Getting the size right: Are clinicians ready for it?

Abstract

ObjectivesDigital examination has many uses in obstetrics and gynaecology, including cervical assessment in labour and measuring for vaginal pessaries. Clinicians must be adequately trained to perform accurate digital assessments and use this information to make decisions.We aimed to evaluate the accuracy of a clinician’s estimate for three different measuring tasks and assess whether there was any difference in the accuracy in relation to seniority or job role. Study designDoctors and midwives were recruited from two perineal trauma training events. Estimates and measurements for three different activities were recorded: length of own index finger, length of an anal sphincter model and cervical dilatation at two different dilatations (7 cm and 9 cm) using a pocket guide cervical dilatation tool. The results were analysed for accuracy of measurements according to job role and seniority. ResultsA total of 369 participants took part. Only 4.6% of participants accurately (to 0.1 cm) estimated the length of their index finger (0% of midwives and 5.5% of doctors). There was a significant difference (p < 0.05) when comparing average differences between estimated and actual lengths measured for doctors and midwives for almost all measurements. When comparing doctors based on seniority there was no significant difference in the accuracy of estimated lengths. A higher percentage of midwives than doctors were accurate at both 7 cm (22% vs 16.1%) and 9 cm (30.5% vs 29.5%) dilated. ConclusionWe found that accuracy was poor for both doctors and midwives when asked to estimate various measurements. We suggest that training will improve awareness of finger length and therefore improve accuracy when performing digital examinations in clinical practice.