Clinical Practice

[WIPANC]

I am a prospective PA student who was just offered my first interview. As I was going through and reading more about the school, I found that the students practice clinically on each other. I was wondering if this is common among PA schools. The school mentioned that students would wear a tshirt and shorts to class and must be able to remove their shirts for thoracic, cardio and abdominal examination. I find this to be a little uncomfortable and was just wondering if this is normal and I should get used to seeing it as a part of the curriculum or if it was something I could avoid. Thoughts?

[cinntsp]

Yes, this is the norm at every program. Females wear a sports bra when shirts come off.

 

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[Planteater]

In our clinical skills lab, we were in small groups to practice (4-6 students in a room). My group was usually all female which I preferred. When we were all together as a big group practicing something, the guys usually volunteered to be the "patient". Also, we tended to have some students that were more comfortable being undressed in the group and they would just let the rest of us practice on them. Anyway, yes it is the norm, but we mostly stuck with individual comfort levels in my program.

[PYRITE]

It is the norm. At our program we had to switch partners every week so we could see as many variants of normal as possible. We worked with male and female partners. As stated above, women wore sports bras and shorts, men wore shorts. It was absolutely no big deal at all. People got so comfortable that men and women often changed for cadaver lab in the same locker room area to save time. No big deal.

[loliz]

Not normal, not professional and weird.

My school hired "patients" for us to learn physical exams. Most of the patients had been doing it for years and were also the patients used in OSCE and in the med school. I think the only time that we learned a new skill on each other may have been the musculoskeletal exam.

A school should not expect adult students to be half naked in front of each other. No, I'm not a prude, but these are my professional colleagues and I don't ever want to be comfortable enough with them that stripping down is no big deal.

[EMEDPA]

we stripped down daily in small sections for all exams including for testicular and breast exams. we had paid models for the pelvics and plastic models with prostates with different pathology for rectals.

but it was the early 90s...

[Timon]

We were assigned partners to learn how to do a physical exam. We'd have a session where 1 person would volunteer as a model for the class of 60. Then we 'd break off into small groups with a bunch of faculty to help us go through it. We were in shorts, females had sports bras. Some females requested female partners and practiced in private.

 

With breast and pelvic exams. We got to use plastic models and later used paid actors in a very structured environment and in groups of 4 and learned the pelvics / breast. This was the only time we did pelvics /breast exams.

 

We also used paid actors for our OSCE labs and verbalized (DRE, Pelvic / Etc). We are also graded on limiting the amount of exposure a patient experiences forcing us to learn how to keep the patient draped appropriately.

[swooshie1]

Not normal, not professional and weird.

My school hired "patients" for us to learn physical exams. Most of the patients had been doing it for years and were also the patients used in OSCE and in the med school. I think the only time that we learned a new skill on each other may have been the musculoskeletal exam.

A school should not expect adult students to be half naked in front of each other. No, I'm not a prude, but these are my professional colleagues and I don't ever want to be comfortable enough with them that stripping down is no big deal.

 

Just out of curiosity, how did you manage to do a musculoskeletal exam without your "patient" in shorts or sports bra (e.g., "half-naked") ?  

 

Practicing on classmates was the norm for my program as well for all but the female gyn/breast and male gu exams.  The program hired out for those roles. Practicing everything else on classmates was NOT a big deal, and since this IS all about practice, we often continued our practice on each other on our own time in prep for OSCEs etc.  This was helpful, not unprofessional. 

[Will352ns]

Not normal, not professional and weird.

My school hired "patients" for us to learn physical exams. Most of the patients had been doing it for years and were also the patients used in OSCE and in the med school. I think the only time that we learned a new skill on each other may have been the musculoskeletal exam.

A school should not expect adult students to be half naked in front of each other. No, I'm not a prude, but these are my professional colleagues and I don't ever want to be comfortable enough with them that stripping down is no big deal.

Your school had patients at the ready at all times for you to practice on?  I find that very hard to believe.  We had to practice quite a bit in order to pass our practicums and OSCE's, not to mention the PD courses lasted over a year.  Or did you guys simply not practice?

 

We only had live models for prostates and vag exams.

[Guest Paula]

10 years ago my class practiced on each other and we wore gowns with shorts and sport bras for women underneath. Privacy was allowed and I did not think it was unprofessional. Funny story: there were paid models for the pelvic, breast and male exams. One of the male models had the prostate exam done so often that he had an abnormal exam detected by a student. He had developed a callous in the rectum from too many exams and had to take a break from his job for a while. I thought the models were a somewhat interesting group of people......

[marktheshark89]

We all practice on each other. It might be uncomfortable for some, but I found it valuable in becoming more aware of what its like being a patient and how uncomfortable that can be. We wore gym attire, girls wore sports bras. 

[rev ronin]

To answer the OP's question, yes, you WILL get used to it. It's no big deal... or rather, it won't be any big deal after you've mastered it.  This is one of the downsides to having limited HCE--switching from "normal" nudity to "medical" nakedness thought processes is something that should happen before PA school.

