Lawrence H. Salud

A simulation-based assessment of clinical breast examination technique: do patient and clinician factors affect clinician approach?

BACKGROUND Recent publications describing widely accepted clinical breast examination (CBE) techniques have sparked interest in setting standards for CBE. In support of CBE training and assessment, the purpose of our study was to quantify CBE palpation techniques using simulation technology and assess the affects of clinical presentation and clinician background on CBE techniques. METHODS Three sensored silicone breast models were configured to represent 3 different clinical presentations. The models were examined by 102 clinicians at a local breast cancer meeting, and their performance was captured by using sensored based data acquisition technology. RESULTS Clinicians had significantly longer examination times on the fatty breast with no masses compared with the breast with a dominant mass and the breast with fibrocystic changes (66.37 seconds, 40.50 seconds, and 42.28 seconds, P < .05). In addition, on average, female clinicians had significantly greater examination times (females = 56.66 seconds, males = 42.09 seconds, P < .05) and touched more sensors (females = 7.97, males = 6.30, P < .05) with greater pressures (females = 5.21, males = 4.82, P < .05) than their male counterparts. CONCLUSIONS Clinical presentation and clinician background may affect CBE technique yet does not appear to negatively affect clinician accuracy. Additional research quantifying the range of CBE techniques used in medical practice may inform CBE standardization and competency testing.

Use of Mannequin-Based Simulation to Decrease Student Anxiety Prior to Interacting With Male Teaching Associates

Background: Previous studies have compared the usefulness of teaching associates versus mannequin trainers for learning physical exam skills. Little work has been done to assess the usefulness of mannequin trainers prior to students’ interaction with teaching associates. Purpose: We studied the effects of mannequin-based simulators on student comfort levels toward learning the male genitourinary examination. Methods: First-year medical students (N = 346) were surveyed before and after a mannequin-based curriculum to assess their comfort levels toward learning the male genitourinary examination. Results: The mannequin-based curriculum significantly increased (p < .001) student comfort levels toward the male genitourinary exam. However, the pre–post improvements were small, and on average students only progressed from being “very uncomfortable” to “somewhat comfortable.” The intimate nature of the examination was the top cause of anxiety toward learning the male genitourinary exam. Students were least comfortable with the digital rectal examination at the beginning of class. Conclusions: We suggest that mannequin-based simulators be used prior to students’ experience with male teaching associates when learning the male genitourinary exam.