Digital rectal examination skills: first training experiences, the motives and attitudes of standardized patients

Nikendei, Christoph; Diefenbacher, Katja; Köhl-Hackert, Nadja; Lauber, Heike; Huber, Julia; Herrmann–Werner, Anne; Herzog, Wolfgang; Jünger, Jana; Krautter, Markus

doi:10.1186/s12909-015-0292-7

Cited by 10 publications

(8 citation statements)

References 62 publications

(53 reference statements)

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“…Plenty of adipose tissue in pelvic cavity could interfere with the result of DRE. Marshall and Nikendei also found that the prostate could be examined by DRE completely in 91.7% of patients with a BMI below 25 kg/m2, and in 14.3% of those with a BMI above 40 kg/m2, which was consistent with our results31, 32. In addition, a total of 3 false-positive DRE results were found, in which 2 were confirmed as uterine fibroids and 1 was confirmed as prostate nodular hyperplasia intraoperatively.…”

Section: Discussionsupporting

confidence: 90%

The Diagnostic and Prognostic Value of Digital Rectal Examination in Gastric Cancer Patients with Peritoneal Metastasis

et al. 2019

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Background : Peritoneal metastasis (PM) is the most common cause of death in gastric cancer (GC) patients. However, diagnosis of PM is still difficult in clinical practice. This study aimed to explore the diagnostic and prognostic value of digital rectal examination (DRE) in GC. Methods : 247 GC patients with PM confirmed by operation were included. The diagnostic yield of DRE compared with computed tomography (CT) was calculated. In another group of 1330 cases receiving radical gastrectomy, 38 cases with DRE (+) postoperatively were analyzed to identify risk factors. A nomogram was constructed to predict postoperative DRE (+). Results : The specificity, positive predictive value and positive likelihood ratio of DRE in diagnosis of PM was 99.8%, 91.2% and 58.4, higher than CT (97.6%, 64.9% and 10.4). Though the sensitivity of DRE (12.6%) was lower than CT (24.7%), 17 of 31 patients with DRE (+) could not be found by CT. Moreover, the overall survival of confirmed PM patients with DRE (+) (PM-DRE (+)) was much lower than PM-DRE (-) patients (P<0.001). In addition, the nomogram to predict postoperative DRE (+) had a bootstrap-corrected concordance index of 0.73 and was well calibrated. Conclusions : GC patients with DRE (+) could be regarded as a special subtype of stage IV ones with poorer prognosis. Supply of palliative care and chemotherapy rather than unnecessary operation might be a better alternative for these patients. DRE was an effective supplement for CT and should be generally recommended for GC patients.

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Section: Discussionsupporting

confidence: 90%

The Diagnostic and Prognostic Value of Digital Rectal Examination in Gastric Cancer Patients with Peritoneal Metastasis

et al. 2019

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“…The former intends to check distal rectum and anal patency for the colonoscopy and the latter, to perform prostate palpation. In addition, recently graduated doctors report they are insufficiently prepared to perform a complete digital rectal evaluation (18) . Such discrepancy of DRE depending on each examiner, to determine sphincter tonus, motivated this study.…”

Section: Is the Physician Expertise In Digital Rectal Examination Of mentioning

confidence: 99%

Is the Physician Expertise in Digital Rectal Examination of Value in Detecting Anal Tone in Comparison to Anorectal Manometry?

Pinto

Neto

Nahas

et al. 2019

Arq. Gastroenterol.

