Training the doctor to do sensitive exams

By Deborah Cohen

CHICAGO (Reuters) - Dr. Carla Pugh seems an unlikely patron of porn shops.

But that's exactly where Pugh, an assistant professor of surgery at Northwestern University's Feinberg School of Medicine, procured some of the male body parts she uses to train medical students about human anatomy.

Pugh, 41, has patented technology that combines portions of fully formed anatomical mannequins with computers to teach medical students to do exams on the body's most private and sensitive areas -- genitalia, breasts and rectums.

These are the exams, she said, that students are often most afraid of and that many medical school instructors, themselves often long-time practicing physicians, still find to be a source of embarrassment.

"We've got big issues in the U.S. with sexuality," Pugh said in an interview during a break from teaching first-year medical students. "These guys have to be able to do it and act professional, so that adds a lot of pressure."

Getting supplies to build the models was no easy task. Medical education has largely glossed over such training, limiting demand for products in the industry. In some cases, erotica was the only option, she said.

The simulators are a far cry from the flesh and bones of a living, breathing person. But they are close enough to the real thing to let students know whether their touch is too rough, too soft or if they've missed a key spot entirely.

NOT THE REAL THING

In traditional medical training, students often go straight from textbook to exam room with live patients, where they observe skilled doctors in action. Questions are asked later.

"Guess what?" said Pugh. "They're sweating bullets because they haven't had a scenario where they can talk about it comfortably, safely and with someone who is more knowledgeable."

During the Northwestern class, training is hands-on. Simulators are arranged at various stations according to exam type. At the prostate station, for example, several models of the male posterior are arranged on a table in various positions.

Inside each plastic model -- yes, they have a fully formed anus and rectum -- are paper-thin sensors that measure a student's touch and send individual readings to an attached computer monitor.

Students show up at the station for a brief overview from an instructing physician and then moments later, fingers are inserted, line readings from sensors go up and down on the computer screen, questions are asked and answered.

Scatological humor is inevitable. An instructor assures a student that, yes, you can tell a patient it's OK to pass wind if necessary during the exam and ask for a warning first.

Time is called and students move on to the next station. On another table, several examples of the penis, circumcised and not, limp and erect, await another round of students, who smile nervously.