by Clinical Practice Resources Managing Director, Richard Claflin
One of the things we all recognize as GTA/MUTA instructors is that we teach an uncomfortable subject that produces a lot of anxiety for learners who are new to performing gynecological, genital or prostate exams. There’s no way around it: these examinations are filled with a lot of complicated medical information and, on top of that, fraught with all sorts of emotions that each student brings to the learning experience from their own personal background and social conditioning. The key to effective learning is to break through those stigmas and taboos so that students (our future practitioners) can conquer their own fears before they’re able to accommodate a patient’s fears in the real world. And that’s just the big picture issues facing the students…there are also practical issues that can add to their stress in the clinical skills lab. Specifically, they’re just meeting their GTA/MUTA instructor for the first time, so they’re not sure what kind of personality they’re about to be interacting with. They may be exhausted from having worked all night. They may have a big final exam coming up, and their mind is on the studying they have to do. In many instances, they don’t even know their fellow students very well, or may be meeting them for the first time, and so there might be a dynamic among the students that adds a layer of stress.
Over the years of teaching these sessions, I’ve learned a few simple ways to relax the students at the beginning of every session. Here’s a short list of the things I do to help things begin smoothly:
- When I introduce myself, I remind them right off the bat that my class is a workshop intended only for their benefit: they aren’t being evaluated by me, they aren’t being filmed, they aren’t being graded by anyone, their regular professors aren’t in the room. In other words, I emphasize that this is an opportunity for them to practice clinical skills in an environment where it’s okay for them to make a mistake, to take a second shot at something, and to take some extra time with something if they need to.
- I tell them that I’ve done this many, many times and I won’t let them hurt me. (Actually, I told my students this even when I was a new instructor and it relaxed and calmed them to such a great degree that I realized it was better for them if I pretended I had tons of experience. Of course I wouldn’t let them hurt me, anyway, but projecting experience on my end lowered their anxiety significantly…which actually made it less likely I would get hurt! And now that I have tons of experience, I’ve learned that projecting confidence…even “fake” confidence…is an extremely valuable skill when it comes to reducing patient anxiety.)
- Without asking anyone to admit how they, themselves, are feeling, I let them know that if anyone has anxiety about what they’re about to do that’s okay…and, in fact, I would be surprised if they didn’t have some anxiety. I tell them to really hang on to that feeling, because after the class they will have much more confidence – but it’s important to remember that in the future it’s the patient who will have anxiety…and their job is to reduce that anxiety, so empathizing with the patient by getting in touch with their own anxiety is a really important thing to do at the start of the class.
- I have them start with a brief “role-play” that enables me to interact with each of them before getting into the genital exam itself: After they wash their hands and glove-up, I ask them to pretend to knock on the door, to introduce themselves, to tell me what their job is, and to give me a broad overview of what to expect as a patient (“Today I’m going to be doing a genital exam and then will finish up with a quick check of your prostate.”). After this, I have them lower my drape – without exposing any genitals – and palpate my inguinal lymph nodes on both sides and then re-place the drape, letting me know when they’re done that “Everything looks normal.” I have each student do the whole entrance-intro-lymph nodes routine before I even get into the actual genital exam instruction. This allows each student an opportunity to experience and get comfortable with the role-play part of the class and to do something “hands-on” that is easily within their comfort zone…and allows me an opportunity to interact with each student one-on-one to assess their level of anxiety, nerves and stress. Giving them a simple task that they can all accomplish right at the start reduces their anxiety enormously, and after that I continue with the now-more-confident class into the more sensitive genital and prostrate exams.
So there you have it…hopefully some of these tips and suggestions will be valuable to you as you think about the way in which you spend the first moments of your time with students. I’d love to hear your ideas and experiences if you have methods that work well for you!