January 11, 2006

Confessions of a genital teaching assistant

I am a simulated patient, or "standardized patient" as we are known at the medical center where I do such work. When people ask what a standardized patient does, I immediately remind them of the Seinfeld episode where Kramer plays a man with gonnorhea for medical students. While my job is not exactly like what Kramer did (he hammed it up quite a bit), it often involves a bit of acting -- becoming a character with a certain ailment or condition and allowing the medical students to interview me in order that they can a) work on their doctor/patient relationship skills and b) diagnose whatever my malady might be.

But sometimes, no acting is involved. Occasionally being a simulated patient means simply being a body upon which medical students can practice various diagnostic techniques. These clinical skills workshops are important to the students because it allows them to put into practice what they have been learning in the classroom. The techniques are often things that you think doctors were born knowing how to do -- taking blood pressure or performing an abdominal exam. Yet a student's first time at these procedures can be very frightening. It may be the first time they touch an actual patient. When I served as a "body" for students learning how to take blood pressure and pulse, one young woman's hands actually trembled when she put the cuff on me.

For me, all of this is paid work. I make $10.00 per hour playing a patient, and as I can have up to four two-hour trainings and 2-3 eight-hour exam days per patient I play, the money can be pretty good.

But the gold is often in a special type of clinical skills workshop, where one serves as a "genital teaching assistant," or GTA. What is that? In essence, a GTA serves as the model for students to learn how to conduct genital exams and, in the case of men, rectal exams. GTA's get paid the $10.00 per hour, and also extra per procedure. Women get $25.00 per pelvic exam, and men get $20.00 per genital exam and $20.00 per rectal exam. Since you can see up to 8-10 students per time, the money adds up nicely.

I know what you're thinking. "Uh, Mike, uh, how can you do that?!!!" Some guys are probably thinking, "What, are you into that thing Mike? Is there something about you that I should know?" Believe me, I didn't quite jump into this enthusiastically. I'm not normally given to going out of my way to seek out such experiences. And, I really hate going to the doctor's office because I'm concerned that I will have to undergo just these types of procedures. Despite my misgivings, however, I recently performed as a GTA for the first time. The money, to a poor graduate student, is appealing and helped me will myself to tough it out. The experience was actually humbling and empowering at the same time. While I would like to say that I was calm and collected, the thought of newly minted medical students coming at my private parts was a bit intimidating, and I almost didn't accept the assignment.

Usually, the encounters go something like this. The examinations take place in small groups, usually 3-4 students and a physician, in an examining room. The physician demonstrates the various techniques for examination on the GTA. The students then follow with their own examinations, one at a time, under the watchful and helpful gaze of the physician and the eyes of their classmates. I did two of these groups, and you can do the math. Or I'll do it for you. I had two genital and rectal exams demonstrated by the physician upon me. I had eight students all take their turn at doing the genital and rectal exams. That's 8 pairs of student eyes upon areas that only my mother (when I was a young boy), my wife, and a few other assorted individuals have ever seen. Of the students, five were women and three were men. So, my genitals were dangling in front of all these people. I also had to bend over and show the least flattering part of myself to them. 10 fingers were inserted into my rear end, one at a time, over the three-hour time block. How's that for a compromising position?!

The funny thing was, that after the first demonstration by the doctor, I began to realize that this wasn't going to be too bad. After awhile, I forgot my self-consciousness, even in front of the women. The students had learned the drill quite nicely. "Can you please pull up your gown? Okay, can you lift your penis up so I can see the skin color underneath. Okay, I'm going to feel your testicles now for any abnormalities. Great! Looks good. Now I'll check for hernia...turn your head and cough please. Okay, now we'll do a rectal exam. Can you place your feet about shoulder width apart and bend over the table here resting on your elbows. Skin around the opening looks okay. I'm going apply some lubrication and it's going to be cold. Now you'll feel some pressure." All the while, the doctor exhorted the students encouragingly. "Turn your finger to the side, then push up and in. Good job!" And what was I doing? I was just kind of there. Another guy who was also a GTA said he usually went off into various thoughts about other things, only coming back to reality when asked a question or addressed. I found that I mostly did the same thing.

After I got over the embarrassment, I began to crack a joke or two to lighten their nervousness between exams. "So, you trim your fingernails?" "I feel I've gotten closer to all of you somehow!" And other stupid stuff like that, though I resisted the old gag "so now are you going to take me to dinner?" When you have people coming at your privates, the last thing you need is for them to be shaking and quaking with fear.

