Turner K J, Brewster S F
Department of Urology, Churchill Hospital, Headington, Oxford, UK.
BJU Int. 2000 Sep;86(4):422-6. doi: 10.1046/j.1464-410x.2000.00859.x.
To assess the acquisition of skills in digital rectal examination (DRE) and urethral catheterization by medical students and house officers associated with a UK medical school, and to determine their confidence in these techniques. Subjects and methods Questionnaires were sent to all final-year medical students at Oxford Medical School immediately before their final examinations. Similar questionnaires were sent to all pre-registration house officers who had graduated from Oxford in the previous year.
Responses were received from 71% of the students and 84% of the graduates; 88% of the students and 94% of the graduates had been taught how to perform a DRE as a medical student, but 42% of medical students had performed fewer than five DREs before qualification. Their findings were rarely checked by a doctor. Of the students, 44% had never felt a clinically malignant prostate gland and 41% were 'not at all confident' in their ability to give an opinion based on their findings on a DRE. House officers performed DRE regularly (53% >/= 50 DREs) but rarely received additional instruction, and exposure to pathology remained limited. House officers' findings on DRE were rarely confirmed by a more senior doctor. Most respondents had been taught how to perform male urethral catheterization as a medical student (92% of students, 89% of house officers) but 48% of students had performed fewer than two catheterizations on qualification and 68% of house officers had received no additional instruction; however, 69% of house officers were 'very confident' in their ability to perform male urethral catheterization.
The DRE is a critical skill in assessing the prostate; students conduct few DREs, lack confidence and are exposed to minimal pathology. Legitimate concerns over students carrying out intimate examinations may be mitigating against the acquisition of skills. Possible solutions are explored. House officers perform DREs regularly, but with no additional instruction they may continue to lack confidence. Students lack experience in male urethral catheterization and rarely receive postgraduate instruction. House officers' confidence in their ability to perform male urethral catheterization may be misplaced.
评估与英国一所医学院相关的医学生和住院医师在直肠指检（DRE）和尿道插管方面技能的掌握情况，并确定他们对这些技术的信心。
在期末考试前，向牛津医学院所有即将毕业的医学生发放问卷。向所有上一年从牛津毕业的预注册住院医师发放类似问卷。
71%的学生和84%的毕业生回复了问卷；88%的学生和94%的毕业生在医学院学习期间学过如何进行直肠指检，但42%的医学生在取得资格前进行的直肠指检少于5次。他们的检查结果很少由医生检查。在学生中，44%从未触摸过临床上患有恶性肿瘤的前列腺，41%对根据直肠指检结果给出意见的能力“完全没有信心”。住院医师定期进行直肠指检（53%≥50次直肠指检），但很少接受额外指导，接触病理学知识仍然有限。住院医师直肠指检的结果很少由更资深的医生确认。大多数受访者在医学院学习期间学过如何进行男性尿道插管（92%的学生，89%的住院医师），但48%的学生在取得资格时进行的插管少于2次，68%的住院医师没有接受过额外指导；然而，69%的住院医师对自己进行男性尿道插管的能力“非常有信心”。
直肠指检是评估前列腺的一项关键技能；学生进行的直肠指检次数很少，缺乏信心，接触病理学知识极少。对学生进行私密检查的合理担忧可能不利于技能的掌握。探讨了可能的解决办法。住院医师定期进行直肠指检，但如果没有额外指导，他们可能仍然缺乏信心。学生在男性尿道插管方面缺乏经验，很少接受研究生阶段的指导。住院医师对自己进行男性尿道插管能力的信心可能没有根据。
