Wilt T J, Cutler A F
Minneapolis Veterans Affairs Medical Center, MN 55417.
J Gen Intern Med. 1991 Nov-Dec;6(6):514-7. doi: 10.1007/BF02598219.
To describe internal medicine residents' training and performance as well as patients' attitudes and knowledge regarding the rectal examination.
Descriptive survey of university-trained internal medicine residents and general medicine clinic patients.
General internal medicine residents' longitudinal clinic at a university-affiliated Veterans Affairs Medical Center.
PATIENTS/PARTICIPANTS: Ambulatory male veterans attending their general internal medicine clinic, all of whom were over the age of 40 years and had previously had a rectal examination (n = 100), as well as all second- and third-year University of Minnesota internal medicine residents (n = 78) were surveyed using a self-administered questionnaire.
Residents differed in their training in, practice of, and understanding of indications for the rectal examination. Little formal instruction regarding patient comfort had been provided to residents, and many residents had never received supervised instruction in the rectal examination. Patients frequently were uncertain about why the examination had been performed, lacked understanding of the results of the examination, and often had preferences for examination comfort measures that differed from those utilized by their physicians.
Increased supervised instruction in the rectal examination in medical training programs is recommended. This should emphasize not only appropriate indications for this procedure but also attention to patient communication and comfort.
描述内科住院医师的培训与表现，以及患者对直肠检查的态度和认知。
对大学培养的内科住院医师和普通内科门诊患者进行描述性调查。
一所大学附属退伍军人事务医疗中心的普通内科住院医师长期门诊。
患者/参与者：在普通内科门诊就诊的男性退伍军人，均年龄超过40岁且之前接受过直肠检查（n = 100），以及明尼苏达大学所有二年级和三年级的内科住院医师（n = 78），通过自行填写问卷进行调查。
住院医师在直肠检查的培训、实践及对检查指征的理解方面存在差异。很少有针对患者舒适度的正规指导提供给住院医师，许多住院医师从未接受过直肠检查的带教指导。患者常常不确定为何进行该项检查，对检查结果缺乏理解，并且在检查舒适度措施方面的偏好往往与医生采用的不同。
建议在医学培训项目中增加直肠检查的带教指导。这不仅应强调该操作的适当指征，还应注重与患者的沟通及患者舒适度。
