DaRE to Approach Differently: Teaching the Digital Anorectal Examination Through a Trauma-Informed Framework

Area of Science:

• Medical Education
• Clinical Skills Training
• Patient Care

Background:

• Digital anorectal examination (DRE) is underutilized due to provider discomfort and lack of confidence.
• Trauma-informed care (TIC) frameworks can improve sensitive examination education but are underused for DREs.

Purpose of the Study:

• To assess if a TIC-focused educational intervention enhances resident physician comfort, confidence, and knowledge for DREs.

Main Methods:

• Prospective study of 136 residents (family medicine, internal medicine, surgery) attending a 30-minute TIC-DRE didactic session.
• Surveys administered at baseline, post-session, and 6 weeks to measure confidence, comfort, and examination deferral rates.

Main Results:

• Six weeks post-intervention, residents showed significantly higher confidence in using TIC (5.09 to 6.79) and performing DREs (4.63 to 6.36).
• Confidence in identifying anal (4.07 to 6.00) and rectal pathology (3.65 to 5.47) also improved significantly (P<.001).
• The rate of deferring clinically indicated DREs decreased from 68% at baseline to 5% post-intervention among those who previously deferred.

Conclusions:

• A brief, low-resource educational session using TIC principles effectively improves resident confidence and comfort with DREs.
• This intervention shows promise in increasing the utilization of the DRE as a clinical tool.