My first GYN exam was mainly over the menstrual cycle and contraceptives.
What they told us: "It will be multiple choice where you fill in the bubble sheet and you will have a choice of questions to answer. We really want you to do a good job."
What they gave us: A 25-ish question exam that was entirely "short essay" in which you had to come up with the material all on your own.
LOL.
It's only funny because I still knew the answers and didn't need the prompting that the multiple choice questions would have given me.
Otherwise, I would have been pissed.
***
So, in midwfery school it seems to be the norm that students practice skills on eachother. This is also the case for nursing school in general...but it's different because in nursing school we aren't talking pap smears and pelvics! From day one I was clear that this was not OK for me. I decline the option of "sharing my body" as is my right. A few others did the same, but by and far most consented. Well, after the first few sessions there were some problems. Students felt that they weren't in control of the sessions (ie; who touched them where or did what, or how involved/physical the faculty were during the teaching) and so they made some complaints (as they should have) and all practice sessions were stopped.
I give our professors credit for how quickly, and sensitively theyhandled the concerns. However, I don't think these sessions should even be a part of the program. I'm not sure if it's just because of the kind of institution that I'm at that makes me feel this way, or if it's the process in general, but I don't like this practice. One issue is that my classmates are not the most sensitive people in the world. A lot of them are very judgemental, naieve, and clueless when it comes to anything outside of their posh upbringings. It is very clear by the statements made in class. So after people make comments about appropriate weight, shape, skin, and social histories that they obviously disdain, how am I supposed to feel comfortable stripping naked for this person to touch me? Some people don't mind doing this in the name of learning. And they are right to point out that people have to learn some way. But at what cost to me? If I am the only fat girl in class, does that mean that I should let everyone try to do a bimanual pelvic exam on me so they can see what it feels like? Should everyone look at my acanthosis nigricans so that they can know how it looks on dark skin? Why should I have to do more than anyone else? Why should my privacy be neglected for the sake of your learning- especially when there are 15 of you and only one of me?
And even when this isn't the issue...there is something creepy and inappropriate to me about practicing on your classmates...in front of your professors...I don't want my professors to see me without clothes on...just like I don't want to see them without clothes on...there's a boundary issue I think.
What do you guys think?
Monday, September 24, 2007
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15 comments:
I just want to say, I wholeheartedly agree. If it was a professor I trusted, and she was in a one on one situation with me, MAYBE there's a miniscule chance I would consent. But otherwise, pelvics on people in my nursing class? Hells no. No way.
And don't get me wrong, I agree with the learning and where it's coming from. We have to do a head to toes and skills check w/a partner every semester, but they are in streets clothes or a gown (if they want). But if med schools can hire people for their med students to practice pelvics on, why not do the same for nursing students as well (actually I do know why, and I know it will never happen, but still. maybe if your school does that you can make that argument)?
I'm sorry to hear about your blog being found out. I loved reading your old site but understand why you would need to throw a password up there. But I'm glad you are going to keep writng and sharing. It does mean a lot to people out there (at least to me).
Hey snMoxie, my other blog will be back up shortly...I'm just trying to remove anything that I might not want people at my school to read (like stuff about me and husband, etc) but I won't be removing anything else, and then it will be open for public viewing again! So check back!!
Thanks for reading/listening!!!
LP
I think it's freak me out. having been the only or one of a few black students just in standard liberal arts college classes and already having felt over-examined and violated, I couldn't imagine being one in a class of nursing students and actually having one of them do a pelvic exam. No way in hell!
I just recently found your blog through another one and am very grateful to hear your stories and experiences--thanks for keeping it up!
it is true that I was the fattest girl in my midwifery class when I offered up my body for my class partner to do her practice and learning on.
did I do it to show them what it was like to do stuff on a fat girl? no, I don't think that was my intention - but I was proud of my body, my breasts, my pussy - and I wanted to feel as free as they did with their size 2 bodies gettin' nekkid and looking at each other's cervixes.
I get how it would be as you described it. It's not my job to make some size 2 never-had-a-baby hippie girl feel ok about my size 16-18 flabby body with stretch marks and grey pubic hair. (at 28!)
Had that been my intention, or perhaps it was on an unconscious level and I was just kidding myself about where I was at with my body pride - it would have felt really degrading.
I've often thought about being a paid model for medical students. Being able to give feedback re: vaginal exams is HUGE. I think few women patients talk about what is painful or what feels degrading to doctors - they need to learn this stuff in school, you know? I'm always up front with my providers, but they seem a bit put off by it (to the point that I tell them how to give me IM injections so it doesn't hurt as much!).
I know where you are coming from, I abhor this part of nursing school. Just last week I was holding up my breast for my male partner to palpate for my PMI. I don't know what was more bothersome, having to place a strang man's hand under my breast or having to let him see the roll that has snuck up and attached to my midsection. Not sure. I am sure I don't want my friend's hand up my vagina...I will be forced to be that guy.
