326 Resident Attitudes Towards Performing Pelvic Exams in the Emergency Department

Abstract

Mounting evidence suggests that emergency physicians tend to avoid patients with gynecologic chief complaints. In one study of all emergency department (ED) visits, patient pickup time was 12 minutes for the chief complaint of vaginal bleeding compared to a median pickup time of 6 minutes for all other complaints (Patterson et al, AEM, 2016). A recent study found that male EM residents were less likely than female EM residents to assign themselves to patients with vaginal bleeding (Agarwal et al, AJEM, 2021). We hypothesized that an underlying reason could be discomfort with performing a pelvic exam. The goal of this study was to assess whether male EM residents report greater discomfort with pelvic exams than female EM residents. We performed a cross-sectional, IRB-approved survey of EM residents at five academic programs. Of 100 residents who completed the survey, 63 self-identified as male, 36 as female, and one selected “prefer not to say” and was excluded from analysis. Residents were asked about their personal comfort with performing pelvic exams, with response options of “very comfortable, ” “hesitate to do, ” “do not feel comfortable, ” or “avoid doing whenever possible.” Responses were compared between male and females using a chi-square test. In secondary analysis, we used a t-test to compare preferences for various chief complaints as well as frequency of performing pelvic exams. Self-reported comfort with pelvic exams did not differ significantly between males and females (p=0.4249). Females reported a slightly higher, though not statistically significant, number of pelvic exams performed over a span of five shifts (mean=2.1, CI=1.6-2.5) than males (mean=1.7, CI=1.3-2.0). Self-reported barriers for male respondents in performing pelvic exams include lack of training, general dislike, and concern that the patient will want a female provider. However, 67% (CI=54%-78%) of male residents reported supervised pelvic exams with faculty in the ED as part of their training, compared to 36% (CI=21%- 54%) of female residents. On a preference scale of 1-5, male residents had a statistically significant lower preference ranking for patients with a chief complaint of vaginal bleeding compared to female residents (mean difference=0.48, CI=0.11, 0.87). Preference ranking was the same between male and females on other chief complaints. There is a sex disparity among male and female EM residents in attitudes towards patients with vaginal bleeding. However, the results from this study do not demonstrate a significant difference in self-reported comfort amongst male and female residents in performing pelvic exams. This may be due to reporting bias, or this disparity may be driven by other barriers including self-reported lack of training and concern about patients’ physician sex preferences.