By Liz Granger Contributing Writer
When Feinberg student Sagar Shroff removed the speculum while performing his first live pelvic exam, one of his fears came true. His "standardized patient," an instructor who is trained to simulate a real patient, flinched because Shroff removed the tool without properly closing it.
Shroff practiced the exam before, but only on rubber models.
Feinberg Prof. Dr. Carla Pugh, the associate director for the Center of Advanced Surgical Education, invented a pelvic exam simulator that includes tiny sensors, which feed information to a computer monitor.
The sensors are placed inside models of vaginas and rectums. As students' fingers move along the anatomy, they can see the location of their hands on a screen.
"When you put your finger in someone's rectum for the first time, you think you know where the prostate is, but you don't," Pugh said. "Several things in medicine are assumed to be learned in time, but I think we can do better than that. You can't teach everybody everything in a lecture format."
She said she believes the medical school curriculum does not adequately prepare students for hands-on work and that they need a "fill-in" between written tests and real patients.
"Graduating from medical school, your skills have been tested with pen and paper," Pugh said. "But that doesn't show if you know how to make an incision."
Pugh's pelvic exam simulators are commercially available and are used in more than 60 medical and nursing schools. They cost between $16,000 and $20,000 each.
She also created breast and prostate prototypes, which she uses in NU's curriculum.
Greg Auffenberg, a second-year Feinberg student, is enrolled in Physical Examinations, a course that uses Pugh's models.
"You do the exam like it were any normal person," Auffenberg said. "You see a picture on a computer screen (and) dots light up representing the area you're in. It's not a 100 percent replication, but it's pretty nice."
To practice the breast exam, people acting as patients don strap-on breast models. Medical students divide into small groups to perform the procedure, which "can take up to three minutes for each breast," according to a video shown in class.
Auffenberg's tactics prove decidedly less intimate than that of his predecessors.
Some American doctors, mostly older ones, learned to give vaginal, rectal, breast and testicular exams on their classmates in medical school.
Shroff said he thinks that sounds terrible.
"Even if you're sticking to the same gender, that would be awful," Shroff said. "Even doing the non-sensitive exams on your classmates is awkward. You have to take your shirt off for the lung exam."
Dr. Shari Goldman, who practices gynecology at Northwestern Memorial Hospital and leads clinical instruction at Feinberg, learned to perform pelvic exams on women who volunteered. She did her first rectal and testicular exams on-site in an emergency room.
"I did all sorts of procedures and exams without having used a simulator before," Goldman said.
She says simulators reassure students about their procedures.
"Models help students achieve a certain air of confidence," Goldman said. "That puts patients at ease, too."
Reach Liz Granger at e-granger@northwestern.edu.
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