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Medical Students’ Perceptions of the Physician’s Role in Not Allowing Them to Perform Gynecological Examinations

van den Einden, Loes C.G. MD; te Kolste, Mieke G.J.; Lagro-Janssen, A.L.M. MD, PhD; Dukel, Lenno MD

doi: 10.1097/ACM.0000000000000055
Research Reports

Purpose To determine how often medical students are not allowed to perform gynecological examinations during their obstetrics–gynecology clerkship, identify the barriers to participation related to physicians and patients, explore the role of the supervisory physician in not allowing medical student involvement, and explore differences between male and female students’ experiences.

Method All medical students entering their obstetrics–gynecology clerkship at a medical school in the Netherlands between May and October 2011 were invited to participate in this study’s questionnaire, which asked them to report the number of gynecological examinations they were allowed and not allowed to perform during their clerkship. Eighteen questionnaire respondents participated in three focus groups.

Results Of the 139 medical students invited, 76 (55%) completed the questionnaire. Students reported a total of 2,196 instances in which they were not allowed to participate in the examination; 89% (n = 1,956) were related to the supervisory physician. Qualitative data from the focus group interviews showed that female supervisory physicians prioritized patients’ autonomy above students’ learning needs. Furthermore, female students were less assertive than male students in asking the supervisory physician for permission to participate.

Conclusions The physician’s role in not allowing student involvement is substantial and results in fewer opportunities for students to perform gynecological examinations. For students to develop the necessary gynecological exam skills during their clerkship, medical educators need to improve the learning environment.

Dr. van den Einden is a PhD student, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.

Ms. te Kolste is a sixth-year medical student, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.

Dr. Lagro-Janssen is professor, Department of Primary Care and Community Care, Unit Gender and Women’s Health, Radboud University Medical Centre, Nijmegen, The Netherlands.

Dr. Dukel is a gynaecologist, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.

Funding/Support: None.

Other disclosures: None.

Ethical approval: The institutional review board of the Radboud University Medical Centre Nijmegen determined that the review of the study protocol was not required.

Correspondence should be addressed to Dr. van den Einden, Department of Obstetrics and Gynaecology (791), Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; telephone: (+31) 24-3615125; e-mail: l.vandeneinden@obgyn.umcn.nl.

© 2014 by the Association of American Medical Colleges