Can we teach a gentler rectal examination?

Abstract

A total of 201 first-year medical students were trained in a standard method of rectal examination; half of the year were additionally instructed to mimic a rectal examination using a clenched left fist (Group 2, n = 103). Competence in rectal examination was assessed during an objective structured clinical skills examination.Technique was assessed using a standardized marking scheme alongside global examiner assessments of gentleness and adequacy (on scales of 1, very poor to 5, very good). Students demonstrated a high standard for the technique (mean 85.1%), with no difference between groups for this score or for adequacy, though group 2 scored significantly better for gentleness. The addition of a simple, practical teaching technique of using the fist to mimic the anus and rectum resulted in an appropriately gentle examination.This approach should help students to develop the confidence to perform the examination when required and whilst ensuring patient comfort.