Rectal examination and urethral catheterization by medical students and house officers: taught but not used.

Abstract

To assess the acquisition of skills in digital rectal examination (DRE) and urethral catheterization by medical students and house officers associated with a UK medical school, and to determine their confidence in these techniques. Subjects and methods Questionnaires were sent to all final-year medical students at Oxford Medical School immediately before their final examinations. Similar questionnaires were sent to all pre-registration house officers who had graduated from Oxford in the previous year. Responses were received from 71% of the students and 84% of the graduates; 88% of the students and 94% of the graduates had been taught how to perform a DRE as a medical student, but 42% of medical students had performed fewer than five DREs before qualification. Their findings were rarely checked by a doctor. Of the students, 44% had never felt a clinically malignant prostate gland and 41% were 'not at all confident' in their ability to give an opinion based on their findings on a DRE. House officers performed DRE regularly (53% >/= 50 DREs) but rarely received additional instruction, and exposure to pathology remained limited. House officers' findings on DRE were rarely confirmed by a more senior doctor. Most respondents had been taught how to perform male urethral catheterization as a medical student (92% of students, 89% of house officers) but 48% of students had performed fewer than two catheterizations on qualification and 68% of house officers had received no additional instruction; however, 69% of house officers were 'very confident' in their ability to perform male urethral catheterization. The DRE is a critical skill in assessing the prostate; students conduct few DREs, lack confidence and are exposed to minimal pathology. Legitimate concerns over students carrying out intimate examinations may be mitigating against the acquisition of skills. Possible solutions are explored. House officers perform DREs regularly, but with no additional instruction they may continue to lack confidence. Students lack experience in male urethral catheterization and rarely receive postgraduate instruction. House officers' confidence in their ability to perform male urethral catheterization may be misplaced.