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Learning the Pelvic Examination
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The inspiration for the present studies was the learning concept that used professional patients (PP) as instructors for medical students in learning how to perfom the pelvic examination (PE).

Interviews performed with women who were PPs showed that they experienced a continuous beneficial increase in knowledge. This promoted personal development related to bodily awareness and affirmed their femininity, making them less vulnerable and reversing their approach to their own body of being an object to becoming a subject. The growing ability to contribute to students’ learning and the feeling of being valuable enhanced the PPs self-esteem and well-being and promoted independence in the learning situation. Being a PP was rewarding and contributed to the feeling of being empowered and growing as a woman in the examination chair.

Two models of teaching the PE to medical students were compared: with PPs or with clinical patients (CP). The outcome showed that the PP students were more skilful in palpating the terus and ovaries and performed more PEs during the clinical clerkship than did CP students.

Female and male medical students were interviewed after they had performed their first PE with PPs as instructors. The female students’ most obvious concern was about looking and touching another women’s vulva whereas male students were concerned about how to establish rapport with the PP. The interactive and supportive feedback from the PPs enabled the students to overcome their hesitation and encouraged creative learning of interpersonal and palpation skills. The LS positively enhanced the female students’ awareness of own bodies and promoted a deeper interest in PEs, both as an examiner and as patients. The male students became aware of the importance of creating a beneficial interaction with the woman and gained an insight into a previously “unknown” female world that deepened their understanding of women’s possible vulnerability during a PE.

Women at an outpatient clinic participated in individual LSs about the female anatomy and the PE, and performed a PE on a mannequin prior to visiting the gynaecologist. Following the visit interviews were performed to gain a deeper understanding of the impact of the LS. The womens’ active participation during the LS generated increased self-confidence and knowledge, triggered emowerment and promoted a creative ability to interact subsequently during their own PE.

Part of the studies involved developing a questionnaire to measure the fear of performing the pelvic examination, the Fear of Pelvic Examination Scale (F-PEXS). The questionnaire was shown to have a very good reliability (e.g. Cronbach alpha is .96) and good construct validity.

Engaging voluntary, healthy and knowledgeable women as instructors in the PE situation creates a safe and ethical learning environment and promotes interaction with students. Immediate constructive feedback enables students to integrate communication and behavioural skills in a professional manner whilst learning to palpate the uterus, facilitating an inner security as a future examiner.

The learning sessions were of benefit to the PPs, the female students in the PP model, and the women in the clinical study. The acquired knowledge started something positive within the women; a will to act and find out more about themselves. The LSs initiated empowerment in the sense that an empowered person has increased capacity to act in goal-directed ways.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin , 2007. , 102 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1031
Keyword [en]
Medical students, women, learning, pelvic examination, empowerment
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-10272ISBN: 978-91-85895-37-3 (print)OAI: oai:DiVA.org:liu-10272DiVA: diva2:17018
Public defence
2007-12-01, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-11-20 Created: 2007-11-20 Last updated: 2013-09-12
List of papers
1. A Stronger and Clearer Perception of Self Womens Experience of Being Professional Patients in Teaching the Pelvic Examination: a qualitative study
Open this publication in new window or tab >>A Stronger and Clearer Perception of Self Womens Experience of Being Professional Patients in Teaching the Pelvic Examination: a qualitative study
2006 (English)In: BJOG: An International Journal of Obstetrics and Gynaecology, ISSN 1470-0328, Vol. 113, no 8, 890-895 p.Article in journal (Refereed) Published
Abstract [en]

Objectives To identify and describe the experience of being a professional patient (PP) in teaching the pelvic examination (PE).

Design Qualitative study using in-depth interviews.

Setting Participant's home, place of work or other place of choice.

Population Thirteen female PPs who teach the PE to medical students and student midwives.

Method Semi-structured interviews analysed with an interpretive phenomenological approach.

Main outcome measures Five themes were identified during the analysis: 'embodied knowledge', 'promoting a proper approach', 'redrawing private boundaries', 'feeling confident' and 'doing something meaningful'. The essence 'experience of stronger and clearer perception of self' emerged from the themes and is the described structure of the lived experience of the women who are PP.

