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Medical Model Teaches Students Art of Gentle Exams

Monday, April 14, 2008

Amy Littlefield became a gynecological model to help medical students learn the fine art of pelvic examination without pain and embarrassment. Despite fumbling the speculum, they received a lesson on the awe of the female body coupled with anatomy.

Subhead: 
Amy Littlefield became a gynecological model to help medical students learn the fine art of pelvic examination without pain and embarrassment. Despite fumbling the speculum, they received a lesson on the awe of the female body coupled with anatomy.



Amy Littlefield

(WOMENSENEWS)--There is a second-year medical student standing in front of me, looking at my vagina. He is holding a speculum and does not know what to do with it. I wonder if he is one of the "ones" the trainer warned us about, one of the ones who has never seen a vagina before. I smile and try to encourage him. After all, he's not the one in stirrups.

It makes a good story. And that's how I got into it in the first place.

A good friend of mine, Megan Andelloux, a sex educator and long-time gynecological teaching assistant--a GTA--made the job sound flat-out cool while talking about it in her introduction to a workshop she runs on female orgasms in Providence, R.I.

"I provide a vagina and breasts to medical students learning to do their first pelvic and breast exams," she said, tossing her hair. She laughed as she told us that students sometimes inadvertently put their thumbs on her clitoris. Once, a male medical student looked at her vagina and exclaimed, "But that's not what it looks like in the books!"

The program gives students a chance to practice one of the most sensitive, awkward duties on someone who is trained to talk back. The goal, according to Dr. Jodi Abbott, the obstetrics-gynecology clerkship director at Boston University Medical School, is to teach future doctors to perform a "painless pelvic exam." "Painless" means that the doctors learn how to talk to the women they examine in addition to learning how to operate the instruments properly.

This year the medical school has placed its new GTA program in Megan's capable hands. When she asked me if I wanted to join up, I eagerly agreed, not only because GTA modeling pays well ($450 for a three-hour session) and because I was incredibly intrigued, but also because I wanted to be part of a program that teaches medical providers how to be sensitive to the needs and feelings of women.

Exams Can Be Painful

Pelvic exams can be painful in more ways than one. Survivors of sexual abuse and assault can be retraumatized by doctors who are unfriendly or brusque, or who use sexually suggestive terminology while examining them. I liked the idea of helping doctors learn the details that make pelvic exams less painful; things like talking a patient through the process, paying attention to cues that indicate she is nervous or upset, and checking in constantly to make sure she is doing OK.

My own doctor--a woman--tells me I look "perfect" after a pelvic exam. I wanted to tell the students that, too.

In training, they informed us that there are many different ways that a medical student can injure you with a speculum. (A speculum is a plastic or metal instrument, shaped like a duck bill that doctors click open to look inside a vagina.) Medical students, the trainers told us, can fail to close the speculum before they take it out, a common mistake that one seasoned GTA told us makes you go "Oooh!" (in a bad way.) They can also close it too soon and clip your cervix.

I was nervous about the prospect of having my cervix clipped by speculum-wielding students who had no idea what they were doing. But I was also fascinated by the idea that my vagina might be the first one that a future doctor ever really, really looked at. A vagina, in my opinion, is a beautiful thing. The students would be witnessing one of the world's greatest marvels for the first time: the Grand Canyon, the pyramids of Egypt, my vagina.

Went Red and Keeled Over

Renita, a GTA who has been at it for years, and who put a down payment on a house with the money she earned, talked to a handful of first-timers before our session at Boston University. She told us about how she once watched a student pass out in the exam room. After performing the exam he turned around, went red and keeled over.

"I thought, 'Did I do that?'" she laughed.

Renita's story made me feel powerful. I wondered if I might knock someone out cold, too.

My first three students came in, introduced themselves and shook my hand. One picked up the speculum, cocked his head and examined it quizzically. He said something like, "I wish we had had more than 30 seconds' worth of training with these things."

Luckily, it turns out that it is more difficult than I had thought for someone to actually hurt you with a speculum. As the students pulled them out without closing them--many times--I could only really tell by the looks of total horror on their faces. A few students broke out in hives as they tried to stammer out the routine medical questions they were supposed to ask. Yet almost all deferred to my knowledge of my own body and listened to my advice.

Positions of Power

When you're a patient, the doctor is in charge and perhaps that is what--more than anything--can make a pelvic exam so terrifying. But as a GTA, when I was in the stirrups, I was in a position of power. With my legs open and my feet up, I directed the students to my cervix, showed them where to feel for my uterus, corrected them when they said things like, "I'm going to touch your area."

"No," I said. "You are going to insert your fingers in my vagina. Say 'vagina.'"

Months ago, as part of a female sexuality workshop at Brown University, I had seen my own cervix for the first time. After much grappling on the floor of my closet with a speculum, a flashlight and a hand mirror, I found it: perfect, round and pink, one of the coolest things I'd ever seen. As the students craned their necks to see my cervix, I hoped they thought it was as cool as I did.

I learned from Dr. Abbott and the students that my uterus is pear-sized. I learned that my ovaries are very difficult to feel--as long as they're healthy--and I watched the looks of surprise from the few students who did find them. "Cool!" one said when he found my ovary, and I knew that he was going to be a good doctor.

I gave each batch of students a little speech about what they had done right and wrong, assured them they had not caused any permanent damage and then let them go. I hoped they would remember the details: explain every step clearly, make eye contact, reassure the patient that she is doing great. They gave me apologetic smiles, words of pity and appreciation, and then they left, probably hoping to God I was going to forget their names before I wrote the story down.

It makes a good story. But what sticks with me, beyond the awkward moments, is the hope that I helped a future doctor learn to respect the sheer awesomeness of the female body.

I was only disappointed that no one fainted.

Amy Littlefield is a junior at Brown University.