Learning Intimate Exams

I work as a male urological teaching associate. I use my body to teach students to find all of the physical landmarks to do a complete exam including inguinal lymph nodes, hernia, testicular cancer, STD's, locate the epididymus, vas deferns, femoral pulse and a DRE. The sessions usually have 4 students at a time.

WHAT? What qualifies one to be a "male urological teaching associate"? You're saying you do this for a living??

I never had a teacher use their own body let alone genitalia to demonstrate something. I didn't even know that was a thing. Having said that it wouldn't really bother me, sure it would be uncomfortable at first but nothing I couldn't overcome. But I understand everyone is different so expect a wide array of responses. I do think it's a good idea to meet the students beforehand and give them a plan of action and what to expect so it's not a total shock and allow them to meet you before the actual examination.

Wow I didn't know teachers used themselves as teaching tools either. Honestly at the end of the day no member bothers me just because well as nurses we have seen many, but I could see how this could put you in a potentially unsavory position. I need more details. Why wouldn't they have you use pictures instead of yourself?

I think you misunderstand the OP's job. Unless he's just one of those guys that gets his jollies from starting discussions like this (and we do get those here, so let's just see how this thread evolves), he's like a sample patient who helps emerging clinicians learn physical assessment before they see actual patients. There are women who help teach pelvic exams, and there are men who help teach prostate palpation.

Being completely boring and playing it straight, I'd say that an intro discussion about societal taboos and cultural factors would be good, and also give you a chance to use those words that your class might feel a little odd about using. Good modeling. After that, the best advice I ever got as a student about this sort of topic was from a famous football coach discussing what he tells guys that act as if their touchdown was the biggest thing ever seen in a stadium: Act like you've been there before.

No, I am a standardized patient who specializes in teaching intimate exams. I have my female counterparts called GTA's who teach students how to give a breast exam and gynecological exam including how to take a PAP smear.

Years ago they would take medical students into asylums and use patients there to teach and practice mostly gynecological exams but male exams to a lesser degree. They reasoned that since the state was caring for them they could use them as they wished.

When that caused an ethical upset in the press they then used anesthetized patients who were in the OR at teaching hospitals prior to an unrelated operation without specific consent or knowledge. They got away with it by burying a clause in the 20 page informed consent form everyone has to routinely sign, often while they are on a gurney headed toward an OR. They reasoned that patients at a teaching hospital should expect such treatment and what a patient does not remember can't hurt her. That still goes on today at some hospitals but is fast fading away.

Then they tried hiring prostitutes and indigent men, often winos. But that made many students feel uncomfortable and the "patients" could not give guided feedback. It was no better than using mannequins.

Some medical schools then used peer physical exams asking students to practice on each other. The reasoning is that students should know what it feels like to be the patient. But students felt used and coerced and resented paying big tuition bills while being subjected to unwanted treatment. Plus with more and more women attending medical school there were huge issues with this.

Since this happened mostly to women, women's rights groups alerted by nurses, began complaining. So about 30 years ago GTA and MUTA programs were begun out of the standardized patient programs. It was lead by women who wanted better treatment by their doctors, mostly men, who often paid little attention toward patient modesty or sensibilities. The idea was to train people to train med students and nurse practitioners how to approach patients with the greatest level of comfort and dignity while preforming an effective exam. Also we can give excellent feedback on where to find landmarks, how hard to press when palpating, and what words to use to avoid patient discomfort. These are things that pictures can not achieve because palpating is a tactile skill not a visual skill.

Although we are paid a fee, nobody can make a living doing this. Just like I donate blood several times a year I do this to help the medical community to improve itself. Otherwise the first exam a new doctor does is on a patient who is in pain. may be fearful, is vulnerable and is not likely to tell the doctor that he is being too rough or doing it wrong. If you Google GTA MUTA Gynecological teaching associate you will read more about these programs in medical and nursing schools.

Nobody can do this for a living. We are paid a small stipend but most of us, male and female, do this to improve the medical profession. Similar to donating blood several times a year. Yes, we are trained by gynecologists and urologists just like every standardized patient is trained. Google GTA MUTA gynecological teaching associate and male urogenital teaching associate. Also ask your director of clinical skills at your school for more information.

Acting like you have been there before when you have not presents students with a dilemma of sorts. How much to tell a patient? Do you intentionally hide the fact that you are new to medicine in order to keep your patient calm or are you honest to develop trust with the patient? As a patient I prefer the later.

As a patient I personally have had doctors and nurses outright lie to me because they assumed I knew nothing about medicine. I gently called them out on it because I knew they, being only human, were a bit insecure and thought they were shielding me. The problem is that the patient very likely realizes that they were "shielded" and learns to mistrust the medical profession. Not good.

