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Ari Silverisenstadt - One of the best experts on this subject based on the ideXlab platform.
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don t ask don t tell a change in medical student attitudes after obstetrics gynecology clerkships toward seeking consent for Pelvic Examinations on an anesthetized patient
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Peter A Ubel, Christopher Jepson, Ari SilverisenstadtAbstract:Abstract Objective: We explore whether the completion of an obstetrics/gynecology clerkship is associated with a decline in the importance that students place on seeking permission from the patient before conducting a Pelvic Examination while she is anesthetized. Study design: Students at five Philadelphia area medical schools (n = 401 students) were asked how important it would be for a patient to be told that a medical student will perform a Pelvic Examination while she is anesthetized. We examined associations between the completion of an obstetrics/gynecology clerkship and attitudes toward consent with the use of linear regression to adjust for gender and the total amount of clerkship experience. Results: After the data were controlled for gender and the total number of clerkships that had been completed, we found that students who had completed an obstetrics/gynecology clerkship thought that consent was significantly less important than did those students who had not completed a clerkship ( P = .01). Conclusion: To avoid this decline in attitudes toward seeking consent, clerkship directors should ensure that students perform Examinations only after patients have given consent explicitly. (Am J Obstet Gynecol 2003;188:575-9.)
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don t ask don t tell a change in medical student attitudes after obstetrics gynecology clerkships toward seeking consent for Pelvic Examinations on an anesthetized patient
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Peter A Ubel, Christopher Jepson, Ari SilverisenstadtAbstract:Objective We explore whether the completion of an obstetrics/gynecology clerkship is associated with a decline in the importance that students place on seeking permission from the patient before conducting a Pelvic Examination while she is anesthetized. Study design Students at five Philadelphia area medical schools (n = 401 students) were asked how important it would be for a patient to be told that a medical student will perform a Pelvic Examination while she is anesthetized. We examined associations between the completion of an obstetrics/gynecology clerkship and attitudes toward consent with the use of linear regression to adjust for gender and the total amount of clerkship experience. Results After the data were controlled for gender and the total number of clerkships that had been completed, we found that students who had completed an obstetrics/gynecology clerkship thought that consent was significantly less important than did those students who had not completed a clerkship (P =.01). Conclusion To avoid this decline in attitudes toward seeking consent, clerkship directors should ensure that students perform Examinations only after patients have given consent explicitly.
Robin Fretwell Wilson - One of the best experts on this subject based on the ideXlab platform.
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unauthorized practice teaching Pelvic Examination on women under anesthesia
Social Science Research Network, 2004Co-Authors: Robin Fretwell WilsonAbstract:Recent reports of medical students performing gynecological exams on anesthetized women without their knowledge or consent have generated a firestorm of controversy and prompted calls for greater regulation. This Commentary examines studies spanning three decades showing that such unauthorized practice is neither a recent phenomenon, nor one unique to the United States. In this Commentary, Professor Wilson tests the justifications for such unauthorized practice offered by teaching faculty, focusing in particular on whether patients have actually or impliedly consented to such exams by coming to a teaching hospital. It then examines newly enacted legislation in California that would criminalize unauthorized exams and argues that it does little to make unauthorized exams more discoverable or to remedy the underlying pressures that have fostered the use of patients as teaching tools without permission. The Commentary ultimately concludes that meaningful change within medical education can only be achieved when key players begin a dialogue about the barriers they face to establishing better practices.
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unauthorized practice teaching Pelvic Examination on women under anesthesia
Journal of the American Medical Women's Association, 2003Co-Authors: Robin Fretwell WilsonAbstract:Medical ethics evolved over the past half-century. This brought close reExamination and scrutiny of medical education and the "hands-on training" of future medical practitioners. Likewise societal opinions have intensified regarding the rights of patients, especially those deemed less likely to express their humiliation if they should discover themselves in compromising positions during treatment. Informed consent is modern medico-legal terminology; if the public felt that all patients were treated with the self-determination and dignity required by current HIPAA regulations, then there would be no reason to legislate such requirements. Law professor Robin Fretwell Wilson, Esq., and obstetrics and gynecology professor Nancy G. Chescheir, MD, present evidence and opinions from the legal and medical perspectives regarding conducting Pelvic exams on anesthetized women without or with vague consent.
Peter A Ubel - One of the best experts on this subject based on the ideXlab platform.
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don t ask don t tell a change in medical student attitudes after obstetrics gynecology clerkships toward seeking consent for Pelvic Examinations on an anesthetized patient
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Peter A Ubel, Christopher Jepson, Ari SilverisenstadtAbstract:Abstract Objective: We explore whether the completion of an obstetrics/gynecology clerkship is associated with a decline in the importance that students place on seeking permission from the patient before conducting a Pelvic Examination while she is anesthetized. Study design: Students at five Philadelphia area medical schools (n = 401 students) were asked how important it would be for a patient to be told that a medical student will perform a Pelvic Examination while she is anesthetized. We examined associations between the completion of an obstetrics/gynecology clerkship and attitudes toward consent with the use of linear regression to adjust for gender and the total amount of clerkship experience. Results: After the data were controlled for gender and the total number of clerkships that had been completed, we found that students who had completed an obstetrics/gynecology clerkship thought that consent was significantly less important than did those students who had not completed a clerkship ( P = .01). Conclusion: To avoid this decline in attitudes toward seeking consent, clerkship directors should ensure that students perform Examinations only after patients have given consent explicitly. (Am J Obstet Gynecol 2003;188:575-9.)
