Thursday, February 18, 2010

University of Minnesota Medical School

Changes Pelvic Exam Lesson For Medical Students

Money for Alternative Medicine, But
We Don't Have Enough For Real Medicine?

Coke (and Pepsi) are the real thing at the University of Minnesota Medical School.

Plastic pelvic exam models, not so much.

The gang that couldn't shoot straight is back in town.

Fresh from the endorsement of homeopathy by the Director the Center for Spirituality and Healing at the University of Minnesota comes the latest example of foot in mouth disease:

From the Strib:

Historically, the students have practiced on paid demonstrators but the university has recently switched to mannequins in an effort to save money.

Each year, the school spends more than $150,000 to hire and train the practice patients.

Starting this semester, however, second-year students will learn the lecture material online and will use the mannequins for their pelvic training.

Assistant Professor Dr. Jan van Dis tells The Minnesota Daily that many students think the change will diminish their education, but she says there's no way to know if that's true.

[How about a little common sense? Also, Dr. van Dis might want to check the medical education literature on this one. Nice study done at Northwestern...]

She says the university will study the change and could switch back if it doesn't work.

[And how will that be decided?]

To no one's surprise, the reaction has been almost 100% negative. There are now 70 comments on this short article and they are well worth reading to see how this new action by the U is perceived.

Once again, you have to ask yourself:

What are these people at the med school thinking?

From the comments on this article:

Women's Health Care
Why am I not surprised that the health care industry thinks that practice could be taught on a mannequin? Are they doing the same for prostrate checks? Every woman is build differently and the fact that they think a cookie cutter doll could cover off on a multitude of shapes & sizes is insane! OY!
posted by horse2 on Feb. 18, 10 at 7:05 AM |
74 of 75 people liked this comment.
And how will you tell if it doesn't work?
posted by kuan on Feb. 18, 10 at 7:07 AM |
71 of 71 people liked this comment.
I agree with Sara626. Tough times or not, there are many things these students will not be learning because of having to use mannequins. I am more than happy to have my tax dollars pay for "real patients".
posted by rushja on Feb. 18, 10 at 7:43 AM |
58 of 60 people liked this comment.
This is news?
Really? Isn't there something more important happening in the world that you could cover?
posted by demlover on Feb. 18, 10 at 7:55 AM |
4 of 94 people liked this comment
Maybe it is a question of priorities?
Would you rather spend money on the Deborah Powell Women's Health Center at the U or to pay actual people for realistic training in this important area. A no brainer...
posted by wbgleason on Feb. 18, 10 at 7:56 AM |
32 of 33 people liked this comment.
I go to med school in Chicago. Since there are 7 med schools in the Chicago area, we all use the same paid "patients" to practice our male and female exams on and thus share the training costs (and, for these brave patients, it gives them a lot of chances to make some money). Maybe the U could look into renting another school's patients? Perhaps it'd be cheaper to fly in 30 standardized patients from Madison or Chicago rather than paying for all the training themselves? I can't imagine going into 3rd year without having real practice in male and female exams - I feel bad for the U students. I guess they could always do what the Candians do and use anesthesized patients going into surgery for practice! (Bad idea)
posted by d44332211 on Feb. 18, 10 at 8:21 AM |
38 of 41 people liked this comment
I went to the U in the early 70's. There were no mannequins, no models; we started supervised on a few patients then were on our own - generally the exams were checked by a more experienced physician. (To all those now 60-somethings who had clumsy pelvics in '72-'73, we're sorry, we were trying our best.) Since then, I've taught other procedures with mannequins. They are ok to teach the rudiments; the basic anatomy, what goes in which hand, what is the sequence, etc, but mannequins do not replicate human tissue. I would rather learn this absolute beginner stuff on a mannequin than a person, but real skill comes only with a lot of practice in real life. I've never worked with a model, but I would think they would be able to give valuable feedback that a patient would not feel comfortable giving. charlie md
posted by carl5100 on Feb. 18, 10 at 8:51 AM |
43 of 43 people liked this comment.

I attended the U of MN med school in the 1990s. I remember learning these exams. Every woman's anatomy is different. You also have to learn to apply the right amount of pressure to the speculum. IMHO, use of mannequins will diminished the students' learning.The paid volunteers gave good feedback. You can't learn these on mannequins. Women, would you want a medical student or resident perform a pelvic exam on you if they've only practice on plastic models?
posted by mch651 on Feb. 18, 10 at 12:15 PM |
17 of 17 people liked this comment.

Students worried too!
I am a current med student at the U of M, and the students are highly worried about this too. For clarification, in past years, students would practice on the plastic mannequin, then work with a standardized patient. Real patients aren't trained to give feedback regarding speculum pressure or location of the ovaries, whereas the standardized patients provide this input. This is detrimental to our education, and while the med school is facing huge budget cuts from the state, I'd like to see what the administrators are doing to maintain the education of MN doctors.
posted by ummedstudent on Feb. 18, 10 at 1:18 PM |
8 of 8 people liked this comment.

I'm a medical student at the U. Our class was one of the last to be trained using both mannequins and real people. I can tell you I felt very confident the first time I did a pelvic exam on a real patient and I would not have felt that way without this workshop. I am saddened to here another frustrating example of the wasted time and money of our medical school. It should not cost the medical school $150,000 to run this training. This should be obvious to everyone reading this article. If you had any idea the number of deans who do the same exact job in the medical school you would be shocked. They promoted a project called Med 2010 for >2 years and thought it would be revolutionary. The problem was that they didn't come up with any specific plan and gave it up. The cuts new dean Lindsey Henson is spearheading are scary for the future of the school. Its a shame the medical school can't get their act together. Did you know the U has the most expensive tuition of a state funded medical school in the country?

A medical student from Chicago mentioned that there are seven medical schools in the Chicago area. This is brilliant-- there's lots of competition and in fact, his medical school provides real patient-actors to work with. Here the medical school has no competition. Many people, including me, chose the U of M because it's located in the Twin Cities where all my family and friends live. $150,000 for the exam? On a per student basis that's $880-- it would have taken me 20 minutes with a real patient. (That's about what it took with the male.) Are we paying our patient actors $2500 per hour? I suspect there is some waste in the system.... Competition within the Twin Cities is the only real fix. Legislators get to work!

And the coup de grâce:

No money for real education

I'm a current student who was directly effected by this cost saving move and I can say it is a terribly short sighted move by the med school. ... my colleagues will be much less confident and more apt to make painful mistakes when we have to (and we all will) do the pelvic exam for the "first time" on a real patient. This cost saving act is particularly ridiculous given the Med school thought it was a good idea to rent a bunch of buses and bring us to a local quack factory (alternative medicine school) but not fund real educational opportunities.

For once it would be nice to see the medical school administration publicly admit that they have made a mistake and back off on this new policy.

Don't hold your breath.

1 comment:

Anonymous said...

As an OB/GYN resident and a former U of MN med student with the equivalent of a house-loan in student loans, if the option is between doing one exam on a living male/female for $150K or training on mannequins, I would choose the mannequins hands down.

While many medical students may go on to require proficiency in the pelvic exam (internal medicine, family practice, emergency med, ob/gyn), one exam on one human being will not lead to proficiency.

The fundamentals can be learned from the mannequin, and medical students can begin to hone their pelvic exam skills in the clinics we attend on clinical rotations. This includes pelvic exams in the OR. A pelvic exam on a paralyzed patient is one of the best ways to become familiar with the shape and size of both the uterus and the ovaries along with any pathology that may be present.