I have been a standard patient (SP) at a medical school for five years now. SPs are not just a stand-in dumb patient; they instruct students about proper draping, visual inspection and hands on examination from the patient’s perspective. First year med students get hands-on experiences in conducting medical exams with live SPs who provide instructive feedback. Urology is just one of many medical system exams that SPs participate. Urology usually is the last system studied.
Students are around 23yrs and [here] are 75-80% female. Students are understandably apprehensive and anxious for the hands-on exams with maybe their first live person (I can tell by their cold hands, lol). Many have only seen pictures of male genitals and little to no prior knowledge of male anatomy. Sessions are in a large standard exam room, includes 2-3 students and their med school instructor. Sessions are an hour each with 4-5 sessions a day. Four SPs can cover our first-year class of students in four to five days.
I start my sessions breaking the ice with pointers: e.g., male genitals are hardy- pull, twist, and poke as necessary; a firm deliberate touch is better than a too light touch; handle testicles as you would touching your eye with eyelids closed. I also tell them I have a small yet detectable right side inguinal hernia and a small varicocele on my left testicle. Maybe 50% find my hernia and less than 20% find the varicocele. But it’s their first time.
Each student does their own exam and watches others conduct theirs. The SP stands and pulls up their gown to expose the genitals. Exams then begin with a comprehensive visual inspection, moving genitals right to left and behind. Penis is lifted to visualize side and underside. I have a low loose circumcision, so some skin is bunched behind my glans. I instruct students to pull back on shaft skin to expose behind the glans as that is a likely location for a lesion. I also mention that is the same maneuver to retract a foreskin.
The exam continues with palpation of the penis; thumb and index finger firmly squeeze both sides and top to underside from abdomen to glans. They should be able palpate the urethra and to milk it for any observable discharge. The meatus gets opened for inspection by pressing on the side of the glans. I sometimes will have a slight discharge after my third or fourth exam (prostate exam is part of the standard exam which sometimes creates a bit of discharge).
For the scrotum exam, students are instructed to use both hands, thumb and two fore fingers. Hold each testicle to compare size, then both hands on one testicle to stable its movement to feel the entire testicle for any irregularities. Then palpate the spermatic cord along the vas deferens. Then with index finger, find the inguinal canal and insert deep, pulling loose scrotal skin in with your finger. A cough or bear down will create a palpable bulge if hernia is present.
The last check is the prostate. One lubed gloved finger, inserted in the anus, curved toward the belly button, deep to find a walnut sized prostate. Move finger side to side over it to discern any irregularities.
That pretty much concludes the teaching exam, 15-20 minutes per student. Then question and answers. Students leave the session thanking for their experience. Being an SP is more than just being a knot-on-the-log dummy. You need to know your genitals and can lead learning students towards developing good bedside manners and examination skills.
Pay is okay, $25/ hr no tipping.