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Abstract
Disorders of defecation, including constipation and fecal incontinence, are very common. The digital rectal examination (DRE) is a key component in the early evaluation of patients with these complaints. Confident performance of a DRE requires dedicated training for the clinician and hands-on experience with the technique. DRE can yield a diagnostic accuracy comparable to specialized physiologic tests, including anorectal manometry. This review will describe in detail the steps required to perform a thorough DRE evaluation, as well as the proper interpretation of observations. Thereafter, the current evidence-based findings supporting the value of DRE in defecatory disorders will be summarized.
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Affiliation(s)
- Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, 915 North Grand Boulevard, St. Louis, MO 63106, USA; Department of Psychiatry, Washington University School of Medicine, 915 North Grand Boulevard, St. Louis, MO 63106, USA; St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA.
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Del Pozo MS, Redondo C, Fernández FR, Sanz MJG, Ríos JS, Borque-Fernando A. Homogenizing the Teaching of Engaged Medical Examinations to Large Numbers of Students: the Experience of the Digital Rectal Examination. J Cancer Educ 2022; 37:81-87. [PMID: 32514727 DOI: 10.1007/s13187-020-01789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This project aims to complement and homogenise the teaching of indications and technique of digital rectal examination (DRE) through the use of simulators, and subsequently analysed the level of satisfaction with the training and skills acquired. The students were distributed into small groups. One of the workshop's coordinators synthesised indications and procedures of DRE. A teaching video was made with all the contents and was distributed between the trainers. During the workshop, trainers explained the indications and the method of performing the DRE. Then, the selected clinical cases were presented, followed by the DRE by specific simulators. Once the students had completed each exploration, the trainers explained each case and discussed it with students. The following week, an anonymous questionnaire was given to participants to evaluate the workshop. Of the 232 participating students, 53 (23%) responded to the questionnaire. The overall level of satisfaction was higher than 98% (score 4-5), reaching 100% in the evaluation of the practical contents, and 93% of the students would recommend the continuity of the workshop in the next courses. The DRE workshop was well received among medical students, with a high degree of voluntary participation and response rate to the subsequent survey. With this project, we have achieved a greater homogenisation of teaching within the subject of Urology, and greater confidence for the students when facing their future clinical practice.
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Affiliation(s)
- M Sanz Del Pozo
- Urology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Cristina Redondo
- Urology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
- IIS Aragon, Zaragoza, Spain.
- Department of Surgery, Gynecology and Obstetrics, Urology area, School of Medicine, University of Zaragoza, Zaragoza, Spain.
| | - F Romero Fernández
- Department of Surgery, Gynecology and Obstetrics, Urology area, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - M J Gil Sanz
- Urology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
- IIS Aragon, Zaragoza, Spain
- Department of Surgery, Gynecology and Obstetrics, Urology area, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - J Subirá Ríos
- Department of Surgery, Gynecology and Obstetrics, Urology area, School of Medicine, University of Zaragoza, Zaragoza, Spain
- Urology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Borque-Fernando
- Urology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
- IIS Aragon, Zaragoza, Spain
- Department of Surgery, Gynecology and Obstetrics, Urology area, School of Medicine, University of Zaragoza, Zaragoza, Spain
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Al Asmri MA, Ennis J, Stone RJ, Bello F, Haque MS, Parle J. Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis. BMJ Simul Technol Enhanc Learn 2020; 7:414-421. [DOI: 10.1136/bmjstel-2020-000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/18/2020] [Indexed: 11/03/2022]
Abstract
BackgroundDigital rectal examination (DRE) is a challenging examination to learn.ObjectiveTo synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.Study selectionEMBASE, Medline, CINAHL, Cochrane, Web of Knowledge (Science and Social Science), Scopus and IEEE Xplore were searched; the last search was performed on 3 April 2019. Included were original research studies evaluating TES to teach DRE. Data were abstracted on methodological quality, participants, instructional design and outcomes; a descriptive synthesis was performed. Quality was assessed using a modified Medical Education Research Study Quality Instrument. The study design domain was modified by scoring the papers based on (1) evaluation of risk of bias for randomised controlled trials, (2) description of participants and (3) assessment of robustness and degree of simulation fidelity of the assessments used to evaluate learning.Findings863 articles were screened; 12 were eligible, enrolling 1507 prequalified medical/clinical students and 20 qualified doctors. For skill acquisition, role player was statistically significantly superior to a static manikin (2 studies). For knowledge acquisition, manikin use was significantly superior to role player (1 study); 2 studies showed no difference. For confidence, manikin use was significantly superior to no manikin (4 studies). For comfort, manikin use was significantly superior to no manikin (2 studies). For anxiety, role player was significantly superior to manikin (1 study).Median overall quality score (QS) was 48% (27–62). Highest median QS was 73% (33–80) for data analysis; lowest median QS was 20% (7–40) for the validity of instrument. Six papers scored over 50% of the maximum score for overall quality.ConclusionsTES training is associated with improved DRE skills and should be used more widely.
