In Tomorrow's Doctors the General Medical Council recommended that medical schools construct a list of procedures in which students should show competence by the time they qualify.1 There is general acceptance that such core skills include passing a speculum, taking a smear, and performing a competent pelvic examination. Anecdotal evidence from medical students, particularly male students, is that experience in this area is difficult to obtain. This is not a problem confined to the United Kingdom. In response to a similar perception among their male students, staff at the University of California studied patients' views on the involvement of medical students in the women's visits in an outpatient gynaecological and obstetric setting.2 They found that 81% of patients accepted the involvement of students during a gynaecological visit, with no preference for a particular sex. However, the study did not directly address the issue of intimate examinations. We surveyed women attending a gynaecology clinic in an inner London teaching hospital to examine women's experience of and attitudes to the sex of medical students.
Methods and results
We surveyed women attending a gynaecology clinic in the academic year 1999-2000. Women were approached only when a student was working with the doctor they had seen. Questionnaires were given out by nursing staff after the consultation. Two hundred questionnaires were distributed and 181 were returned. The age range of respondents was 17-79 years (mean 40 (SD 13) years). Just under a quarter (44) of the women were attending a gynaecology clinic for the first time. Ten women had never been sexually active, and 64 had no children. In the sample 166 women had interacted with students. Six women who saw more than one student at the same consultation were omitted from the analysis. Ninety seven women had interaction with male students and 63 with female students.
Students had low levels of interaction with patients. Just under half (73) of the women reported that students asked questions, 25 that students did general examinations, and 31 that students did intimate examinations. There was a trend towards female students being more actively involved in examination: in 12 of the 63 visits (19%) involving female students the student did a general examination, compared with 13 of the 97 visits (13%) involving a male student, and the corresponding figures for intimate examinations were 14 (22%) for female students and 15 (15%) for male students.
The women were asked to consider the potential involvement of a student during a consultation. Their attitudes differed according to the sex of the student, with a preference for female students in all types of interaction. More women said they would allow a female student than a male student to observe their genital area (140 v 93 of the 181 women; χ2=45, P<0.001), and more said they would allow a female student than a male student to do an intimate examination (114 v 72; χ2=63, P<0.001).
From a practical perspective we were interested in ways of identifying women who would agree to intimate examination by students of either sex. This would reduce the difficulty of the encounter and embarrassment for patient and student. We chose parity and age as easily identifiable markers, both suggested during the questionnaire design process. Older women were more likely than younger women to agree to intimate examination by students of either sex, as were women who had had children, compared with women who had not (table). Although older, parous women were more accepting of the involvement of students, the difference according to sex of the student was maintained.
Comment
Our findings support the claim of male medical students that it is more difficult for them than for female students to get experience of gynaecological examination. Some women attending this outpatient clinic were agreeable to examination by students of either sex. It may be necessary to target such women for involvement with student education.3 It may be appropriate to use different teaching methods and settings for different aspects of teaching gynaecology: the teaching of consultation skills could be confined to the outpatient clinic, while pelvic models and volunteers could be used to teach clinical skills.
Table.
Numbers (percentages) of women responding to the question “Would you allow a student to do an intimate examination?”
| Respondents
|
Yes to male or female students
|
Yes to female students, no to male students
|
No to both male and female students
|
χ2
|
|---|---|---|---|---|
| All respondents (n=170) | 72 (40) | 41 (23) | 57 (31) | — |
| Respondents who had had children (n=105) | 53 (50) | 25 (24) | 27 (25) | 10 (P=0.007)* |
| Respondents aged ⩾41 years (n=86) | 45 (52) | 27 (25) | 15 (17) | 20 (P<0.001)† |
Compared with women who have not had children.
Compared with women aged ⩽40 years.
Footnotes
Funding: NO'F is currently funded by a researcher development award under the national primary care development programme.
Competing interests: None declared.
References
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