CR22P DIGITAL RECTAL EXAMINATION – DO JUNIOR DOCTORS NEED POINTERS IN THE RIGHT DIRECTION?

Abstract

Purpose: Digital Rectal Examination (DRE) is an essential skill that newly qualified doctors are expected to have, but what are they like in reality?Methods: Newly qualified doctors were asked to complete a questionnaire. Their responses to clinical scenarios, diagnosis of anal conditions as well as confidence in DRE were assessed.Results: 90 (52 F, 38 M) newly qualified doctors responded to our questionnaire (response rate of 90%). 69 (77%) of doctors have never felt a rectal tumour, many felt uncomfortable diagnosing anal and rectal cancers and two thirds of respondents had only performed up to ten DREs before graduation. Although 78 (87%) had been taught how to perform a DRE, a third of doctors were not confident in performing this examination, and the vast majority (91%) did not have their findings checked by a senior colleague. Seven (8%) doctors do not routinely perform a DRE in a patient presenting with rectal bleeding; reasons included that there was no time to perform the examination, it was unfair to subject the patient to multiple examinations or that there was no chaperone to do the examination. 74 (82%) of doctors felt that better training at an undergraduate level would improve their confidence and abilities. In comparison with other forms of examination, these same doctors were less comfortable with PV and testicular examinations but most confident in groin hernia examinations.Conclusion: DRE is an important skill but despite being taught at medical school, many newly qualified doctors felt that they lacked confidence in this. More attention to developing this competency should be included in the junior doctor inductions.