The difference between the genders in their examinations was an interesting discovery for me. Men were more gentle when dealing with a sensitive physical area, such as the testicles, than women! Maybe innate instinct and personal experience with what actually happens if the family jewels are mistreated was the explanation for this surprising experience. Women were a bit rougher. Once, I had to tell a woman to not squeeze a particular sensitive area so hard. On the other hand, the women were more likely to be compassionate and inquire of my mental and emotional feelings, even outside of the examination. At least three women, after an encounter, asked me how I was holding up with an expression of genuine concern, even though they did not perform the examination. The guys, on the other hand, tended to not say much. I don't think that they were being derisive of my sacrifice for their education, but were probably sensitive to my position. After all, women have much more experience having yearly exams on and in their nether areas than men do.

So, how does it feel to have done this service for medical students? The money is nice. I made about $450 for 3 hours of work. But beyond that, I feel good that 8 future doctors now have some sort of skill at conducting such exams, and relied on me to tell them when I was comfortable or uncomfortable during the process. I was able to tell them afterward my thoughts and feelings on their performance. I feel that in some small way I have helped create better and more sensitive doctors. Of course, not everyone wants to perform like this, and I had major qualms going in -- I told the students and doctor that it was my first time and that I was nervous. But I told them that in a way, their experience with me would be like an experience with an actual patient who doesn't know what to expect and is nervous about it.

At least one person I told about my experience asked me if I was worried about an uncontrollable response that would become physically evident to everyone. I can guarantee you that in this situation, there is no sexual tension at all. Charlize Theron or Uma Thurman or any other sexually attractive female could have been doing this procedure on me in this type of setting and there would have been no physical response from me. It's just too exposed. I've been asked if I would do it again. I do not have to make that decision for another year, thankfully, and I'm not sure I will repeat the experience. If I do, I won't be as nervous next time, and I'll know that a new generation of doctors, male and female, will learn how to be sensitive to the vulnerability of a man, in this case me, standing in front of them and putting his junk on display. I'll also be able to grade the performance of my own doctors when the time comes for me to have these examinations in earnest. As long as they don't have big fingers, and they trim those nails, I'll be okay!

16 Comments:

Blogger The Movie Guys said...

The end of your story sort of reminds me of how actors/actresses respond to the "Do you get aroused?" question while filming love scenes...Their response is uniformally no, that is near impossible to get aroused when you're under that much scrutiny.

1:16 PM  
Blogger Mary B. said...

Whoa. You are one of the bravest people that I've met to date. I have friends that sell their plasma for extra cash and I must say, out of the two, being a GTA sounds far more noble. Both are things I'd have to be seriously strapped for cash to consider doing, but noble none the less. Sorry for the belated comment. I didn't know that you'd made the switch to Blogger as well. Until next time!

4:47 PM  
Anonymous Trent said...

Hello Michael,

I do something quite similar to you for a Medical School in central Illinois. But in our case, the Standardized Patients chosen for the "Male Genital/Rectal Exam" procedure have been specially trained to teach the exam ourselves to the med students. We are called "Patient Instructors".

The Patient Instructors come from all walks of live and all backgrounds. We each have been trained by faculty of the med school in how to do the exam, how to teach the exam, and how to evaluate a student's technique.

So we don't usually have a faculty member in the room with us. We take the students (usually two at a time) and instruct them in how to do a male exam by using our own bodies as the prop. The students then take turns practicing the exam on us.

There are 7 of us Patient Instructors and we teach a class with 75 students. So we each average about 10-11 students apiece. We occupy 7 different rooms at the Med School, and there is always one faculty member out in the hall for use if needed. Otherwise, we are on our own in doing the teaching.

Later during the same academic year, the students return for an "Evaluation" of their technique. In this evaluation, they have to perform the exam on us without any assistance offered. We then evaluate the student on a grading scale. Those that don't pass are scheduled for remedial training with a Patient Instructor.

I have been doing this now for the Med School for 7 years.

As an aside note, I also model for Life Drawing classes at the local colleges.

11:35 AM  
Blogger Michael L. Hess said...

Trent, it's great to hear from you. I'm glad that you are doing this work, as somebody needs to help medical students learn their trade. Our program is planning to have us start teaching also, but hasn't made it happen yet. It sounds exciting, though, to be able to have that opportunity.

9:57 PM  
Anonymous Trent said...

Michael,

I have to agree with you about the gender difference while performing the testicle & scrotum exam. In my 7 years of teaching the Male Exam, it has been primarily the women who get too rough.

I have had many females pinch too hard on the testicle while they were trying to find the epidymis or spermatic cord. I have had to tell them "not so hard, please". Often times, I react first from the sudden pain before I have a chance to tell them that they are being a bit too rough.

I have also had a few actually twist the scrotal sac while trying to locate structures. You know that has to hurt!

9:54 AM  
Anonymous Anonymous said...

Michael,

I also do this type of work, and have worked with medical students, and graduate nursing students.

I fell similar to you, and you have presented a very real description of one's feelings during this type of instruction.

I find it reassuring to speak to the students, especially females, to set them and ease.

Keep up the good work.

