Tuesday, March 20, 2007

Training the doctor to do sensitive exams

Training the doctor to do sensitive exams

CHICAGO (Reuters) - Dr. Carla Pugh seems an unlikely patron of porn shops.

But that's exactly where Pugh, an assistant professor of surgery at Northwestern University's Feinberg School of Medicine, procured some of the male body parts she uses to train medical students about human anatomy.

Pugh, 41, has patented technology that combines portions of fully formed anatomical mannequins with computers to teach medical students to do exams on the body's most private and sensitive areas -- genitalia, breasts and rectums.

These are the exams, she said, that students are often most afraid of and that many medical school instructors, themselves often long-time practicing physicians, still find to be a source of embarrassment.

"We've got big issues in the U.S. with sexuality," Pugh said in an interview during a break from teaching first-year medical students. "These guys have to be able to do it and act professional, so that adds a lot of pressure."

Getting supplies to build the models was no easy task. Medical education has largely glossed over such training, limiting demand for products in the industry. In some cases, erotica was the only option, she said.

The simulators are a far cry from the flesh and bones of a living, breathing person. But they are close enough to the real thing to let students know whether their touch is too rough, too soft or if they've missed a key spot entirely.


In traditional medical training, students often go straight from textbook to exam room with live patients, where they observe skilled doctors in action. Questions are asked later.

"Guess what?" said Pugh. "They're sweating bullets because they haven't had a scenario where they can talk about it comfortably, safely and with someone who is more knowledgeable."

During the Northwestern class, training is hands-on. Simulators are arranged at various stations according to exam type. At the prostate station, for example, several models of the male posterior are arranged on a table in various positions.

Inside each plastic model -- yes, they have a fully formed anus and rectum -- are paper-thin sensors that measure a student's touch and send individual readings to an attached computer monitor.

Students show up at the station for a brief overview from an instructing physician and then moments later, fingers are inserted, line readings from sensors go up and down on the computer screen, questions are asked and answered.

Scatological humor is inevitable. An instructor assures a student that, yes, you can tell a patient it's OK to pass wind if necessary during the exam and ask for a warning first.

Time is called and students move on to the next station. On another table, several examples of the penis, circumcised and not, limp and erect, await another round of students, who smile nervously.

Dr. Sudha Rao, a pediatrician, prepares to give an overview of the proper methods for performing an examination of the penis.

"It's very helpful," said Rao of the anatomical models. "I think they're fantastic to be able to show a young student who is starting out."


Pugh began performing "surgery" on her dolls as a child, transplanting eyes and limbs with a sewing kit borrowed from her mother. Since then, she said she has always maintained a hands-on approach to medicine.

She was disappointed with the level of feedback she received while doing her own surgical training in medical school at Howard University in Washington.

"It frustrated me because I was unsure," said Pugh, one of fewer than 400 black women surgeons in the United States. "I didn't have the level of access to the human body that I wanted."

She came up with the idea for the technology while working on a doctorate in education at Stanford University and obtained a patent for the sensors and data accumulation technology in 2001.

Pugh formed a licensing agreement with Medical Education Technologies Inc., a company specializing in medical training products, in early 2003.

Her pelvic exam simulators are already on the market at prices ranging from $16,000 to $20,000 each, and are used by more than 60 medical and nursing schools around the country. The prostate exam simulators used in the class as well as those for breast exams are still in prototype form.

Any help in these often taboo topics will make the first clinical encounters with a patient's private parts a little easier for medical students like 28-year-old Meredith Hirshfeld at Northwestern University in Chicago.

"It's the first time we're doing something invasive," she said. "It's nerve-racking."