 

In normal society, people undress partially or fully to show off their nice-looking bodies, to make others jealous or entice them.  Full nudity is something shared with intimate partners. The only people displayed naked in media (Schindler's List excepted) are beautiful, desirable people. There are other exceptions, but you get the point.

 

In medicine, nakedness is utilitarian.  We need patients naked because so we can see their problems; they are going to describe problems to us, and expect us to look at their vaginal discharge, their hemorrhoids, their breast lumps, their inguinal rashes, penile warts, and the like.  In emergency medicine, we need to see their orifices to stick tubes, specula, or the like into them, or we need to see the unconscious trauma patient stripped naked to survey and inspect their injuries.  It's not sexy to see patients naked--it's part of the sacred trust of medicine.

 

Moving between the two modes of dealing with human bodies isn't automatic or easy.  If the only time you've ever seen a member of the opposite sex without clothing is in a sexual context, you need to start somewhere in learning to react professionally--not just behave appropriately or intellectually understand what's going on, but emotionally distance yourself and conduct the encounter clinically.  Working with classmate partners in minimal clothing and working on trained models for genital or breast exams is a crash course in medical nakedness during your didactic year, that, just like the rest of didactic year, serves to set you up for clinical year where you refine and develop the approach.

 

There's usually some awkwardness involved in the learning process.  I remember matter-of-factly stating "you're nowhere near my scrotum" to a female classmate who was hesitatingly trying to find a femoral pulse on me, which set one of the other women in our practice group to giggling, and we quickly lost the next few minutes laughing at my absurd yet direct statement.  It's not just the invasive exams that need models, either: if you've never handled an uncircumcised penis before, when are you going to learn to appropriately manipulate a foreskin? Hopefully sometime before your first patient...

[taotaox1]

Rev nailed it so I don't know there is much for me to say other than:

 

A.  Yes it is normal.  Not sure where loliz went to school, but it would be very out of the norm to not be practicing on eachother.

B.  No, it is not something you can (or should even if you could) get out of.

C.  Everyone was at least as dressed as they would be at a swimming pool (and generally more, as women wore running shorts and sports bras not bikinis).  You won't be doing Pelvic/GU/Rectals on each other (you will have paid patients for this).  Listening to bowel sounds is about as rough as things get. 

[Maynard]

we stripped down daily in small sections for all exams including for testicular and breast exams. we had paid models for the pelvics and plastic models with prostates with different pathology for rectals.

but it was the early 90s...

EMEDPA,

 

Is this post for real? I honestly can't tell. I've heard some crazy (and true) stories regarding cultural practices with regards to nudity, but I've never heard of students playing the patient for testicular and breast exams.

 

Interesting (and disturbing) side note: if you go back even further in time, it used to be the norm for med students to practice pelvic exams on anesthetized female patients, without their knowledge or consent. 

 

I agree with MarktheShark that playing the patient helps providers to appreciate what real patients go through. I've worked with many in nursing who are so accustomed to nudity that they have no sensitivity for what the patient might be feeling, to the point of being borderline callous.

[hitzgrl123]

As most everyone else has said, yes it's normal. However, I am in the minority here and will say that I HATED it. We had to switch partners weekly and we're not allowed to pull curtains closed, so the whole class could see everyone.

 

I know that in medicine skin is no big deal, but for me, MY skin being on display like that in front of my peers was a huge deal that caused me anxiety each time we had to do it. My favorite thing about being in my clinical year is that I get to keep all my clothes on!

 

In the long run though, it was a small price to pay for the privilege of being a PA-C someday.

[patachok]

I echo Timon, as we had it in our school exactly as he described.

I came with a pretty extensive medical background, and have seen so many naked people (in the OR and on the floor) that I see no problem with exposed skin. I am also adult enough to not care about stripping down to shorts and sports bra.

However, I respect and understand other people's concerns. There are always things you can do to ease off your anxiety, i.e work with a female partner and so on. I am sure you will find a way around it.

[lov2xlr8]

A few of my old professors that had graduated in the 80's told me that breast exams on each other were common, hard to think about the ramifications of that now, but definitely a different time period then

[loliz]

Obviously the patients were not available at all times. They were there for us to learn the exam and we also had class time to practice with them. For additional practice we were on our own, some people worked with friends or classmates, others worked with family or whatever. As for musculoskeletal, which someone asked about, its pretty easy to learn this exam in shorts and a tank top. No need for undressing.

 

Apparently, I am very wrong in assuming this is how most schools do this. And its not that I am not adult enough to deal with some skin, it just seems like a weird request of a school. Especially the school that doesn't allow the curtains to be pulled… strange.

 

I stand corrected, and very surprised!

[rpackelly]

At a well known long established Cali program, students did pelvics and testicular exams on each other from the 1970s through the early 1990s.   And, the instructors also volunteered annually.  So this thread seems pretty funny to me.  How times have changed!