JFOA Journal

Discussion

This study evaluates the effectiveness of DRE teaching sessions in the confidence level of family medicine residents when performing DRE. This study’s findings revealed a significant improvement in the confidence levels of the family medicine residents when performing DRE after the teaching sessions. The overall mean confidence score before the teaching session was 9.34 points, increasing to 13.1 points post-teaching sessions (p<0.001). In Australia [4], 92% of the final-year medical students expressed that they received education on performing DRE, with 81% reporting receiving a tutorial regarding plastic models technique, and despite that, 79% of this group said this teaching was beneficial, only 52% among those who found the tutorial helpful were able to carry out a DRE post-tutorial session. However, in Canada [6], comparing the knowledge of DRE between students who received lectures and presentations (control group) versus students who received the same methods plus further training from a rectal teaching associate (experimental group). Findings suggest that both groups’ mean knowledge scores increased significantly after the training (18.73 to 22.32, p<0.001). However, the experimental group scored higher on the Objective Structured Clinical Exam (OSCE) (27.52 versus 23.80, p=0.001) and rated the rectal teaching associate as a more effective DRE method. The outcome of our study suggests that teaching sessions prior to performing DRE among the residents may yield better confidence levels among them. Hence, it is worth implementing this type of education method, considering the evidence found in this study.

Data in our study suggest that the confidence levels of male and female residents were comparable before and after teaching sessions. Furthermore, comparing the number of DRE performed between male and female residents, our results yield insignificant results (p=0.529), indicating similar number of DRE performed in both groups. This observation is consistent with the report of Dakum, et al. [9], wherein the number of performed DRE did not vary significantly between age and gender.

Prior to DRE teaching sessions, only 7.9% strongly agreed with their confidence to perform and accurately assess using DRE; however, after the sessions, the confidence increased to 42.1%. Similarly, in post-intervention, most residents felt more confident in understanding the indication to perform DRE and were adept with their techniques. Our results seem to be better than the study of Bussières, et al. [2]. Based on their accounts, during the course of training, one-third of trainees did not receive any supervision for or feedback on the DRE-related techniques, and 71% demonstrated a lack of knowledge to identify the nature of abnormal examination findings at least once during their training. Similarly, Eziyi, et al. [10] indicated less confidence among the final year medical students when providing an opinion regarding the findings of DRE, as only 3.9% were very confident, although 82.7% showed reasonably confident. However, in a study by Nwachukwu [11], some misconceptions were seen among medical students. Accordingly, researchers documented that 19% of the students do not believe that DRE is for medical students, and approximately 20% were of the opinion that their choice of future specialty influences their attitude toward DRE.

All our residents performed DRE, with 39.5% performing at least twice throughout their careers. Prior to the training session, 44.7% (agree: 34.2%; strongly agree: 10.5%) reported clinical exposure to DRE during residency training. In Ireland [3], medical students who had no experience of DRE have been reported at 24%, with mannequin-only experience in a further 20%. The author added that the most common reason for the limited exposure was the misunderstanding that the medical students were not allowed to perform DRE on patients (51%). In Nigeria [9], a higher number of final year medical students (80.3%) have done at least 1 to 5 DRE; however, there were about 2.4% had never done such type of examination.

Conclusion

The confidence level in performing digital rectal examinations of family medicine residents improved significantly after the teaching session. However, the satisfaction of teaching sessions seems to have a similar effect on both male and female residents. In addition, all family medicine residents had experience in performing DRE regardless of gender. This study provides evidence that teaching sessions are crucial for improving the confidence level of family residents in conducting DRE. Thus, we support the full implementation of such teaching to increase residents’ awareness, satisfaction, and confidence toward DRE.

References

1. Alghamidi IG, Hussain I, Alghamdi MS, El-Sheemy MA (2014) The incidence rate of prostate cancer in Saudi Arabia: an observational descriptive epidemiological analysis of data from the Saudi Cancer Registry 2001-2008. Hematol Oncol Stem Cell Ther 7: 18-26.
2. Bussières A, Bouchard A, Simonyan D, Drolet S (2017) Family medicine residents’ training in, knowledge about, and perceptions of digital rectal examination. Can Fam Physician 63: e232-e237.
3. Fitzgerald D, Connolly S, Kerin MJ (2007) Digital rectal examination: national survey of undergraduate medical training in Ireland. Postgrad Med J 83: 599-601.
4. Lawrentschuk N, Bolton D (2004) Experience and attitudes of finalyear medical students to digital rectal examination. Med J Aust 181: 323-325.
5. Patel MI, Kakala B, Beattie K (2019) Teaching medical students digital rectal examination: a randomized study of simulated model vs rectal examination volunteers. BJU Int 124: 14-18.
6. Popadiuk C, Pottle M, Curran V (2002) Teaching digital rectal examinations to medical students. Acad Med 77: 1140-1146.
7. Okotie OT, Roehl KA, Han M, Loeb S, Gashti SN, et al. (2007) Characteristics of prostate cancer detected by digital rectal examination only. Urology 70: 1117-1120.
8. Redmond EJ, Saleem SN, Domes T, Rourke KF (2020) Deficits in urological knowledge and skills among family medicine residents in Canada. Can Urol Assoc J 14: E631-E635.
9. Dakum N, Ramyil VM, Agbo S, Ogwuche E, Makama BS, et al. (2007) Digital rectal examination for prostate cancer: Attitude and experience of final year medical students. Niger J Clin Pract 10: 5-9.
10. Nwachukwu AC (2019) Digital Rectal Examination (DRE); A Despised Clinical Sign among Medical Students? World Journal of Innovative Research 6: 30-33.
11. Eziyi AK, Ademuyiwa AO, Eziyi JAE, Salako AA (2010) Digital rectal examination for prostate and rectal tumour: knowledge and experience of final year medical students. West Afr J Med 28: 318-322.