WTP1.11 Do I know what I feel? Training and confidence in digital rectal examinations

Digital rectal examinations (DRE) are covered briefly at medical school, however, outside of specialty clinics these are commonly performed by foundation doctors. This project aims to identify the confidence of medical students and foundation doctors in performing and identifying clinical signs on DRE. From one NHS trust, foundation doctors and final year medical students were given a self-assessed questionnaire to state their confidence level on identifying clinical signs and pathologies on DRE. Confidence was assessed on a Likert-scale (unconfident to very confident), with DRE divided into inspection, palpation, neurology and withdrawal. Under 20% of respondents rated themselves confident across all aspects of DRE, with none being very confident. Over 95% expressed a desire for further training. Confidence was highest on the withdrawal aspect, with over 75% confident; fresh PR blood over 90% were confident in identifying, with 20% very confident. In contrast, more specific pathologies including prostate changes and rectal masses only 20% and 35% stated they could confidently identify them. Responses also noted a lack of consistency about how to clinically document any identified pathologies. DRE is a key examination, recognised by NICE as essential for clinical investigations of several conditions. Yet there is a lack of specific training during medical school and foundation years, compared to other system examinations. This is highlighted by the lack of confidence expressed within the questionnaire and desire for further training. Additional training should increase confidence and the ability to identify pathologies, with further research required to identify the training approaches required.