Abstract
BackgroundA graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex.MethodsA cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students’ perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students’ confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis.ResultsOne hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student’s clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13–3.79) and as high as 3.06 (1.53–6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27–0.88) for cardiovascular and 0.39 (0.21–0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04–0.28) and vaginal examinations 0.22 (0.02–1.98) and more male students conducting prostate examinations OR 11.00 (1.39–87.03) and male genitalia examinations OR 16.31 (3.75–70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all.ConclusionsIn our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching.Trial registrationNon interventional thus not required.
Highlights
A graduating medical doctor is expected to be competent in physical examinations across all systems
The sample, not random is closely representative of all final year medical students, across gender and nationality, except for fewer older medical students completing the study questionnaire than in the class cohort (Table 1)
The ethnicities in our sample generally reflect the ethnicities of final year Jordan University of Science and Technology (JUST) medical students
Summary
A graduating medical doctor is expected to be competent in physical examinations across all systems. One cornerstone of being a good doctor is competent clinical examinations, a standard followed by medical educators globally [1, 2]. Physical examination is part of the diagnostic process and can save considerable costs through decreased testing [5, 6] and its absence may adversely affect the doctor-patient relationship [7]. A graduating medical doctor is expected to be competent in all physical examinations, including intimate examinations [1] which are still an important component of clinical care [8]. Learning intimate clinical examinations, such as genital examinations has long been challenging for medical students due to their sensitive nature [9]. Various factors contribute to this such as anxiety and discomfort from students [10] and challenges finding patients who are willing to be examined [11]
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