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Schneiderman H, Lopetegui-Lia N. Better Rectal Examinations: Technique, Teaching, Teamwork. Am J Med 2020; 133:1045-1047. [PMID: 32450127 DOI: 10.1016/j.amjmed.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Henry Schneiderman
- Department of Internal Medicine, Saint Francis Hospital and Medical Center, USA/Trinity Health Of New England, Hartford, Conn; Department of Internal Medicine, University of Connecticut School of Medicine, Farmington; Department of Medicine, Quinnipiac University School of Medicine, North Haven, Conn; School of Nursing, Yale University, New Haven, Conn.
| | - Nerea Lopetegui-Lia
- Department of Internal Medicine, University of Connecticut School of Medicine, Farmington
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DeZeeuw J, O'Regan NB, Goudie C, Organ M, Dubrowski A. Anatomical 3D-Printed Silicone Prostate Gland Models and Rectal Examination Task Trainer for the Training of Medical Residents and Undergraduate Medical Students. Cureus 2020; 12:e9020. [PMID: 32775100 PMCID: PMC7405975 DOI: 10.7759/cureus.9020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The current generation of graduating medical students is entering into practice with minimal exposure to the digital rectal examination (DRE), a necessary component of a complete physical examination. Simulation-based medical education (SBME) using anatomical silicone models and task trainers can provide hands-on training opportunities for medical students to rehearse DREs. However, there is a scarcity of affordable, validated, and anatomically correct silicone prostate models and task trainers for rehearsing DREs. This technical report describes and validates evidence for silicone prostate models and a DRE task trainer created from three-dimensional (3D)-printed molds for medical student- and resident-training and clinical skills maintenance. A pre-existing 3D human model and five different prostate models from open-source, royalty-free websites were converted using Fusion360™ (Autodesk Inc., San Rafael, CA) into stereolithography files and altered to produce negative molds. The prostate molds were filled with silicone and polylactic acid filament “nodules”. The buttocks were isolated from the human model and an anal canal was designed with a larger cavity on the interior to hold the silicone prostate models to simulate a real DRE. Five practicing urologists were recruited to evaluate the 3D-printed silicone prostate models and the DRE task trainer. The participants were provided with a qualitative survey and asked to rate the perceived realism and educational effectiveness of the prostate models and task trainer. The silicone models and task trainer were found to be useful for simulation training when attempting DRE techniques. The feedback from the participants was positive overall and provided recommendations for improvement including stabilizing the prostate models in the task trainer, smoothening the transition between the rectum and the prostate, and adding an additional “normal” prostate model. Silicone prostate models and DRE task trainers created from 3D molds are economical and anatomically and tactically accurate training tools to teach and maintain DRE skills as compared to commercially available, cost-prohibitive models. After making the suggested and appropriate modifications, the prostate models and DRE task trainer could potentially be used as tools for clinical skills training and maintenance and for patient education in the future.
