The pelvic exam is by nature a challenging procedure to perform well, as it requires a provider to establish with a patient a level of trust high enough to permit inspection and palpation of one of the most private and intimate parts of the body. Unfortunately, data suggest that providers have not mastered the art of performing a sensitive and tolerable pelvic exam, in that approximately 30% of patients overall report experiencing psychological and/or physical distress associated with the exam. Levels of distress have been shown to be especially high among certain groups, including patients with sexual and gender minority status, disabilities, obesity, and a history of trauma. Individuals who experience exam-related pain or discomfort are less likely to return for future care; accordingly, disparities in cervical cancer screening have been documented in each of the aforementioned populations.
For the past three years, we have implemented (and continued to use) this OSCE as one of the four stations that we administer at the end of the PGY2 year. To date, 12 PGY2 residents (four per year) enrolled in the HIV Primary Care Track have participated in this OSCE station. Aggregate results of their completed faculty and standardized patient checklists are presented in Table 2 in the Instructor's Guide.
By the end of this OSCE, primary care residents will be able to:
- Address a patient’s questions or concerns about having a pelvic exam/Pap test.
- Review options to optimize the patient’s comfort during the pelvic exam, including determining the patient's preference for a specific support person or chaperone.
- Obtain the patient’s verbal consent prior to proceeding with the pelvic exam.
- Conduct the pelvic exam/Pap test in a respectful and supportive manner that maximizes the patient’s sense of safety, comfort, and control.
- Perform pelvic exam maneuvers and cervical sampling in a technically proficient manner.
- Provide support and reorientation to the present and use grounding techniques when the patient dissociates during the exam or otherwise signals emotional distress.
- Conclude the encounter by providing clear information about next steps and discussing an immediate self-care plan to help the patient cope if the patient continues to experience distress after leaving the office.
None to report.
This OSCE was developed in the context of the Beth Israel Deaconess Medical Center Internal Medicine Residency Program's HIV Primary Care Track. This track was funded by American Recovery and Reinvestment Act - Residency Training in Primary Care Health Resources and Service Administration Training Grant #1D5FHP20672-01-00.
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