That being said, there is also something to be said for being able to put a little starch in your demeanor. Experienced nurses I know all have that stone face that they can put on when having to do an unpleasant procedure. It is a fine line that has to be walked and it is always a judgement call.

The "act like you've been there before" refers to professional demeanor, not being deceptive about your credentials or experience. That's what the football coach meant, too. Act like a pro.

It is perfectly appropriate to say, "I'm a nursing student/NP student/MEd student/whatever," and if the patient asks, "This is a procedure I've learned in my program, and I'd really appreciate your feedback."

I like the blood donor analogy. :)

I've been a patient in teaching facilities, with students of many types. Maybe it's the nurse in me,but I always take the opportunity to teach them if I can. I remember once, when I was admitted with what turned out to be a viral meningitis, having my history of present illness taken by a student. He was faltering a bit, so I suggested, "What makes it better and what makes it worse?" He brightened, and said immediately, "Whatmakesitbetterandwhatmakesitworse?" I smiled, painfully, because my head was killing me, "One at a time, dear."

I know what you mean. Years ago when I was in my 20's I was taken to the ER for difficulty breathing and was diagnosed with pneumonia. The Doc said he would order a shot of antibiotics to "kickstart" the fight with the infection followed by oral meds for a week or so. He walked over to the nurse who was in charge to give the orders. She looked at me, turned away with a slight smile and looked around for a nurse to give me the shot. She selected the youngest nurse who looked about 16. Had to be her first week working in the ER. When she came over the expression on her face was priceless - deer in the headlights look, and fumbled a bit filling the hypodermic right in front of me. Nothing was prepackaged back then. She then turned toward me and with a sheepish stammer asked me for my, ... um, ... er, .... um hip. I saw her boss looking at us over the young nurses shoulder so I thought I would help her out.

I asked if she was new. Of course she was. So I suggested these things to talk her through it:

1. Never show the patient the needle. Prepare it out of sight.

2. Tell the patient that the doctor ordered you to give them an injection of whatever it is.

This confirms to the patient that you have the right orders and sort of blames the doctor.

3. Be sure to close the curtain.

It gives the patient his privacy and avoids being watched by your boss.

4. Ask the patient to turn around, lower their trousers and underwear, and lean over the exam table

a bit. He won't see the needle or have to watch you seeing him undress.

5. Then tell your patient you will be touching his right hip, find your landmarks in the upper outer

quadrant, tell him you are swabbing the site, ask him to take a deep breath and exhale, and

then insert the needle firmly just as you learned in school and you will be fine.

She was so relieved and asked if I was a nurse. I told her no. Everything I learned was from a corpsman, often near a rice paddy.

SMH - very weird thread.... but interesting. Maybe OP doesn't realize that nursing education is not funded well enough to hire standardized patients. If we're lucky, we have high tech manikins. One of my grad school instructor's hubby had a very interesting heart murmur, so she "voluntold" him to come to class as a guinea pig, but we certainly didn't do anything more intimate than stethescope to chest.

"Voluntold", eh? I like that He should be commendedHow many faces did he light up when the

It is sad that we do not fund our nursing students and even our medical students better. However there are many nursing schools that do, specifically for nurse practitioners. NP's and PA's need to be expanded otherwise we will not have enough medical personnel to cover our aging population, especially in rural areas.

Sometimes the nursing students are transported to a medical college but some schools are large enough to have the proper clinical skills facilities available. The problem for the schools is the cost of floor space and equipment that is not in constant use. I can see a day when there will be more clinical skills centers, separate from a medical college, designed to teach specific technical skills on high end mannequins and well trained standardized patients.

Who should be the first person that you stick a needle into to draw blood? Or have you place a Foley? Or administer an IM injection for the first time? An unsuspecting patient who may be in pain or fear or somebody who has been trained to guide the student and accept the risks?

BTW, I have also participated as a test subject (human lab rat) in a clinical trial of a minimally invasive surgical implant device. I endured repeated examinations, sedation, surgery, bleeding, risk of infection, pain and discomfort, and about a week's worth of recuperation. As part of the process I agreed to multiple immodest exams by a fair number of people from the manufacturer as well as the medical staff conducting the study and greed to be photographed and witnessed by medical students or residents so that they can learn a new technique. I may have received the implant device or may have been in the sham control arm. I do not know and may never know. I did this to advance medicine without a guarantee of benefit to myself It is the only way to get new technology approved by the FDA.

Think of the fireman who enters a burning building, the police officer who chases the bad guys or the soldiers who advance toward the sound of guns. They all are trained and are willing to accept the risks for a greater cause. This is no different for me.