Challenging Pelvic Exam

Abstract Introduction 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. 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. This resource includes all of the materials needed to run an OSCE station focused on providing formative feedback to primary care residents regarding their ability to perform a sensitive and technically proficient pelvic exam/Pap test for a standardized patient who identifies as lesbian and has a history of trauma. Methods For the past 3 years we have implemented (and continue to use) this OSCE as an integral component of a multistation OSCE designed to provide formative feedback to residents enrolled in the HIV Primary Care Track of the 3-year BIDMC internal medicine residency program. After completion of each year of training, residents rotate through four sequential OSCE stations; this OSCE is one of these stations administered at the end of the PGY2 year. Results To date, 12 PGY2 residents (four per year) enrolled in the HIV Primary Care Track have participated in this OSCE station. Total performance, encompassing history, exam, and counseling skills, as rated by faculty checklists was 23.5 out of 30. Communication performance (i.e., patient centered communication, interpersonal skills, and global rating), available for eight of the residents, as rated by standardized patients, was 78.3/90. Discussion The pelvic exam is by nature a challenging procedure to perform well. Unfortunately, data suggest that providers have not mastered the art of performing a sensitive and tolerable pelvic exam. This OSCE includes all the materials to run a station focused on providing formative feedback to residents regarding their ability to perform a sensitive and technically proficient pelvic exam. With minor adaptations, the case can be adapted to feature a patient on the female-to-male t