Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers

Patel, Manish I.; Kakala, Benedict; Beattie, Kieran

doi:10.1111/bju.14778

Cited by 11 publications

(8 citation statements)

References 15 publications

(20 reference statements)

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“…Additionally, in specific interviews with M aori men, Williams et al [23] addressed health system failure to consider cultural factors as a significant contributor to the reluctance among men to seek healthcare for prostate-related problems. DRE may be one of these factors because, in spite of the simplicity of the test, it could represent a source of distress to many men [24].…”

Section: Discussionmentioning

confidence: 99%

Ethnic and socio‐economic disparities in prostate cancer screening: lessons from New Zealand

2020

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To investigate the presence of ethnic and socio-economic disparities in prostate cancer (PCa) screening and identify its impact on cancer outcomes. Materials and MethodsFrom January 2008 to December 2017, all men in the Northern region of New Zealand who had a prostate-specific antigen (PSA) test performed in the community were identified from the electronic laboratory reports database. Asymptomatic men, with no known diagnosis of PCa, were included. Variables collected were age, ethnicity, social deprivation, medical therapy, PSA test information and cancer data. Disparities were investigated by comparing the frequency of PSA testing, proportions of men screened, and rates of cancer detection, between M aori (indigenous) and non-M aori ethnic groups. ResultsThe study cohort included 248 491 men, who each received approximately 3.45 PSA tests over the 10-year study period. M aori men were less likely to be tested compared to non-M aori men (25.4% vs 46.1% of the total aged-matched region population; P < 0.001). Moreover, they received less frequent PSA testing irrespective of their deprivation status (mean difference of 0.97 PSA tests per person; P < 0.001). The higher testing frequency in non-M aori men was associated with increased PCa diagnosis rates. Nevertheless, cancers detected in M aori men were 73% more likely to be of high grade (Gleason 8 or above), compared to those in non-M aori men. ConclusionThere were significant ethnic disparities in PCa screening rates in the Northern region of New Zealand. M aori men, regardless of other demographic factors, were disproportionately affected. The difference in the rates of screening by ethnicity had influenced the incidence and clinical significance of the diagnosed cancers.

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Section: Discussionmentioning

confidence: 99%

Ethnic and socio‐economic disparities in prostate cancer screening: lessons from New Zealand

2020

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“…Worryingly, senior medical students lack training in performing a DRE and up to 44% have never performed the examination on a human subject when graduating 17,18 . A randomized controlled study found that medical students that had practiced DRE on phantoms and human volunteers had an increased confidence in performing and trusting the results of the examination compared with students who only practiced on phantoms 19 . Like many other practical clinical skills, the DRE has a learning curve.…”

Section: Discussionmentioning

confidence: 99%

Case Report: The importance of examining colon and rectum in patients with appendiceal cancer

et al. 2021

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Appendiceal cancer is rare and is often diagnosed incidentally in patients undergoing appendectomy for acute appendicitis. However, patients with appendiceal cancer are at increased risk of synchronous malignancy. In this case report, we present a 58-year-old man initially diagnosed with acute appendicitis after presenting to the emergency department with abdominal pain. He had an appendectomy and was discharged the following day. Unexpectedly, the postoperative histopathologic examination showed a primary adenocarcinoma in the appendix. A computed tomography scan showed rectal wall thickening and the patient was referred to colonoscopy where an experienced endoscopist found a rectal tumor during the digital rectal examination prior to the colonoscopy. The tumor was initially missed by the newly qualified doctor who examined the patient during his first admittance to hospital. The patient’s two primary cancers were treated with a laparoscopic right hemicolectomy for the appendiceal cancer and a low anterior resection for the rectal cancer. This case supports the importance of a full colorectal workup in patients with appendiceal cancer. It also emphasizes the value of a thorough digital rectal examination and the need for improved focus on teaching and practice of the procedure.

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“…Clinical examination should provide baseline information on the presence of deformity, the point of maximum curvature, presence/location/size of the plaque, penile length, and areas of tenderness. On examination, the penis should be stretched fully to assess the penile length and palpate for the presence of any penile plaque [15,16]. Digital photographs are often helpful and penile examination with the aid of vasoactive intracavernosal injection can be used to confirm and document the extent of penile curvature/deformity, vascular integrity and erectile response [16].…”

Section: Patient Evaluation and Diagnosis: Clinical Principle/ Expertmentioning

confidence: 99%

A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association

Chung

Gillman

Tuckey³

et al. 2020

BJU International

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Objective To provide a clinical framework and key guideline statements to assist clinicians in the evidence‐based management of Peyronie’s disease (PD). Methods We conducted a review of the published literature relevant to PD management, with an emphasis on published clinical guidelines. References used in the text have been assessed according to their level of evidence, and guideline recommendations have been graded based on the Oxford Centre for Evidence‐based Medicine Levels of Evidence. Results The management of PD involves taking a detailed penile and sexual history, with a focused penile examination to identify plaque and hourglass deformity, and digital photographs of the erect curved (deformed) penis. Penile colour Duplex ultrasonography evaluates tunical plaque and underlying cavernosal smooth muscle and blood flow variables. The current therapy for PD can be divided into two main groups, namely, medical therapy and penile reconstructive surgery, and the patient should be counselled on the benefits and risks of each treatment option. Conclusions Peyronie’s disease remains a clinical challenge and presents a considerable therapeutic dilemma as the current therapy addresses existing penile curvature only and is not very effective in preventing future penile fibrosis and/or reversing underlying erectile dysfunction.

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Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers

Abstract: ConclusionThis study showed that teaching DRE with the assistance of volunteer patients improves inexperienced students' confidence in performing DRE, and the incorporation of such training should be considered in the DRE education programme.

Cited by 11 publications

References 15 publications

Ethnic and socio‐economic disparities in prostate cancer screening: lessons from New Zealand

Ethnic and socio‐economic disparities in prostate cancer screening: lessons from New Zealand

Case Report: The importance of examining colon and rectum in patients with appendiceal cancer

A clinical pathway for the management of Peyronie’s disease: integrating clinical guidelines from the International Society of Sexual Medicine, American Urological Association and European Urological Association

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