Department of Thematic Studies - Technology and Social Change, Linköping University, Linköping, Sweden.
Department of Obstetrics and Gynaecology, Linköping University, Linköping, Sweden.
Med Educ. 2020 Apr;54(4):348-355. doi: 10.1111/medu.14126.
Teaching intimate examinations to medical students has been recognised as difficult because of the anxious feelings that the students may experience. For their professional development, previously incorporated understandings need to be relearned: how to transgress boundaries that regulate intimacy and physical closeness, learning to examine and touch other peoples' bodies, and talking about things that are otherwise taboo.
This paper compares how students learn to perform two intimate examinations: (i) the digital rectal examination (DRE) of the prostate, and (ii) the bimanual pelvic examination (PE) and analyses how norms and expectations affect how students learn to approach them.
This study is based on ethnographic work: in-depth qualitative interviews with two urologists and nine medical students in semesters four, eight and 11 of a medical education programme in Sweden, observations of three learning sessions where 16 students performed the PE on professional patients, and 2 days of observations at a urology outpatient clinic.
The educational approach to the PE and DRE differ. The PE is taught as sensitive and to be handled with care, using a well-documented learning concept including interpersonal and technical skills. The patient's exposed position in the gynaecological chair, possible previous negative experiences of PE or sexual exploitation are taken into account. In contrast, there is no educational concept for teaching the DRE. The students perform their first DRE on a clinical patient. The DRE is also handled with care, but with less sensitivity. The patients' possible previous negative experiences are not discussed and are thus made invisible.
Well-established routines in performing the PE help doctors and students to be attentive to patients' emotions and previous experiences, and remind them to perceive the examination as sensitive. Aligning the teaching of the DRE with that of the PE will improve how the male prostate patient is approached.
由于学生可能会感到焦虑，因此向医学生教授私密检查一直被认为是困难的。为了他们的专业发展，以前的理解需要重新学习：如何跨越规范亲密关系和身体接触的界限，学会检查和触摸他人的身体，并谈论其他禁忌的事情。
本文比较了学生如何学习进行两种私密检查：（i）直肠指检（DRE）前列腺，以及（ii）双合诊（PE），并分析了规范和期望如何影响学生学习的方法。
本研究基于民族志工作：对瑞典医学教育计划的第四、八和十一学期的两位泌尿科医生和九名医学生进行深入的定性访谈，观察了 16 名学生在专业患者身上进行 PE 的三次学习课程，以及在泌尿科门诊观察了两天。
PE 和 DRE 的教育方法不同。PE 被教授为敏感的检查，需要小心处理，使用包括人际和技术技能在内的有充分文件记录的学习概念。考虑到患者在妇科椅上的暴露位置、可能之前的 PE 或性剥削的负面经历。相比之下，没有用于教授 DRE 的教育概念。学生在临床患者身上进行第一次 DRE。DRE 也以谨慎的态度处理，但敏感性较低。患者可能之前的负面经历没有被讨论，因此变得不可见。
在进行 PE 时，既定的常规操作有助于医生和学生关注患者的情绪和以往的经历，并提醒他们将检查视为敏感。将 DRE 的教学与 PE 的教学对齐将改善对男性前列腺患者的处理方法。
