h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I'm awfully sorry to those of you that are eating at this point.

But I'm interested in the non-medical opinion on it, I'm currently on the Obs and Gynae part of my course.

Yes you the first time you do one it's on a plastic model, but real women don't feel much like models, and models don't tell you if you're being too rough. So eventually you have to do your first one on a real woman.

Herein lies the problem. Not many women are likely to let you.



There are several options.


In general practice, ideally we're meant to learn on our general practice attactment, knows it's our first time, and is comfortable with that.

Needless to say no GPs managed to find patients who were willing to be examined, certainly not by a male student.


Then there's in gyneacological outpatients clinics, which also isn't ideal, the consultant doesn't always have time to teach you, so you feel a bit rushed, the patients might feel pressurised into saying yes, because they're intimidated.


Or we can learn in operating theatre, just before a patient has a gyneacological operation, the surgeon, quickly shows us how to examine them.

I have never ever felt as awkward as when I went up to a patient and said 'May I examine you whilst you're anaestisted?'


Some medical schools employ gyneacology teaching assistants who teach you to examine a model, and then let you examine them - for some reason this feels like the sort of thing that people shouldn't be asked to do as a job.


Or not at all. Which means that we won't be able to competently take a cervical smear, so our patients might get cancer, which is the worst option really.

Soo a question for the women, if you were a patient which of these would you object to the least?

Blimey, good question, Z.

Still mulling that one over for you...

Will return.

I'm happy to say that I have actually been lucky enough to do enough examinations to be competent, or at least I hope I have. I'm not scared anymore. But I know I'm lucky, a lot of students haven't.

'May I examine you whilst you're anaestisted?'

sorry, it sounds like the world's worst pick up line

So which one of the above methods gave you the most experience?

I've thought of my answer, btw. You get asked so often at GP practices whether a student can sit in, or do this or that,so I would say the GP option I think.

Although sometimes one can feel like there's no real option to say 'no', as you mentioned about the consultant option.

Jules

I've always agreed to have students present when i've had anything done as I recognise the important of you learning properly..and I expect I'll continue to do so..especially after getting a very incompent internal exanm from a quialified dr at the hospital once! I'd have no objections to helping anyone learn within reason.

I think the model option is just as good if not better than any of the others.

I dont mind having students prod and maul me but not everyone has my attitude why not let people who are willing make a coupple of quid out of making sure that trainee quacks know the ropes.

Isnt that what lecturers do, just that they expose you to their knowledge and the models would expose you to their...well your the one with the training you should know what Im talking about...their lady gardens

one love

Actually I'm tempted to say that it could be a paid service, but now I'm worried that that's a bit weird. Get the sex workers off the streets and into the doctor's office?

Or even bored women who could do with a change from the normal routine (or the boyfriend!) could pop along to earn a couple of pints.

Which one was better to learn from?

I have only examined gynea patients in clinic or during an operation.

In clinic was good, but I was lucky enough to be with a consultant who didn't pressurise the patients, and was very good at explaining to them why we needed to do it.

Practiceing on an anaestised patient was useful, because you could work out where everything was without having to worry about taking too long or hurting them. But asking for consent in advance was quite awkward, only about one in ten patients consents. For some reason asking 'may I examine you whilst you are anaestisted' was more awkward than 'may I examine you'. I think the main problem was that the patients didn't understand what I wanted to do, and probably thought I was some sort of pervert!

It could have been a lot easier if there had been a leaflet that explained who medical students were, and why it was important to us, and that they could say no without it affecting there care.

On the question of employing women to be examined.

On one level it's a great idea, It would be great to examine someone who was giving you constant feed back, 'no that hurts', 'you're pressing too hard' etc. On another level, there's something odd about it isn't there?

I wouldn't like the idea that the women were doing it because they had no choice. And there's no way of guarenteeing that they do have choice, it may be the only job that they can find, or the only job that practically fits in around childcare.

We certainly get paid for it here in the US! Most medical schools have fliers up advertising for "pelvic exam instructors" -- pays quite well, about $75 for a 2-3 hour session, from what I recall.

I really dislike having multiple students poke around in me while I'm going in for my own exam, but it's a very different matter when a) I'm not there about my own personal health, and b) I'm in a situation where I'm encouraged to give lots of feedback and have a little control over the situation.

Well unfortunaly I have already been subjected to the medical student im sorry to use the word "subjected" but thats what it felt like, I went for a blood test and i was the students guinea pig, i didnt really mind but would have liked to have been asked first as i was only 16 at the time (18 now) and nervous of needles, however she did ok but just for the life of her couldnt get any blood out of me, in the end the trainer took over and my arm went numb for about half an hour.

