflections (termed “field notes”) and formal faculty feedback.

Results: This IPE curriculum is the most highly rated element in the Doctoring course: 187 students over two years rated the sessions at 5.4 (1-6 Likert). Students’ writing ranges from introspection to critical reflection when processing this emotionally challenging learning.

Discussion: We have designed, implemented and evaluated a successful and sustainable curriculum to teach intimate examinations that provides the knowledge, attitudes and skills necessary for medical student training.

Conclusion: Based on student evaluations of the curriculum and course, as well as feedback from senior students, medical students feel well prepared to perform intimate exams as clerkship students, both technically and psychologically.