The use of certain palpation techniques does enable the detection of smaller and more numerous abnormalities, and we seek to abstract these techniques into a systematic protocol for use in the clinic.
This paper seeks to quantify finger palpation techniques in the prostate clinical exam, determine their relationship with performance in detecting abnormalities, and differentiate the tendencies of nurse practitioner students and resident physicians. One issue with the digital rectal examination (DRE) is that performance in detecting abnormalities varies greatly and agreement between examiners is low. The utilization of particular palpation techniques may be one way to improve clinician ability. Based on past qualitative instruction, this paper algorithmically defines a set of palpation techniques for the DRE, i.e., global finger movement (GFM), local finger movement (LFM), and average intentional finger pressure, and utilizes a custom-built simulator to analyze finger movements in an experiment with two groups: 18 nurse practitioner students and 16 resident physicians. Although technique utilization varied, some elements clearly impacted performance. For example, those utilizing the LFM of vibration were significantly better at detecting abnormalities. Also, the V GFM led to greater success, but finger pressure played a lesser role. Interestingly, while the residents were clearly the superior performers, their techniques differed only subtly from the students. In summary, the quantified palpation techniques appear to account for examination ability at some level, but not entirely for differences between groups.
Prostate cancer is detected in part via the digital rectal examination. Training for this hands-on exam is limited, in particular, by feedback given trainees with respect to finger palpation. This work characterizes finger palpation technique exerted by participants, using a simulator that can electronically record finger pressure on the prostate gland and abnormalities. In principal, we analyze 1) global finger movement, 2) local finger movement and 3) average finger pressure. The analysis determined that participants utilize four patterns of global finger movement (U, V, L and line), three patterns of local finger movement (tapping, vibration, smooth movement), and distinct finger pressures (in Newtons). This analysis also determined that participants who utilized certain techniques were better able to detect presented abnormalities.
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