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don t ask don t tell a change in medical student attitudes after obstetrics gynecology clerkships toward seeking consent for Pelvic Examinations on an anesthetized patient
American Journal of Obstetrics and Gynecology, 2003Co-Authors: Peter A Ubel, Christopher Jepson, Ari SilverisenstadtAbstract:Objective We explore whether the completion of an obstetrics/gynecology clerkship is associated with a decline in the importance that students place on seeking permission from the patient before conducting a Pelvic Examination while she is anesthetized. Study design Students at five Philadelphia area medical schools (n = 401 students) were asked how important it would be for a patient to be told that a medical student will perform a Pelvic Examination while she is anesthetized. We examined associations between the completion of an obstetrics/gynecology clerkship and attitudes toward consent with the use of linear regression to adjust for gender and the total amount of clerkship experience. Results After the data were controlled for gender and the total number of clerkships that had been completed, we found that students who had completed an obstetrics/gynecology clerkship thought that consent was significantly less important than did those students who had not completed a clerkship (P =.01). Conclusion To avoid this decline in attitudes toward seeking consent, clerkship directors should ensure that students perform Examinations only after patients have given consent explicitly.
Barbro Wijma - One of the best experts on this subject based on the ideXlab platform.
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gynecological patients learning to perform the Pelvic Examination a win win concept
Sexual & Reproductive Healthcare, 2013Co-Authors: Karin Siwe, Carina Bertero, Barbro WijmaAbstract:Objective: This study explored gynecological patient perceptions of previous Pelvic Examinations (PE), a learning session about PE prior to a scheduled PE consultation, and the impact of the learni ...
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medical students learning the Pelvic Examination comparison of outcome in terms of skills between a professional patient and a clinical patient model
Patient Education and Counseling, 2007Co-Authors: Karin Siwe, Klaas Wijma, Martin Stjernquist, Barbro WijmaAbstract:Objective: To compare two models of learning the Pelvic Examination (PE) for medical students, with professional patients (PP) or with clinical patients (CP), by measuring perceived distress and le ...
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the first Pelvic Examination
Journal of Psychosomatic Obstetrics & Gynecology, 2007Co-Authors: Marie Oscarsson, Eva Benzein, Barbro WijmaAbstract:Purpose. To describe adolescents' experiences of their first Pelvic Examination.Methods. Data were collected by tape-recorded interviews with 15 adolescents, who had had their first Pelvic Examination (PE) performed by a midwife at a Youth Clinic. Data were analyzed by qualitative latent content analysis.Results. The result is presented in terms of the themes: Emotional ambivalence, Being in control and A step into women's world. The adolescents generally believed that PE was beneficial to their health and they were curious to see how they would manage. On the other hand they also felt embarrassed about getting undressed. They described several factors which contributed to feelings of being in control of the situation, e.g., when the examiner shared the process of decision making, thoroughly explained the PE procedure in advance, and assured them that the PE could be discontinued at any time. They considered their first PE as a step into a women's world. It seems important that the examiners perform the f...
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attitudes towards Pelvic Examination in a random sample of swedish women
Acta Obstetricia et Gynecologica Scandinavica, 1998Co-Authors: Barbro Wijma, Mats Gullberg, Berndt KjesslerAbstract:Background A Pelvic Examination is the most common procedure in gynecological practice. A majority of women have negative experiences of such Examinations. The aim of the present study was to explore attitudes to and experiences of Pelvic Examinations, as well as possible background factors to such attitudes and experiences. Methods A postal inquiry was sent to 788 randomly selected Swedish women, of fertile age. Sixty-seven per cent answered the questionnaire, which had 56 items and covered, inter alia, attitudes to and experiences of Pelvic Examinations, as well as possible background factors. Results The women had positive, uniform attitudes to Pelvic Examinations in general, but negative experiences of the specific parts of the procedure. Women's attitudes to and experiences of Pelvic Examinations correlated. The experience of the first Pelvic Examination was more negative than the experience of the last. A negative experience in general and the experience of pain during the first Pelvic Examination correlated. The first Pelvic Examination emerged as a statistically powerful background factor for subsequent attitudes to Pelvic Examinations. Conclusions Swedish women have positive attitudes to Pelvic Examination in spite of negative previous experiences. A powerful background factor for subsequent attitudes to Pelvic Examination was the experience of the first one. A woman's first Pelvic Examination should therefore be used as an opportunity to condition positive emotions and behaviors to the Examination situation, as a basis for future positive experiences.
Daniel M Breitkopf - One of the best experts on this subject based on the ideXlab platform.
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lateral decubitus position to facilitate Pelvic Examination of the patient with severe obesity
BMC Women's Health, 2021Co-Authors: Daniel M BreitkopfAbstract:Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic Examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity. A case series was collected. From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during Pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with Examination in dorsal lithotomy position until the cervix was visualized. Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.
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lateral decubitus position to facilitate Pelvic Examination of the patient with severe obesity
BMC Women's Health, 2020Co-Authors: Daniel M BreitkopfAbstract:BACKGROUND Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic Examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity. METHODS A case series was collected. From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during Pelvic exam in the dorsal lithotomy position in the author's clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with Examination in dorsal lithotomy position until the cervix was visualized. RESULTS Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. CONCLUSIONS In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.