Do undergraduates need to learn vaginal examination?
Rapid response to:
Education And Debate
The ethics of intimate examinations—teaching tomorrow's doctorsCommentary: Respecting the patient's integrity is the keyCommentary: Teaching pelvic examination—putting the patient first
Do undergraduates need to learn vaginal examination?
As an undergraduate, I think I performed about 10 vaginal
examinations, all in out-patients with verbal consent. In my pre-
registration house officer year in a very large inner city hospital I did
not need to perform any vaginal examinations and in the following year, as
a senior house officer in adult medicine in a medium sized district
general hospital, needed to perform this examination on one patient. I
then began my career in paediatrics and in the last 15 years, I have never
performed a speculum examination, and never expect to do one again.
The expansion of medical knowledge has lead to an examination of the
goals of the undergrauduate curriculum in most medical schools. It is now
clear that the medical student cannot learn or retain all, or even most of
the current body of knowledge in all specialties. The emphasis has shifted
to teaching core information and equipping students for "life long
learning."
It seems to me that there is a large group of doctors who do not need
to be able to perform vaginal examination throughout their careers. There
is a second group who need to be competent; it is unlikely they become
competent as a result of undergraduate teaching and should be trained at
postgraduate level. A third group probably perform occasional vaginal
examination; I would question whether their skills are reliable and if a
speculum examination is needed, a gynaecologist should be asked to see the
patient.
During my career I have needed to perform endotracheal intubation on
hundreds of infants, insert chest drains and umbilical catheters, yet no-
one is concerned that medical graduates have not been taught these skills
whilst students. Surely a form of examination which most patients dislike
and which is unlikely to be taught well after a few attempts should be
learned in training posts appropriate to those specialties which require
the skill.
Rapid Response:
Do undergraduates need to learn vaginal examination?
As an undergraduate, I think I performed about 10 vaginal
examinations, all in out-patients with verbal consent. In my pre-
registration house officer year in a very large inner city hospital I did
not need to perform any vaginal examinations and in the following year, as
a senior house officer in adult medicine in a medium sized district
general hospital, needed to perform this examination on one patient. I
then began my career in paediatrics and in the last 15 years, I have never
performed a speculum examination, and never expect to do one again.
The expansion of medical knowledge has lead to an examination of the
goals of the undergrauduate curriculum in most medical schools. It is now
clear that the medical student cannot learn or retain all, or even most of
the current body of knowledge in all specialties. The emphasis has shifted
to teaching core information and equipping students for "life long
learning."
It seems to me that there is a large group of doctors who do not need
to be able to perform vaginal examination throughout their careers. There
is a second group who need to be competent; it is unlikely they become
competent as a result of undergraduate teaching and should be trained at
postgraduate level. A third group probably perform occasional vaginal
examination; I would question whether their skills are reliable and if a
speculum examination is needed, a gynaecologist should be asked to see the
patient.
During my career I have needed to perform endotracheal intubation on
hundreds of infants, insert chest drains and umbilical catheters, yet no-
one is concerned that medical graduates have not been taught these skills
whilst students. Surely a form of examination which most patients dislike
and which is unlikely to be taught well after a few attempts should be
learned in training posts appropriate to those specialties which require
the skill.
Competing interests:
None declared
Competing interests: No competing interests