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GenitoUrinary

Naughty-sounding words are a big no-no in pelvic exams & students learn a long list of “Do Not Utter” expressions — like “pull out”, (too raunchy), “stirrup” (too equestrian) & “droop”, because what woman wants to hear that her breasts droop? - Lizzy Ratner

GenitoUrinary

image by: Kimberly Smith - Public Health Image Library

When it comes to GU issues there should be less apprehension, thanks to GTAs and MUTAs...

"Mark Manning knows his body well. In fact, if you were to take your index finger (gloved, of course) and insert it into his rectum, he would be able to tell you exactly when your fingertip is pressing against his prostate, a male reproductive gland that is said to be slightly larger than an unshelled walnut. And if you were to cup your hand around one of his testes, he could guide you toward his epididymis, an elusive piece of male anatomy that he describes as feeling like “a macaroni noodle, half-cooked” in an endearing Georgia drawl.

Like most people who are well-versed in a particular field, Manning knows these things because it is his job to know them. As a male urogenital teaching associate, or MUTA in medical shorthand, the 58-year-old retired General Motors employee teaches the testicular and rectal exam to unseasoned medical students, using his own body as a live model. Employed by the Atlanta-based company, Clinical Skills USA, Manning and his colleagues (including female instructors called gynecological teaching associates, or GTAs) travel the country to lead aspiring doctors through reproductive exams—the pelvic and breast exams for women, and the rectal and testicular exams for men—which are notorious for being among the procedures most dreaded by the general public, second only to root canals and colonoscopies.

As MUTA, Manning estimates he’s had somewhere around 4,000 male urogenital exams throughout his nine years in the field, and oftentimes as many as eight per day when he’s on duty—most of those performed by nervous second-year medical or nursing students who’ve had very little, if any, interaction with living, breathing patients.

But that’s part of the point. As a clinical guinea pig, Manning’s job is to ease their anxiety and train them in the basics of these routine exams. He does this using humor: “Y’all, please check your nails. We had to trim one earlier. It was pretty long.” But he also mixes in practical, patient-friendly tips: “Make sure to turn your back to your patient while they’re wiping to give them that little moment of dignity.”

Manning also works to dispel a prevailing myth that has come to accompany reproductive exams over the years—namely that they’re often uncomfortable for the patient. One of the core principles of Clinical Skills USA’s teaching curriculum is that neither the male nor female exams should be remotely painful, or evenly highly uncomfortable, if performed properly. Any physician who does hurt a patient, they argue, has not been correctly trained, which is often the case for those who attended medical school prior to the ’90s.

Then, and still in many instances today, medical students learned and practiced reproductive exams using either simple plastic manikins or actual patients, with the guidance of a clinical instructor (“preceptor,” as they are referred to in the field). And for the female exams, some schools even hired prostitutes or used anesthetized women who were never given the opportunity to consent.

Today nearly every medical school uses standardized patients (essentially actors playing patients) for basic training, such as practicing doctor-patient encounters and diagnoses, but the use of the more specialized GTAs and MUTAs is much less prominent. In fact, just over half of the medical programs in the United States employ GTAs, and less than half employ MUTAs, since unabashed male teachers are especially difficult to recruit.

This was where Scott George saw an opportunity. After working as an independent MUTA for a few years, George founded Clinical Skills USA in 2004 to bring teaching associates to schools without their own in-house programs. George, now a strapping, handsome 61-year-old in the way of middle-aged men in Cialis advertisements, began by recruiting groups of MUTAs and GTAs for teaching sessions at schools in the Atlanta area, but quickly expanded to include programs around the county.

“The schools jumped right onto it,” he says on a recent trip to Rocky Vista University, a College of Osteopathic Medicine located just outside of Denver. “As my people were working more and more at these schools, they were developing a greater sense of self-confidence and acquiring more knowledge, and I suddenly had a commodity.”

His commodity, as it were, is what he prefers to call “guiding patients,” rather than MUTAs or GTAs, because it’s easier for him to recruit people using that term. It also works to highlight the advantages his employees bring to the exam table over other methods. Preceptor-led training is less than ideal since patients have no idea when to tell a student that they have correctly located their ovary or palpated their prostate with just enough force. And though manikins have become more technologically advanced, fitted with sensors to help students judge pressure and position, there’s no computerized response to communicate pain.

Clinical patients may also expect the exam to hurt and therefore fail to tell the student when it does, which again, fuels a potentially dangerous misconception. Studies have shown that fear of a negative experience can deter patients from going for routine physicals, which means serious ailments could go unchecked for years.

Guiding patients, on the other hand, can direct students to perform the exam comfortably and correctly because they know exactly what it should feel like. “We are teaching students to give patients a positive experience,” George says. His 25 employees also make it a priority to train students on how to treat their patients in a friendly and professional manner, which transcends reproductive exams to apply to all patient-doctor interactions.

“I am a customer service nut, and this is customer service where it’s needed most,” George says. “If you’re going to get people to come in and do what they should be doing, which is to regularly come in for well-men and well-women exams, then you have to do what you can to make the experience as un-daunting as possible. And that’s what we try to teach the students—to help their patients relax.”

They also try to teach the students to relax. Variations on the phrase, “Remember that we are not here to assess you, but to teach you,” are commonly repeated refrains, and nearly all of the guiding patients have a talent for making students laugh. The use of lame puns such as “bare with me” or anatomy jokes are welcome in this context—anything that helps break the ice between the student and the partially nude teacher standing before them. “We love laughter,” George says. “Laughter is great. It’s their way of easing their anxiety.”

Helping students overcome their apprehensions—about hurting someone, screwing up or otherwise—is an essential part of the job, because for many future doctors or nurses, this may be the only time they get to perfect the exam before conducting it in a clinical context..."

Source: Elizabeth Kulze, Excerpt from These Medical Models Use Their Own Bodies As Teaching Tools, Vocativ, February 19, 2015.


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