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Affiliation(s)
- Jasmine DeZeeuw
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Noel B O'Regan
- Anesthesiology, Memorial University of Newfoundland/Janeway, St. John's, CAN
| | - Christine Goudie
- Medical Education and Simulation, Memorial University of Newfoundland, St. John's, CAN
| | - Michael Organ
- Urology, Memorial University of Newfoundland, St. John's, CAN
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Affiliation(s)
- Satish S C Rao
- Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Clements MB, Schmidt KM, Canfield SE, Gilbert SM, Khandelwal SR, Koontz BF, Lallas CD, Liauw S, Nguyen PL, Showalter TN, Trabulsi EJ, Cathro HP, Schenkman NS, Krupski TL. Creation of a Novel Digital Rectal Examination Evaluation Instrument to Teach and Assess Prostate Examination Proficiency. J Surg Educ 2018; 75:434-441. [PMID: 28923535 DOI: 10.1016/j.jsurg.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/16/2017] [Accepted: 08/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To create a validated tool to measure digital rectal examination proficiency and aid with teaching of the examination. DESIGN The Digital Rectal Examination Clinical Tool was created using a modified Delphi method with 5 urologists and 5 radiation oncologists. The instrument was then validated in a population of preclinical medical students examining male urological teaching associates, and clinical trainees (third- and fourth-year medical students and urology resident physicians) examining prospectively enrolled subjects. Trainees completed paired examinations with an attending urologist, and responses were scored with reference to the attending responses. SETTING The instrument was validated at the University of Virginia in the urology clinic, endoscopic operating room, and main operating room settings. PARTICIPANTS We tested the instrument on consenting subjects consisting of male urologic teaching associates (n = 12), clinic patients (n = 4), and operating room patients (n = 64). The participants were undergraduate (n = 302) and graduate (n = 9) medical trainees. RESULTS In preclerkship trainees, improved scores in subjects without abnormal compared to those with abnormal findings demonstrated validity. In clinical trainees, scores on the Digital Rectal Examination Clinical Tool increased by 2% for each additional year of training, demonstrating construct validity. CONCLUSIONS We used an expert panel to create a novel instrument for measuring digital rectal examination proficiency and validated it with preclinical and clinical trainee cohorts at our institution.
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Affiliation(s)
- Matthew B Clements
- Department of Urology, University of Virginia, Charlottesville, Virginia.
| | - Karen M Schmidt
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | | | - Scott M Gilbert
- Department of Urology, Moffitt Cancer Center, Tampa, Florida
| | - Shiv R Khandelwal
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Bridget F Koontz
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stanley Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Paul L Nguyen
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Edouard J Trabulsi
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Helen P Cathro
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Noah S Schenkman
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, Virginia
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McAlpine K, Steele S. Missing the mark: Current practices in teaching the male urogenital examination to Canadian undergraduate medical students. Can Urol Assoc J 2016; 10:281-285. [PMID: 27878052 DOI: 10.5489/cuaj.3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The urogenital physical examination is an important aspect of patient encounters in various clinical settings. Introductory clinical skills sessions are intended to provide support and alleviate students' anxiety when learning this sensitive exam. The techniques each Canadian medical school uses to guide their students through the initial urogenital examination has not been previously reported. METHODS This study surveyed pre-clerkship clinical skills program directors at the main campus of English-speaking Canadian medical schools regarding the curriculum they use to teach the urogenital examination. RESULTS A response rate of 100% was achieved, providing information on resources and faculty available to students, as well as the manner in which students were evaluated. Surprisingly, over one-third of the Canadian medical schools surveyed failed to provide a setting in which students perform a urogenital examination on a patient in their pre-clinical years. Additionally, there was no formal evaluation of this skill set reported by almost 50% of Canadian medical schools prior to clinical training years. CONCLUSIONS To ensure medical students are confident and accurate in performing a urogenital examination, it is vital they be provided the proper resources, teaching, and training. As we progress towards a competency-based curriculum, it is essential that increased focus be placed on patient encounters in undergraduate training. Further research to quantify students' exposure to the urogenital examination during clinical years would be of interest. Without this commitment by Canadian medical schools, we are doing a disservice not only to the medical students, but also to our patient population.
