Teaching assessment of opposite gender patients

[Riblett]

I am having some difficulty getting my EMT students to conduct assessments appropriately, particularly on opposite gender 'patients.' The female students don't seem to have an issue with it.

Some of the male students don't take it seriously and laugh the whole time. Others are so uncomfortable that the stammer through the whole thing and don't do an accurate assessment because they are too scared to actually touch their classmate.

I am not talking about ob/gyn type stuff here, just your typical secondary survey (head to toe) on a fully clothed fellow student. Obviously this involves assessing the chest area to assess the clavicles, ribs, and sternum, but I (a female instructor) am always present when they are doing opposite gender practice assessments.

I try to make sure they can practice assessing patients of both genders, but now I am reconsidering. Should we not be making our students peform assessments on opposite gender during their class? Should we allow them to opt out? How will this effect their ability to perform them in the field?

Edited January 27, 2012 by Riblett

[dstevens58]

Being comfortable will come with practice. You can't pick your patients, so some sort of randomized picking of Student:Patient partnering needs to be drawn up.

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[JakeEMTP]

Tell them to grow the hell up, stop giggling and do a proper assessment. If they can't handle it in the classroom with a fully clothed pt, then how will they act in the field with a real patient?

EMS is can be serious stuff. Trauma calls are where EMT-Bs can really help and assessments are where they can really show their education. There is no place for wannabe heros. I would like to think if one of my daughters required a trauma assessment, the responding EMS personnel could handle it without acting like a couple of grade 8 pubescents.

It is imparative that they practice assessments on both male and female patients. Don't give up, heaven forbid it may be you that needs their assistance. You'd want them to conduct themselves professionally and do the job correctly.

Practice, practice, practice. They will eventually get over it I hope. Maybe if you had the same partners for a little while and they became more comfortable with the "assessee" before moving on to different patients may help. If not, show them the door.

Edited January 27, 2012 by JakeEMTP

[nypamedic43]

I agree with Jake. It is absolutely imperative that they get over this grade school stuff. They have to practice on opposite sex classmates to work this out and get comfortable with the skill. We can't pick real life patients, females assess males and males assess females. They have to be able to do this skill without giggling and being shy. That doesn't do anyone any good.

[EMT-B 55]

When we have male students as you described we put them on the old CRP Annie first and expain to the class (1) modesty at times goes out the window and(2) that by doing a proper assessment, there is nothing sexual about the hands on assessment

[Eydawn]

What's the age range of your problem students?

Just curious. If they're all younger, tell them they're too young to be in EMS if they can't practice assessments on their non-injured classmates.

You could create scenarios where the female "patients" have a life threat that needs to be found and provide incentive for finding them quickly... I hate to go this simple, but candy is a good motivator for teaching (as far as I've found)... and if they can't focus, and keep giggling, kick them into the hallway. Sternly. It may mean singling someone out, but the example needs to be set that EMT class is not to dick around in.

Just my thoughts.

Edited to add: Asked my 21 year old brother (who is an EMT) and he says to hide a $5 bill on the female "patient" somewhere that must be found via doing a proper assessment. They do it right, no giggling, they get to keep it...

Wendy

CO EMT-B

Edited January 27, 2012 by Eydawn

[dstevens58]

When I was in law enforcement training, they hid weapons all over our subject/suspect. We had to find them all, or it cost us a quarter for each item missed. In real life, it could cost a life if the bad guy still had weapons on them after you searched.

Same thing goes with assessments. Gear your reward system towards the class, but when properly explained to a real patient out in the field, you can do a assessment with modesty intact (mostly). Being on both sides, my modesty went out the window when I fractured my leg in three places some years ago (poor x-ray tech was more embarassed than I was).

I just completed a basic class last year (after being away from medicine for quite a while) and was surprised at the immaturity, giggling and rude comments came when discussing anatomy & physiology; assessment & treatment, obstetrics, etc from the majority-male students.

[mobey]

I am pretty quick to "light up" a group about professionalism, sounds like they could use it.

The standard has been set in your classroom that giggling/immaturity and unprofessional conduct is accepted. YOU have set that standard now YOU must raise it.

[Bieber]

I'm with everyone else on this. We've all seen our fair share of naked patients of both genders and all ages, and it's part of our job to see and touch people in ways that would normally result in you going to jail (please, no one misconstrue this, you know what I mean), and it's important for all EMTs and paramedics to be comfortable and proficient in performing a physical exam. There's nothing shameful about it, and while doing it on non-patient classmates for practice can be a little awkward, that will get easier the more you practice.

I would suggest making your students do additional patient assessments until they get it right, and emphasize that they will HAVE to (see, not should) be able to perform a physical assessment on any and everyone, no matter who it is, because you honestly do not know who your next patient may be. Your next call could be to a super model involved in a car crash or a little old lady or the biggest guy in the world, and they all deserve a provider who is able to look past their own discomfort and feelings and give them the most appropriate physical assessment in a professional manner that is respectful of the patient and their dignity and is also thorough and valuable to making clinical decisions and determining the next step of patient care based off of the information obtained.

[DwayneEMTP]

I've never though of it that way before, but I really like the 'hide a piece of paper' trick, though not money.

Maybe make it a test. Hide a piece of paper on the ribs below a boob, under a bra strap or on the panty/underwear line, under the hair where it should be found during a center point spinal exam, or just under the belt at the top of the buttox, inside a sock. Make it worth some serious points, and make it be pass or fail. Then you can just let the gigglers flunk out.

It sounds as if the tone of these exercises has been that of a game, not serious business.

One of the coolest things I saw when training came from a basic helping out with scenarios in this indoor town created by a college. There were cars, and fires, and telephone poles...it was cool as hell. But the instructors told everyone to behave exactly as if this were real life....

This basic was smokin' hot with a body to die for. She was the driver in one of the crashed cars and was complaining of chest pain, showing obvious resp anxiety, complaing of knee, thigh and pelvic pain when fully responsive, and was moving in and out of responsiveness.

The medic that had this patient (I was his basic partner in the scenario) whipped out his shears and grabbed the bottom of the sundress she was wearing and cut it completely up one side, exposing her appropriately, but also completely, as she was wearing nothing under her dress.

I could see her entire body blush with embarassment, but she made no move to break character or cover herself. He tried to grab her dress and cover her as he realised that this wasn't meant to happen, but it was made of that stretchy stuff some girls wear and it was impossible...so he continued his assessment, called for a burn dressing (no sheets or such, only jump bags) which I got for him and he covered her up and we continued.

Though I had a second of, "Holy shit! She's hot!", it passed in a moment, (Calling bullshit if you're claiming that you've never had such moments) but she's stood out in my mind years later as an example of what we should all strive for. If we're going to be good, we need to practice, and sometimes practicing sucks. If you've ever had to allow students to poke you with IV's then you know what I mean. But I had to learn on someone, so what kind of a douche would I be if I refused to be practiced on?

Being serious about EMS doesn't mean being miserable. Intensity can be fun too... I'd be willing to bet that 80%+ of the students in the class are disappointed that the gigglers are ruling the class.

Dwayne