Vaginal and Speculum Examination in Medical Curricula

EDITORIAL COMMENT: We hope that this paper will receive close attention from all our readers especially those who as professional teachers or full‐time clinicians instruct medical students or midwives in performing vaginal examination, either bimanual or with a speculum, either at an outpatient clinic or in the labour ward. It seems to the reviewers of this paper that there is an urgent need to improve our teaching experience concerning vaginal and speculum examination, and the first step is to realize how inadequate our teaching is at present. The suitability of the outpatient clinic for instruction of students would be enhanced if time was put aside specifically for the purpose of instructing the students rather than expecting the consultant to cope with a busy workload and also the problem of student teaching. It would also seem that the more detailed and prolonged the teaching vaginal examination is, the more necessary it becomes for the supervisor to gain formal consent from the patient, which is an increasingly sensitive issue in teaching hospitals in Australia. It is the Editor's opinion that teaching bimanual vaginal examination when the patient is anaesthetised is a very suitable procedure, but should only be practised when the woman realizes that the student is a member of the medical team looking after her, and that there is only 1 student in the team, and that she can choose not to consent to the teaching examination. Summary: Medical students' perception of their own psychomotor skills and attitudes to different methods of teaching the gynaecological examination were studied. Students rated their physical skills poorly, only 7% feeling confident they could detect an abnormality and only 14% considering their ability to perform a Pap smear was good or very good. They rated their doctor/patient skills better, 55% considering they are good at conducting an examination with sensitivity and 67% at explaining to their patient what they were doing and why. Students' first preference for instruction was to examine patients in the Outpatient Clinic under the supervision of a doctor, a method experienced by most students on one occasion. The next preferred method was for students to work with 2 trained gynaecological assistants, acting as patient and instructor, with discussion of feelings and feedback (see Subjects and Methods). The option of student volunteers was a least favoured method but was cited as first preference by 5 % of students. Over 25 % of the female students considered volunteering for vaginal examination a ‘possibility’ if they were examined by a student of the same sex. Over 25% of males would ‘possibly’ volunteer for rectal examination only if the same sex was present. The comments by the students offer help in the future planning of teaching vaginal examination.