Last year, Hannah Shacter learned to perform a procedure known to invoke anxiety among medical students: the infamous pelvic exam.
But the third-year medical student may have been among the last batch to practice the task on a person early on in her medical education. Recently, the University of Minnesota Medical School decided to replace the expensive standardized patients with mannequins for pelvic exams in an effort to save money. Each year, the school spends more than $150,000 to hire and train standardized patients.
“It’s just incomparable to be able to actually do the true exam on a woman who is explaining to you how to do the exam,” she said. “It’s really the only way to learn it. Learning on a mannequin is not the same thing.”
During their second year of training, students learn how to perform physical exams, interviews and develop relationships with patients, including the female breast and pelvic and male genital workshops.
In the past, students participated in a lecture, practiced on plastic pelvic mannequins and then worked with patients. Starting this semester, however, second-year students will learn the lecture material online and will use the mannequins for their pelvic training, in addition to watching a detailed video of the exam.
Jane van Dis, assistant professor of obstetrics and gynecology, said there’s an assumption among students that their education will suffer because of the change.
“My response to that is that we don’t know the answer,” she said.
The decision is not set in stone, and the school will conduct surveys on students before and after their OB-GYN clerkship — mandatory training that happens later in their medical education — to find out how they learn best.
The surveys will be given to students who used both the mannequins and humans to learn the pelvic exam.
“We want to know if in fact there is even a difference,” van Dis said. “Maybe the study will show that the pelvic model is better than the standardized patient.”
If the results show students prefer to practice on people, adjustments could be made to the curriculum. The evaluations from students will be critical in making the decision, said Linda Carson, professor and chairwoman of the OB-GYN department.
“It’s not assumed that because we’ve made a change that’s the right approach,” she said.
Third-year medical student Rachael Long, who learned how to perform a pelvic exam on a person last year, said the change will be “detrimental” to medical education at the University.
Performing the exam on a person is much more difficult because a mannequin is made of plastic and a person is made of tissue, she said.
“With a mannequin, no matter how bad your technique is, you’ll find the cervix anyway,” Long said. “You don’t have to be gentle on it.”
In recent years, mannequins have become much more anatomically correct, said M. Brownell Anderson, Association of American Medical College senior director of educational affairs.
In addition, it saves everyone involved from being in an uncomfortable situation and allows students to take their time and practice as many times as they need to, she said.
“The mannequins allow them to practice over and over and over again,” Anderson said. “They’re not hurting anyone.”
At this point, the standardized patients will still be used in all other parts of the physical exam training, including the breast exam and male genital exam, said Sharon Allen, family practice and community health professor.
At the University of Wisconsin School of Medicine and Public Health, paid “teaching assistants” are used for pelvic exams, professor Jane Zanutto Crone said. The school does not use mannequins in any part of pelvic training.
While the assistants are extremely expensive to train and employ, students tell Crone they never would’ve been able to learn the procedure without them.
“You will never be in the situation again where you go to palpate someone’s ovary and they say, ‘You’re nowhere near it. Let me tell you how to move your hand,’ ” she said. “A true patient is not going to give you that kind of feedback. These women do.”