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I just want to ask if I’m overreacting to something that happened to me. So I had a clinical skills exam and during the pulmonary part I percussed and auscltated over breast tissue. My proctor freaked out at me and I had a professionalism meeting. It was a mistake sure but I think that it’s a mistake that should have been fixed in lab or our previous clinical skills exam I did it the same way in both and got no negative feedback. They documented the unprofessionalism and I feel super uncomfortable about it. I requested a zoom meeting with the program director. Every person that I have talked to has said that it is a reasonable mistake given the way the material is taught. I feel as though having this documented against me is a big deal even if my faculty advisor acts like it isn’t. What happens if I get a complaint on obgyn rotation next year? They’ll look at my file and say I have a history of inappropriately touching women. For reference I attached the picture that was on our rubric for the clinical skills exam. Opinions?

241CF0E7-C4DC-4893-89FC-9F51F49A88D9.png

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I'd like a little more context about what happened:
- Clinical skills exam means simulated patient, right? Was this a classmate, a paid actor, or a community volunteer?
- What is your age, sex, and the age and sex of the person you were examining?

Off the top of my head, that sounds like an odd way to approach a pulmonary exam. I'd be additionally worried that auscultating and especially percussing over breast tissue would be uncomfortable for the patient and unproductive. I don't do a whole lot of detailed pulmonary exams--and you probably won't either in practice, as a CXR is cheap--but I do the vast majority of my work on the back and have since EMT school.

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6 hours ago, rev ronin said:

I'd like a little more context about what happened:
- Clinical skills exam means simulated patient, right? Was this a classmate, a paid actor, or a community volunteer?
- What is your age, sex, and the age and sex of the person you were examining?

Off the top of my head, that sounds like an odd way to approach a pulmonary exam. I'd be additionally worried that auscultating and especially percussing over breast tissue would be uncomfortable for the patient and unproductive. I don't do a whole lot of detailed pulmonary exams--and you probably won't either in practice, as a CXR is cheap--but I do the vast majority of my work on the back and have since EMT school.

Opposite sex; percussion of anterior lung is part of rubric as is the picture posted; partner was female student; she said that she was not uncomfortable; attached is a picture from the rubric for the clinical skills exam; idk if this matters but this is my first semester and while I understand my technique was definitely wrong I wish they treated it more as a learning experience than a witch hunt 

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If this was a typical practical exam on a female classmate, it usually frequently means they are wearing a sports bra. Doing so can have the effect of smashing the breasts together making it impossible to percuss along the sternal borders. In a "real" patient, they would remove their bra and if you have them recline slightly, gravity will get breasts out of the way.

My practical exams were many years ago, but it was always understood that a female student would help move her anatomy around as necessary to facilitate the practical exam. It's not likely much was documented in your file, and I would not expect it to reappear anywhere. 

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So, the rule as a male is anything you do to a female is automatically wrong unless it's explicitly OK. It's not really that bad, but if you act from that standpoint, you are much better off.

You didn't answer my question about age, and didn't explicitly answer that you are male and she was female. Get away from the idea that it doesn't matter and learn to answer questions that were asked, please. In addition to sex based power dynamics, there's also potential age issues. If she's 22 and you're 40+ that's also a power differential you need to be aware of.

So, yes, if you did the auscultation per the male diagram on a female, you're into a lot of breast tissue unnecessarily and I suspect even counterproductively: you can't hear as much through breast tissue, so why even approach the exam that way?

But the need to touch female breasts for any reason in an exam should be explicit and well understood before going there. As @CAAdmission notes, asking a post pubescent female to hold and move her own breast tissue so that your contact is minimized is something I was taught as an EMT, well before PA school. Other tidbit was that if incidental contact or displacement was needed, such as placing leads V3-6, the back of your gloved hand was preferred.

The good news is you didn't creep your exam partner out. The bad news is that she knew what you were doing and why, which a random female patient might not. If she thought you were inappropriately touching her breasts for your own sexual interest, you would probably be gone from PA school already. If you did that on a rotation, you might get sent home and fail the rotation. If you did that at your first job, you might get fired and possibly a board complaint. So while a professionalism note in your file sucks and feels like you got shafted, it's a lot better than making that mistake later on.

War story: young adult female presents for asthma, accompanied by dad who is my age--red flag I missed. Rx'ed meds for the exacerbation, EMR alert for "needs pap" came up, I commented how inappropriate that would be at this visit due to asking her to lie back with her current breathing difficulties, and moved on. Next week, got a complaint about that. Called into my medical director's office, she was like "I can hear you saying that and know exactly what you were trying to say there, but that patient apparently was a sexual assault survivor and so it landed wrong." Totally unfair complaint, the SA history was not documented in the problem list, but at the end of the day I did say something that retraumatized the patient. I left a very sincere yet nonspecific voicemail apology and that was the end of that... Except it was one of three strikes I was allowed.

So, even if it was not fair, it's still something that could have had worse consequences. Yes, the school should have been more explicit about how to do the exam on female patients, but at the end of the day it is about respecting patients' bodily integrity 

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18 hours ago, cbull said:

I just want to ask if I’m overreacting to something that happened to me. So I had a clinical skills exam and during the pulmonary part I percussed and auscltated over breast tissue. My proctor freaked out at me and I had a professionalism meeting. It was a mistake sure but I think that it’s a mistake that should have been fixed in lab or our previous clinical skills exam I did it the same way in both and got no negative feedback. They documented the unprofessionalism and I feel super uncomfortable about it. I requested a zoom meeting with the program director. Every person that I have talked to has said that it is a reasonable mistake given the way the material is taught. I feel as though having this documented against me is a big deal even if my faculty advisor acts like it isn’t. What happens if I get a complaint on obgyn rotation next year? They’ll look at my file and say I have a history of inappropriately touching women. For reference I attached the picture that was on our rubric for the clinical skills exam. Opinions?

241CF0E7-C4DC-4893-89FC-9F51F49A88D9.png

quoting for history

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11 hours ago, cbull said:

Opposite sex; percussion of anterior lung is part of rubric as is the picture posted; partner was female student; she said that she was not uncomfortable; attached is a picture from the rubric for the clinical skills exam; idk if this matters but this is my first semester and while I understand my technique was definitely wrong I wish they treated it more as a learning experience than a witch hunt 

Quoting for history.

For context, this thread is locked because the original author had tried to delete it.  Hiding mistakes is detrimental to the purpose of the site: pseudonymous sharing. This isn't Huddle where your profile is linked to your NCCPA identifier. Here, you're not required, or even encouraged, to use your real name, so that it's safe to share stories like this for the benefit of all.

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