Keith

11:30 PM  
Anonymous lixy said...

hi Michael,
I have been a female patient educator (or GTA, which originally meant "gynecological teaching associate"), in California.
I hope the school where you work institutes a program more like what i and Trent and Keith do, as i think you'd find it even more interesting and fullfilling, being the teacher yourself rather than merely the "body" or "model" for the doctor-professor. It's much easier--as you have discovered!--to demonstrate to the students on your own body how to make an potentially frightening exam like this more comfortable and effective, because you can tell them precisely what hurts and how to do things so they don't hurt; these are things patients are too scared or embarrased to do, and even the best doctors don't often know, or are out of practice. A big part of the session is discussing appropriate language and any other issues the students may think of. Students unfailingly appreciate all of this, and are eternally grateful.
As a female educator I have found no significant difference, BTW, in discomfort caused by either men or women, and neither do the guys who teach in our program--but then again, we were specifically trained to do this kind of work, we check in and discuss our teaching methods regularly, and we know our own bodies well :-)
Also, reports of success for these kinds of programs WITHOUT the presence of an "authority figure" such as the doc/prof in the room (potentially making the students even more nervous!) are consistently high. Best of luck!

1:06 PM  
Anonymous Anonymous said...

It might be interesting and fun to chat about our "teaching" experiences and feelings, and the things in our programs that work and don't work.

My email is lightningflash2001@yahoo.com

Trent and lixy email of your care to share, you too Michael.

Keith

6:21 PM  
Blogger Maxnix said...

I am a life model and just got a call today from a hospital near where I live,in Bergen county NJ, asking if I would be interested in doing the same thing. $150 for three hours of work. I immediately said yes. I am excited about the job. I found life modeling a very liberating experience and think this will be more so. With art I feel I am an important part of the experience and now feel the same about medicine. Thanks for yoiur blog. It has given me more encouragement.

7:29 PM  
Anonymous Anonymous said...

http://www.google.com/search?q=readability+white+on+black

11:32 AM  
Blogger Brandy said...

I go to a VA hospital, and many times the "doctor" we'll see is a very recent graduate from UCLA. We have many interns in many areas of the hospitals. Usually I'm ok with that.

As a female, however, I'm glad there is now a dedicated Women's Health area, with experienced doctors, nurses, and PA's. Having a young doctor trying to do a vaginal exam is one thing, having a young VIRGIN doctor doing it is another. And those specula can get tangled in hair, can grab a bit of skin on the INSIDE, or can just plain hurt in so many ways! Sigh... still in service to my country, LOL!

I've been a nude art model, it's pretty much the same, except usually a warm lamp. Pay is the same....

How would one get into this job? Just being in the right place at the right time? Attending a medical college? Craigslist? It may be a good job for someone like me (if it pays cash direct, I'm on disability...)

-----
word verif: reendie - getting ANOTHER exam on the nethers?

11:33 AM  
Blogger Thomas said...

Michael,

You commented that three of the students were men and the other 8 were women. Was the physician female?

How were the students grouped together? Did they tend to mix genders or did the male students all end up in one group?

Did you end up being a patient model again the next year? I know some standardized patient programs refer to this position as a CTA or Clinical Teaching Assistant. That has a much better sound to it than Genital or Gynecological Teaching Assistant.

-Tom

1:12 PM  
Anonymous Anonymous said...

It was great to read your blog! Fifteen fellow students from a small private university in Baltimore served as medical models during our Jr & Sr. undergraduate years, and I served the first two years of post graduate. The doctors and med students were great and we were treated respectfully. At that time,1966-1970, we were paid $5 per hour for a 4-5 hour class which was held each Wed. for both semesters. Needless to say, I've had more than the average number of general physical,genital,rectal & DRE exams; plus close to 40 yrs. of personal PEs. Hopefully we helped educate and formed some sensitive doctors. Lastly, at that time the student body was male. I might have needed more encouragement if the students were gender mixed-but that's just personal. If faced with the same opportunity at that time in my life,I certainly would make the decision to participate again.

2:36 AM  
Anonymous JW Man said...

Hello This is JW and I have begun training to be a general "standardized patient" (SP) for medical students on Long Island, NY. I was both enlightened and appreciative of the candid and personal stories of personal experiences. Now I am not for one minute going to say m y training even comes close The GTA work.

But I am interested in GTA work on LI for the 2 main reasons mentioned by most posters -- $$ & the intrinsic reward of helping properly train future MD's.

Does anyone have suggestions (either advice, specific programs, etc.) about programs on LI or Queens, NY? Please feel free to contact me through my email: williebgood49@hotmail.com, or right here. Thank you in advance!

9:36 PM  
Blogger Dania Lopez said...

how to do you become a "GTA" I am very interested in becoming one. I have searched on the web with no success. I think I would be very good at this I am a biology major in college.

8:48 AM  
Blogger Dania Lopez said...

Maxnix
I am from your area can you please tell me how I can become GTA.

9:46 AM  

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