Conclusions Being a PP in this setting was beneficial for the women. They acquired increased knowledge about their bodies and PE procedure, which led to a new awareness of their own body. Contributing to students' learning in such an intimate examination procedure was rewarding and increased self-esteem.

Keyword
Interpretive phenomenology, pelvic examination, professional patient, qualitative study, women's experience
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12769 (URN)10.1111/j.1471-0528.2006.01019.x (DOI)
Available from: 2007-11-20 Created: 2007-11-20 Last updated: 2013-09-12
2. Medical students learning the pelvic examination: Comparison of outcome in terms of skills between a professional patient and a clinical patient model
Open this publication in new window or tab >>Medical students learning the pelvic examination: Comparison of outcome in terms of skills between a professional patient and a clinical patient model
2007 (English)In: Patient Education and Counseling, ISSN 0738-3991, Vol. 68, no 3, 211-217 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To compare two models of learning the pelvic examination (PE) for medical students, with professional patients (PP) or with clinical patients (CP), by measuring perceived distress and learning outcome in terms of skills.

Methods: Prospective longitudinal study. Assessments of self-perceived distress on four occasions at the prospect of performing a PE. Evaluation of the learning session (LS) and clinical clerkship concerning outcome of palpation skills.

Results: During the LS, students in the PP model (PP students) received enough guidance from their coaches, were certain they had palpated the uterus and at least one ovary, and were less distressed afterwards compared with students who were instructed using the CP model (CP students). During the clinical clerkship, the PP students performed twice as many PEs as CP students did and had more often confirmed palpating the uterus and an ovary.

Conclusion: PP students were more skilful in palpating the uterus and ovaries and performed more PEs during the clinical clerkship than did CP students.

Practice implications: Engaging healthy and voluntary women as PPs takes time and effort. It is, however, worthwhile as it increases the confidence of students who perform PEs, makes them more competent, and ultimately improves their skills in performing the examination during their clinical clerkship.

Keyword
Pelvic examination, Medical students, Professional patient, Learning outcome, Skills
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12770 (URN)10.1016/j.pec.2007.05.007 (DOI)
Available from: 2007-11-20 Created: 2007-11-20 Last updated: 2009-08-21
3. Performing the First Pelvic Examination: Female Medical Students’ Transition to Examiners
Open this publication in new window or tab >>Performing the First Pelvic Examination: Female Medical Students’ Transition to Examiners
2007 (English)In: Patient Education and Counseling, ISSN 0738-3991, Vol. 69, no 1-3, 55-62 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To gain a deeper understanding of how female medical students perceive and experience performing their first pelvic examination (PE).

Methods: A qualitative study. In-depth interviews after the students’ involvement in a learning session about the PE, with professional patients (PPs) as instructors and a gynaecologist as supervisor. The interviews were analysed according to the constant comparative method to acquire a deeper understanding of the students’ experiences and the ongoing social processes.

Results: “Transcending unspoken boundaries and taboos, a prerequisite for learning” was the essence of the entire material and was identified from two categories: “A didactic design facilitates the transition to examiner” and “Interactive support enables creative learning of interpersonal and palpation skills”.

Conclusion: Through interactive guidance from the PPs, the students overcame affective obstacles and achieved the aim of becoming an examiner. The favourable learning experience heightened their awareness of their own bodies and promoted a deeper interest in PEs, both as examiners and as patients.

Practice implications: Engaging voluntary, healthy and knowledgeable women as instructors in the PE situation creates a safe learning environment and promotes interaction with students. Immediate feedback teaches students to integrate communicative and behavioural skills in a professional manner and to palpate the uterus.

Keyword
Pelvic examination, Medical students, Professional patients, Education, Interactive learning, Qualitative method
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12771 (URN)10.1016/j.pec.2007.07.002 (DOI)
Available from: 2007-11-20 Created: 2007-11-20 Last updated: 2013-09-12
4. Female patients learning to perform the pelvic examination"Active involvement triggers empowerment": a qualitative study
Open this publication in new window or tab >>Female patients learning to perform the pelvic examination"Active involvement triggers empowerment": a qualitative study
2007 (English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12772 (URN)
Available from: 2007-11-20 Created: 2007-11-20 Last updated: 2013-09-12

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Siwe, Karin

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