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Affiliation(s)
| | - Stephen Steele
- Department of Urology, Queen's University, Kingston, ON, Canada
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Abstract
The digital rectal examination (DRE) is performed in children less often than is indicated. Indications for the pediatric DRE include diarrhea, constipation, fecal incontinence, abdominal pain, gastrointestinal bleeding, and anemia. Less well-recognized indications may include abdominal mass, urinary symptoms, neurologic symptoms, urogenital or gynecologic symptoms, and anemia. Indeed, we believe that it should be considered part of a complete physical examination in children presenting with many different complaints. Physicians avoid this part of the physical examination in both children and adults for a number of reasons: discomfort on the part of the health care provider; belief that no useful information will be provided; lack of adequate training and experience in the performance of the DRE; conviction that planned "orders" or testing can obviate the need for the DRE; worry about "assaulting" a patient, particularly one who is small, young, and subordinate; anticipation that the exam will be refused by patient or parent; and concern regarding the time involved in the exam. The rationale and clinical utility of the DRE will be summarized in this article. In addition, the components of a complete pediatric DRE, along with suggestions for efficiently obtaining the child's consent and cooperation, will be presented.
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Affiliation(s)
- Susan R Orenstein
- University of Pittsburgh School of Medicine, 303 Church Ln, Pittsburgh, PA, 15238-1063, USA.
| | - Arnold Wald
- Division of Gastroenterology & Hepatology, University of Wisconsin School of Medicine & Public Health, Centennial Building, 1685 Highland Ave, Madison, WI, 53705-2281, USA.
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Rodríguez-Díez MC, Díez N, Merino I, Velis JM, Tienza A, Robles-García JE. Simulators help improve student confidence to acquire skills in urology. Actas Urol Esp 2014; 38:367-72. [PMID: 24332529 DOI: 10.1016/j.acuro.2013.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/23/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To know the level of confidence of fifth year medical students in order to perform maneuvers in bladder catheterization and rectal examination before and after training with simulators. To be able to assess student satisfaction regarding the use of the simulation as a learning method. MATERIAL AND METHODS The study was conducted in the Simulation Center of the Faculty of Medicine. A total of 173 students who completed a practical workshop on the subject of Urology participated. The students were asked to answer anonymous questionnaires on their level of confidence in performing a bladder catheterization and rectal examination before and after the workshop as well as their satisfaction in using the simulation as a training tool. The workshops were organized using groups of 10 students. A teacher or a resident in that area of expertise supervised each student individually, resolving their doubts and teaching them the proper technique. RESULTS All the evaluations made on the different abilities were significantly higher after training (P<.001). Significant differences were found in the confidence level between men and women before the training regarding male urethral catheterization maneuvers and recognition of normal or pathological prostate, The confidence level was lower in women (P<.05). These differences disappeared after training. The level of overall satisfaction with the workshop was high, going from 4.47 ± 0.9 to a maximum score of 5. CONCLUSIONS Simulation is a training method that helps improve the confidence of the medical student in performing a bladder catheterization and digital rectal examination.
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Affiliation(s)
- M C Rodríguez-Díez
- Unidad de Educación Médica y Centro de Simulación, Facultad de Medicina, Universidad de Navarra, Pamplona, España.
| | - N Díez
- Unidad de Educación Médica y Centro de Simulación, Facultad de Medicina, Universidad de Navarra, Pamplona, España
| | - I Merino
- Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España
| | - J M Velis
- Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España
| | - A Tienza
- Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España
| | - J E Robles-García
- Departamento de Urología, Clínica Universidad de Navarra, Pamplona, España
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