BMJ  2003;326:1327 (14 June), doi:10.1136/bmj.326.7402.1327-a

Letter

Please don't touch me there: the ethics of intimate examinations

Integrated approach to teaching and learning clinical skills

The first 150 words of the full text of this article appear below.

EDITOR—Coldicott et al raise several issues.¹ How do students acquire clinical skills without practising on patients? Rather than contribute to the ethical debate, we propose that alternatives be explored to support students in the development of clinical skills.

Coldicott et al recognise that technical skill is just one element of competence in vaginal examinations. The ability to communicate sensitively is crucial, and indeed each patient's definition of an intimate examination must be central. Practising on an anaesthetised patient provides no opportunity to develop communication skills and reduces vaginal examination to a purely technical task. Observing a student performing a vaginal examination provides no guarantee of what is palpated. Conventional pelvic manikins have similar limitations, but pressure sensitive manikins, fitted with electronic sensors, can provide feedback on which organs are palpated and with what force.^{2 3}

We have developed an approach to teaching and learning clinical skills that links manikins . . . [Full text of this article]

Centre for Medical and Health Sciences Education, Monash University, Clayton, Victoria 3800, Australia debra.nestel@med.monash.edu.au

Department of Surgical Oncology and Technology, Imperial College London, St Mary's Hospital, London W2 1NY

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The ethics of intimate examinationsteaching tomorrow's doctors • Commentary: Respecting the patient's integrity is the key • Commentary: Teaching pelvic examinationputting the patient first

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