Stanford's E-Pelvis Teaching Tool Builds Skills in Difficult-to-Learn Procedure.

News Editors & Medical/Health Writers

STANFORD, Calif.--(BW HealthWire)--March 6, 2002

Ask the average woman to compile a list of life's unpleasantries and chances are, pelvic exams will rank close to the top. And women aren't alone with that sentiment -- the procedure isn't much of a crowd-pleaser among physicians in training, either.

"Giving a pelvic exam is never something you look forward to," said Jason Ehrlich, a fifth-year M.D./Ph.D. student at the School of Medicine. "It's awkward to begin with and then you have to wonder, 'What do I do?'"

In an effort to answer that question, researchers at the Stanford University School of Medicine have developed E-Pelvis, a tool that helps students learn how to conduct a pelvic exam. Stanford is the only school in the country to teach students on the device, which simulates the procedure.

E-Pelvis -- which Ehrlich describes as "rubber wrapped around things that look like legs" -- is an electronic pelvic mannequin attached to a computer monitor. With the help of sensors built into the mannequin, students are able to practice an exam while they and their instructors monitor on a computer screen the location and intensity of touch applied.

Carla Pugh, M.D., Ph.D., developed the device four years ago after seeing a need for better training. Second-year students at Stanford typically practice on gynecological teaching associates -- female instructors who explain how to give pelvic and breast examinations, guiding students along the way. The associates then offer feedback as students practice. At many other medical schools, however, students practice on patients, and because it's an internal exam, observing clinicians can't easily tell how the students are doing.

"When students put their hands inside, you can't tell where they're touching and you don't know if they're feeling what they're supposed to," explained Pugh, a research associate with Stanford University Medical Media and Information Technologies, and a surgeon with Kaiser Permanente.

Pugh said she realized she had developed something important while watching students use the device. "The students looked like they were doing the right things, and if I had evaluated them based on this alone, I would have thought they were giving a thorough exam," she said. "But then I looked at the computer screen and it was like night and day. One student was barely touching anything."

Along with anecdotal evidence from Pugh and fellow instructors, a study conducted by Pugh and her team demonstrates that medical students may be missing their mark when it comes to pelvic exams. The study compared results of medical students and clinicians who performed on the E-Pelvis and found a discrepancy in exam skills. In other words, said Pugh, "you can tell the difference between students' exam and clinicians" -- a finding that supports the use of the device for training.

"The pelvic exam has been an exam that we've assumed students and residents will learn in time -- but this device could speed up the process," she added.

Today Stanford students use and are evaluated on the E-Pelvis before entering their session with the female teaching associates. "It feels like students enter the room at a different level," said Nancy Finkle, one of Stanford's teaching associates. "When students use the E-Pelvis they get the basic stumbling out of the way and then focus on their soft skills when they're with the educator. The students can play the role of a practicing physician and can work on patient comfort and consent."

Ehrlich, who used the E-Pelvis for the first time this winter, agrees that the device is helpful for both students and future patients. "Being able to simulate techniques and physical movements made it much more comfortable when I had to do it on an actual woman," he said. "A patient doesn't want an exam from someone who feels nervous or doesn't know how to do one, so anything that better prepares clinicians will make the patient more comfortable."

Pugh said she's excited about the potential applications for non-students, as well. "This is a teaching and assessment tool, but it can also be used as a research tool," she said. "It can be used to categorize how different groups of people do the exam."

Stanford University Medical Center integrates research, medical education and patient care at its three institutions -- Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For more information, please visit the Web site of the medical center's Office of Communication and Public Affairs at http://mednews.stanford.edu.