However I know what its like to have no one what you near them or their pets in my case as i want to train as a vet nurse, so i really have no problem with trainees examining me as i have had it all done before and you gotta start somewhere.

In answer to the first question - carefully

Theres plenty of women like myself who spread them when asked nicely at family planning.

I would much rather be concious than unconcious for a pelvic exam. Or just about any other physical exam, for that matter. I want to know what is going on.

I wouldn't mind at all if my regular Ob/Gyn presented a single medical student during my exam and asked if it was okay if said student could learn on me. I wouldn't permit a line up of multiple students taking turns, however.

after having many trips to the docs or gyne-hospital, theres not been that many times where students have been present,and i cant for the life of me remember having been examined by one...,if anything theyv'e just stood there and watched..
but ive generally just felt like a guinnea pig anyway..having had 2-laparoscopys,..found i have endometriosis...poly-cystic ovaries...dont ovulate every month...and then given the option at 21yr to have an hyterectomy...in which i refused,so i was put on male hormone injections in my stomach to see if that helped..nope it didnt..
tho i went on to have a child without any help from hospital..
i probably would allow a student to examine me,as they cant be that much worse than what ive experienced from prof-docs..

I have never had a student physician present during any of my doctor visits - OB/GYN or otherwise. That said, whether I would mind or not would depend on the doctor.

If my OB took on a student I would consent to letting him or her examine me, because I love my OB and trust her implicitly. If I were going to a clinic where I didn't regularly see the same doctor or if it were a doctor I was unfamiliar with, I would prefer it be just me and the doc.

On a somewhat related note, I wouldn't feel as comfortable with a student working with my GP, as I don't like him as well and don't trust him as much. (I'm currently considering switching docs).

I think the examination instructor/model situation sounds like a good idea. I wouldn't worry so much that women didn't have a choice about taking the job, there are certain jobs I would prefer to collect unemployment than do myself. I would probably even consider taking such a job, if only to see the looks on people's faces upon telling them I lay on my back and spread my legs for a living . On a much more serious note, I would be interested in passing on to students techniques that I've experienced that I've been very comfortable with.

Mmmm, as a woman, I'd have to say - one student at a time, who asked and explained that they were learning, yes.

But what I hated when I was having my son in 1986, was a whole herd of students, accompanying the consultant, who all lined up to examine me, while the consultant asked them questions, as if I was non-sentient!

"I wouldn't like the idea that the women were doing it because they had no choice. And there's no way of guarenteeing that they do have choice, it may be the only job that they can find, or the only job that practically fits in around childcare."

Out of interest why would it bother you that someone was doing a job because they had no choice, or that was the only one they could find or fit in around childcare? Or is what bothers you that someone was doing a job that involved their 'privates'?

I've done lots of jobs that I hated because they were the only job I could find at the time (so I had no choice), and I've just given up a job I loved because it doesn't fit with my family live, so in effect I'm now doing the only job that practically fits in around childcare.

If people are turning up willingly, then that's all you need to worry about, surely?

On the subject of being examined while knocked out - no I wouldn't like that much. I'd rather be awake so I know exactly what's going on.

More or less what Mina said. It strikes me that the paid instructor bit is the best option of all, or even volunteer instructors. A more entertaining way of volunteering than helping out in an Oxfam shop or doing Meals on Wheels.

It seems to me to be like being a life model but different, and I am sure that there are enough women out there who would be willing. I would, simply because I find the different ways I relate to my body interesting, and I find a lot of them difficult. This is one I would find challenging to be honest, and all the more reason to do it.

Regarding being examined during an appointment: I would feel more comfortable having a student examine me if the 'real' doctor was one I saw regularly, whether they were my GP or a specialist. I would also feel much more comfortable if it was a routine exam, not one where there was a lot of emotion around the build-up and the result.

I would probably say 'yes' to being examined while anesthesised, but it would be my least preferred option of all.

Ben

There's one point in favour of patients (consenting, naturally) being used instead of paid instructors, and that's that it in all likelihood, an instructor will be in good health, whereas a patient may have a complication which the student will need to know how to identify.

It seems to me the best system for any students to learn about performing any type of examination. As mentioned, some people may feel they can't refuse, but I think the many people would say so in no uncertain terms if they didn't like the idea of students being present.

The problem with women consenting to being examined whilst they're under anasthestic might be that they can't say ouch.

That's what would stop me from consenting. If it hurts and I'm awake I'd tell the medic to stop, or to be more gentle and they therefore wouldn't damage fragile tissues or whatever. If I'm out cold, potentially the medic could be too rough, without realising it and accidently cause some damage, which would only be apparent when the patient woke up.