Pelvic exam by a medical student for the first time

by Paul B. Kubin

They say you never forget your first “real” patient.  Mine was a woman who didn’t need a pelvic exam, but who got one anyway.

Next door, minutes later, my second patient provided another personal first: a male genital and rectal exam, also, without need. Medical students like me begin training by practicing the basics on one another–listening to heart sounds, and looking into each other’s ears and eyes—but eventually, every clinician-in-training must lay hands on a complete stranger.  As medical students, this is a moment we look forward to as the official start to our medical career, and also dread for its awkward potential to demonstrate how much we have yet to learn.

Historically, it has been common practice for medical students to do full exams on each other, irrespective of their genders. Yes, you read that right.  Imagine being told to shuffle into an exam room with another student (male or female) to look at, listen to, and feel each other’s anatomy – and I mean all of it.  The rationale for this practice is the belief that the only way a clinician can understand what a patient goes through is to spend some time going through it too.  It’s an admirable goal, but let’s face it: your doctor or physician assistant, no matter how caring, is not your friend.

My school, a University of California medical school, did it this way until about 2004, and I give thanks every day that students are now broken in a little more gently.  Nowadays we only do the simple exams on each other while wearing shorts and shirts or bras.  Later, when it comes to the more “invasive” exams, we work with standardized patients. These are “real” strangers who are paid on a per-exam basis to provide the type of learning experience you can’t get from a plastic model.  Usually they are the first strangers we touch as medical students.

Despite the time spent preparing for my first standardized patient, the days leading up to the experience were full of dread.  I read my texts carefully.  I practiced on anatomical models.  My dreams were fraught with visions of passing out under the stirrups, or nervously saying something stupid, like “Well, everything looks great down here!”  I even asked my wife what a pelvic was like. “Honey,” she rolled her eyes, “you have no idea.”  It wasn’t helpful at all, but that was the point; I needed to figure it out for myself.

She was right, of course; I had no idea.  Thankfully my patient was a cheerful woman who had worked with students before.  She noticed how nervous I was, and made a joke or two to put me at ease.  She even gave me helpful feedback about my technique – feedback that I know better than to go into here.  Despite my fears, it turned out fine.  It was a great (if surreal) experience, and I realize now that everyone has to start somewhere, even if that somewhere is totally lost.

Paul B. Kubin is a physician assistant student who blogs at Inside PA Training.

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