Pelvic examinations by medical students

Article Abstract:

Medical students learn from doing examinations on patients in an educational setting. The pelvic examinations performed in obstetrical and gynecological departments are particularly uncomfortable and intrusive to women. Patients have the right to refuse to participate in procedures performed by any students. Although patients should be notified of the educational aspects of the examination by means of informed consent forms, these policies are often not strictly followed. A questionnaire was sent to 123 heads of obstetrical and gynecological departments in accredited medical schools to evaluate the policies and practices of medical student education. The medical students themselves were also questioned. Of the departments responding, 60 percent reported that informed consent was used to notify patients of the medical student's role in the practices of the healthcare team. No information was given to patients in 23 percent of the departments. Healthy volunteers were used as subjects of practice physical examinations in 75 percent of the medical schools polled, while 23 percent of the students had no previous contact with volunteers before examining actual patients. While most medical schools encourage students to identify themselves as such to patients, 42 percent of third-year students polled do not identify themselves as students. It is concluded that the policy of informed consent was not being adhered to. The guidelines of this policy state that patients must be informed of the educational status of any healthcare provider. Teaching hospitals are a unique environment and informed consent should be obtained before patient contact. Ultimately, the patient will benefit from what is being practiced, in the sense that physicians will benefit from actual patient contact during training. Although it is sometimes difficult to obtain an informed consent, the process should be part of developing a strong relationship between the healthcare provider and patient.

Psychological aspects, Usage, Physician and patient, Physician-patient relations, Informed consent (Medical law), Informed consent, Medical education

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Prediction of preterm delivery: Is it substantially improved by routine vaginal examinations?

Article Abstract:

Preterm delivery, occurring before the 37th week of pregnancy, is associated with a poor outcome of the pregnancy. Knowing the risk for preterm delivery helps to plan pregnancy management protocols. Risk status is determined by maternal characteristics such as age, socioeconomic and marital status, number of previous deliveries, reproductive history and current symptoms. Vaginal examination can tell whether premature delivery is imminent by revealing the condition of the cervix. However, repeated vaginal examinations are thought to increase uterine contractions and contribute to the early rupture of the membranes surrounding the fetus. To see if routine vaginal examinations improves the prediction of preterm delivery, 6,909 women attending a prenatal clinic were evaluated. Known risk factors for preterm birth and results obtained by vaginal examination were compared. Women were classified at two periods of gestation, 25 to 28 weeks and 29 to 31 weeks of pregnancy. Although the improvement was not great, vaginal examinations did enhance the ability to predict preterm delivery. Of women in their first pregnancies who were given high-risk status (a total of 30 percent), 55 percent were correctly identified by risk factors alone. When the results from vaginal examinations were added in, the number of correctly identified high-risk pregnancies increased to 63 percent. Risk factors alone predicted 52 percent of the high-risk women with a previous history of pregnancy, which increased to 55 percent when results of vaginal examinations were considered. Although the prediction of a preterm delivery was improved by using vaginal examinations, the tradeoffs between the modest degree of improvement and the positive and negative effects of the procedure itself need to be assessed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Risk factors, Medical examination, Pregnant women, Premature labor

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Resident data collection: do the numbers add up?

Article Abstract:

Comparisons among obstetrics and gynecology residency programs would be difficult because residency programs do not have standardized data collection systems. A two-part survey was sent to the 272 accredited U.S. and Canadian obstetrics-gynecology residency programs. The first part asked questions about data collection. The second part asked program directors to assign responsibility according to the involvement of the residents in three hypothetical cases. Fifty-three percent of the programs responded. Nearly 80% of the programs used a paper-based system. Only 27% had systems for resolving responsibility questions where entries conflicted and only 31% had a system for evaluating accuracy of data entry. Only 8.3% of programs could collect data on primary care experiences, which is becoming an important part of residency training. Directors varied widely in how they assigned responsibility in the three hypothetical cases.

Practice, Information management, Residents (Medicine), Gynecology, Graduate medical education, Postgraduate medical education

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