S T A N F O R D M E D I C I N E
Volume 16 Number 4, SUMMER 1999
Medical students practice
the pelvic and breast examinations
on their teachers.
By Kristin Weidenbach
AT A RECENT MONDAY NIGHT TEACHING SESSION, THIRD-YEAR STUDENT REBECCA LEIBOWITZ WAS A STUDY IN COMPOSURE AS SHE SAT, FINGER POISED, READY TO BEGIN HER FIRST RECTAL EXAM. Her subject, Barry Forgione, had already demonstrated the four possible positions for the exam, and now waited patiently, knees-to-chest, to talk her through the procedure. "That wasn't so bad," Leibowitz said when the ordeal was over. "The anticipation was a lot worse."
Forgione and others regularly lay aside their inhibitions and submit their bodies to repeated explorations by hesitant student fingers to coach the novices through these most intimate of examinations. Known as patient educators, these trained specialists teach medical students how to conduct pelvic and breast exams for men and women.
Alternating with her classmate, Justin Massengale, Leibowitz was winding up a complete breast, genital and rectal examination of Forgione. In separate cubicles down the hall, three other student pairs were being similarly schooled by male educators paid $60 an hour to have their bodily cavities and protuberances poked and prodded. On a previous night Massengale and Leibowitz had learned the exams with a female educator.
The patient educators are an integral part of teaching the pelvic and breast exams to second- and third-year students taking the course Preparation for Clinical Medicine. For most of the students it is the first time they have conducted one of these exams and for some of them it may be the first time they have seen a naked man or woman. "We create a very safe space for them to learn," says patient educator and coordinator of the program, Norma Wilcox. "We tell them this is the place to feel embarrassed and this is the place to ask questions. We are not expecting perfection."
Patient educators differ from the "standardized patients" used elsewhere in the curriculum (see main story) in that, as the name implies, a patient educator is both a pretend patient and an educator. Patient educators take an active part in the examination; telling students if their touches are too hard or too soft and telling them too when their probing fingers have found their goal. "I can tell the students when they're palpating the ovaries," says Molly Kenefick, who has been a patient educator for five years.
Many of those who become patient educators for Stanford medical school learned about the unusual job opportunity through volunteering at San Francisco Sex Information's hotline. Wilcox carefully selects people who are comfortable with their bodies. Each candidate completes a five-hour training session with Wilcox before they are qualified to work with students and all educators gather together once a year to practice their skills.
"It really takes a very special person," says Wilcox. "They are not doing it for the income. Many are also nurse practitioners, marriage or family counselors, or sexologists," she says.
Wilcox has been a patient educator since the Stanford program started in 1980. She currently has 14 men and 14 women in the program, many of whom have been patient educators for several years. The men in the program now are the same group that Wilcox recruited to launch the men's program in 1986.
Patient educators are not unique to Stanford. Since the concept was first conceived in 1972 at the University of Iowa Medical School, patient educators have become a respected part of the teaching program at most North American medical schools. Wilcox emphasizes that using patient educators is superior to other teaching methods because the educator can comment on the student's communication skills, body language and touch.
Like Wilcox, Kenefick and Forgione take great pride in what they do, and feel they are providing an important service, not only to each group of medical students that they instruct but to all of the future patients that these students will see. "We focus on really making it a positive experience for each student. If the first experience can be a positive one, that can affect thousands and thousands of patients," says Wilcox. SM