Taking the Pressure Off the Patient - Understanding Digital Rectal Examinations on a Real Subject

Area of Science:

• Medical Education
• Surgical Skills
• Haptic Technology

Background:

• Understanding palpation techniques in physical examinations is crucial.
• Previous studies primarily used benchtop models, limiting real-world insights.
• Expert performance on actual subjects remains under-researched.

Purpose of the Study:

• To investigate expert palpation techniques during Digital Rectal Examinations (DREs) on a real subject.
• To analyze performance metrics including pressure, position, and anatomical contact.
• To establish a baseline for expert DRE performance in a clinical context.

Main Methods:

• Recruited four consultants from relevant medical specialties.
• Utilized a Rectal Teaching Assistant for examinations.
• Equipped examining fingers with position and pressure sensors.
• Analyzed 3D models of pelvic anatomy against sensor data.

Main Results:

• Primary care consultants demonstrated a more holistic anatomical examination compared to secondary care.
• Maximum applied pressure during examinations was 3.3N.
• Pressure on the prostate was consistently higher than on rectal walls.
• A urologist applied the highest pressure with notable frequency (15.4 and 25.3 Hz).

Conclusions:

• The study provides insights into expert palpation performance during DREs.
• Findings suggest a typical range of pressure applied during palpation.
• Results can inform the development of performance metrics and training tools.