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BACKGROUND: Digital rectal examination (DRE) is part of the physical examination, is also essential for the colorectal surgeon evaluation. A good DRE offers precious information related to the patient’s complaints, which will help in decision making. It is simple, quick and minimally invasive. In many centers around the world, the DRE is still the only method to evaluate the anal sphincter prior to patient’s management. On the other hand, anorectal manometry (ARM) is the main method for objective functional evaluation of anal sphincter pressures. The discrepancy of DRE depending on the examiner to determine sphincter tonus in comparison to ARM motivated this study. OBJECTIVE: To compare the DRE performed by proficient and non-experienced examiners to sphincter pressure parameters obtained at ARM, depending on examiners expertise. METHODS: Thirty-six consecutive patients with complaints of fecal incontinence or chronic constipation, from the anorectal physiology clinic of the University of São Paulo School of Medicine, were prospectively included. Each patient underwent ARM and DRE performed by two senior colorectal surgeons and one junior colorectal surgeon prior to the ARM. Patient’s history was blinded for the examiner’s knowledge, also the impressions of each examiner were blinded from the others. For the DRE rest and squeeze pressures were classified by an objective scale (DRE scoring system) that was compared to the parameters of the ARM for the analysis. The results obtained at the ARM were compared to the DRE performed by the seniors and the junior colorectal surgeons. STATISTICAL ANALYSIS: Descriptive analysis was performed for all parameters. For the rest and squeeze pressures the Gamma index was used for the comparison between the DRE and ARM, which varied from 0 to 1. The closer to 1 the better was the agreement. RESULTS: The mean age was 48 years old and 55.5% of patients were female. The agreement of rest anal pressures between the ARM and the DRE performed by the senior proficient examiners was 0.7 (CI 95%; 0.32-1.0), while for the junior non-experienced examiner was 0.52 (CI 95%; 0.09-0.96). The agreement of squeeze pressures was 0.96 (CI 95%; 0.87-1.0) for the seniors and 0.52 (CI 95%; 0.16-0.89) for the junior examiner. CONCLUSION: More experienced colorectal surgeons used to DRE had a more significant agreement with the ARM, thereafter would have more appropriate therapeutic management to patients with sphincter functional problems. ARM, therefore, persists as an important exam to objectively evaluate the sphincter complex, justifying its utility in the clinical practice.

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“…Moreover, the finding shows that with corresponding training [35], it is possible for PIs to become very well qualified in a very short time.…”

Section: Discussionmentioning

confidence: 99%

“…This equally good result of faculty staff physicians and PIs is particularly striking as the PIs were unable to make any notes during the examination, and had to remember the individual points, while the physicians–as is customary in normal teaching–already made notes for later feedback during the examination. Moreover, the finding shows that with corresponding training [ 35 ], it is possible for PIs to become very well qualified in a very short time.…”

Section: Discussionmentioning

confidence: 99%

Physical examination skills training: Faculty staff vs. patient instructor feedback—A controlled trial

et al. 2017

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BackgroundStandardized patients are widely used in training of medical students, both in teaching and assessment. They also frequently lead complete training sessions delivering physical examination skills without the aid of faculty teaching staff–acting as “patient instructors” (PIs). An important part of this training is their ability to provide detailed structured feedback to students which has a strong impact on their learning success. Yet, to date no study has assessed the quality of physical examination related feedback by PIs. Therefore, we conducted a randomized controlled study comparing feedback of PIs and faculty staff following a physical examination assessed by students and video assessors.Methods14 PIs and 14 different faculty staff physicians both delivered feedback to 40 medical students that had performed a physical examination on the respective PI while the physicians observed the performance. The physical examination was rated by two independent video assessors to provide an objective performance standard (gold standard). Feedback of PI and physicians was content analyzed by two different independent video assessors based on a provided checklist and compared to the performance standard. Feedback of PIs and physicians was also rated by medical students and video assessors using a questionnaire consisting of 12 items.ResultsThere was no statistical significant difference concerning overall matching of physician or PI feedback with gold standard ratings by video assessment (p = .219). There was also no statistical difference when focusing only on items that were classified as major key steps (p = .802), mistakes or parts that were left out during physical examination (p = .219) or mistakes in communication items (p = .517). The feedback of physicians was significantly better rated than PI feedback both by students (p = .043) as well as by video assessors (p = .034).ConclusionsIn summary, our study demonstrates that trained PIs are able to provide feedback of equal quantitative value to that of faculty staff physicians with regard to a physical examination performed on them. However, both the students and the video raters judged the quality of the feedback given by the physicians to be significantly better than that of the PIs.

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Digital rectal examination skills: first training experiences, the motives and attitudes of standardized patients

Cited by 10 publications

References 62 publications

The Diagnostic and Prognostic Value of Digital Rectal Examination in Gastric Cancer Patients with Peritoneal Metastasis

The Diagnostic and Prognostic Value of Digital Rectal Examination in Gastric Cancer Patients with Peritoneal Metastasis

Is the Physician Expertise in Digital Rectal Examination of Value in Detecting Anal Tone in Comparison to Anorectal Manometry?

Physical examination skills training: Faculty staff vs. patient instructor feedback—A controlled trial

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