a Department of Family and Community Medicine , University of Maryland School of Medicine , Baltimore , Maryland , USA.
Teach Learn Med. 2013;25(4):383-91. doi: 10.1080/10401334.2013.827969.
Current training in the United States for pelvic speculum examinations (PSEs) has a primary focus on the physician-centered goal of visualizing the cervix but may not inform practitioners of potential iatrogenic effects. Such oversight leaves trainees unprepared and unskilled in preventing and addressing adverse outcomes. This article incorporates a literature review into a step-by-step guide to aid the teaching of PSEs.
Iatrogenic effects of PSEs may include mild discomfort, extreme pain, anxiety, psychological (re)traumatization, and sexual pain disorders. A literature-based guide is presented to identify patients at risk for adverse outcomes, set up the exam room, set up the patient, perform the exam, calm distressed patients, and avoid exam-interfering behaviors.
Although PSEs can lead to adverse outcomes, awareness of the iatrogenic effects allows clinicians to utilize techniques to prevent or reduce negative effects. A method of incorporating techniques described in this article into teaching is provided.
目前美国针对阴道窥器检查（PSE）的培训主要侧重于以医生为中心的观察宫颈的目标，但可能不会告知从业者潜在的医源性影响。这种忽视使受训者在预防和处理不良后果方面准备不足且缺乏技能。本文将文献综述纳入逐步指导，以帮助教授 PSE。
阴道窥器检查可能会产生一些医源性影响，包括轻度不适、极度疼痛、焦虑、心理（再）创伤和性功能障碍。本文提出了一个基于文献的指南，以识别可能出现不良后果的患者，布置检查室，安排患者，进行检查，安抚紧张的患者，并避免妨碍检查的行为。
虽然阴道窥器检查可能会导致不良后果，但对医源性影响的认识使临床医生能够利用技术来预防或减少负面影响。本文提供了一种将本文所述技术纳入教学的方法。