I would agree with Sage femme's comments, although I was initially put off by being exposed in front of my peers, overall I am proud of my body. Proud that it doesn't look like anyone else's. And I think there's some rebelliousness in relishing your curves when all of society/media/etc tell women what size is "normal" and what is "abnormal."
I'm not the *only* curvaceous student in my whole entire nursing class, but in our small clinical groups, I am. But I would agree with Ashley, I am a 40DD (?) and was lifting my breast up last week so my partner (a female) could palpate my PMI. And to clarify, we're not practicing GYN exams...yet. It's not until I get into advanced practice.
I am so excited you found my blog and I can now read yours! It sounds like we have a lot in common. I hope you keep reading and commenting. Insight is always wonderful.
I'm a Latina/Native American student homebirth midwife in California. Thanks so much for writing about this topic! I'm so glad you decided to keep your blog going - I was definitely looking for something just like it. So nice to know I'm not alone!
We learned all the assessment and gyn stuff on each other too. And I have to say it was one of the things I loved best about my program. It was handled exceptionally well, the class was tightly bonded, discussions and sharing had taken place regarding anxiety/trust issues and abuse histories. We were set up to all feel as comfortable as we could be learning these hands on skills.
Our almost 70 y/o instructor had the process all demonstrated on her in front of the whole class, talking through everything, pointing out important differences in her (post menopausal) anatomy. We worked with partners we chose ourselves and while it was definitely anxiety inducing and a bit nerve wracking (I also was among the largest women in the group) it was also kind of empowering and humbling recognizing that this is how we felt in a class full of women we *knew* (to a greater or lesser extent) and who we knew were anxious too. It was nice to realize this in the context of someday going to perform a pap or a bimanual or a cervical check on a teenager or an abuse survivor, or random client you never met who doesn't know you from adam. I felt like it was really good for me to feel some of that anxiety. It makes me want to give a gentler exam, be a better practitioner. I was also really happy to meet nulliparous and multiparous cervixes and vaginas. It was really, really good for me to learn how to do a reasonably comfortable pap with a classmate with a super tight introitus, super long vagina and WAY posterior cervix before I actually had to locate one on a poor unsuspecting client. I actually got to recognize a cystocele or rectocele in a classmate and have them be able to say "Hey Morag, get your thumb off my clit please!". I'll never make that mistake again because my classmate made sure I recognized my error.
I do think that there is benefit in shared learning but I can understand and sympathize with your anxiety and discomfort though. I should note that I would probably feel very different if there were men in my class - which there are not.
I love your blog. Please keep writing!
Yeach. I learned how to due pelvic and breast exams on paid, trained volunteers, and would not have had it any other way. They were trained to provide feedback and could tell me instantly if I was doing something wrong. I can not imagine being forced to learn on each other or some unsuspecting poor patient for the first time. I think if med schools can hire trained models, your school should too! So great to not be worried about being perfect, or taking advantage of a client, but knowing the trained model was doing this as a job, and was prepared to assist me, a learner, not expecting care out of the situation!
Yes, I, too, LOVE the GTA teaching sessions! It is so wonderful to hear that feedback.
YellowRose15 I'm glad you found me here in cyberspace and good luck with school, it's wonderful!!
Thanks for the comments and encouragement to keep writing. It's nice to know people are listening.
I have no qualms with anyone seeing my naked body (ok: admission time - I once went to a nudist campground/resort). I wouldn't mind at all being a model patient for a GYN exam.
However, I think students should have the option to NOT be made to be the model patient while in school.
LP,
I totally agree with you. I had a similar shock about the expectation of being "practiced on" with your peers and seeing/be seen with little to no clothing by your fellow students and professors.
I believe, however, we have models on which to practice our pelvic exams, etc. I think for the general health assessment stuff, we may still be expected to practice on one another.
Thanks for bringing this us -- it's a fascinating topic and one which I think needs to be re-examined by nursing schools in general. It doesn't really happen anywhere else that you'd be expected to take clothes off and allow someone to touch you as part of your grade.
- Amanda
Just catching up on your blog after a crazy busy year finishing my BSN, and I had to make sure you saw this recent commentary in the J of Women's Health and Midwifery on this very topic. I can't figure out how to attach it to this comment, but it is here should you have missed it:
Levi. Examining Ourselves: Exploring Assumptions about Teaching Pelvic Exams in Midwifery Education. 53 (5): Sep-Oct 2008. Pages 403-405.
It's taking a more legal/ethical look that I found interesting - can anyone really give informed consent for a peer pelvic?
Anyway, keep writing!! I love your blog and always learn something new that helps me on my midwifery journey. Take good care, LP.
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