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

The digital anorectal examination (DRE) is a valuable clinical tool but is often underutilized due to provider discomfort, lack of confidence, and concerns about patient experience. Trauma-informed care (TIC) frameworks have improved education for other sensitive examinations, but their application to DRE instruction remains limited.

To evaluate whether a TIC-focused educational intervention improved resident physician comfort, confidence, and knowledge related to the DRE.

From October 2024 to February 2025, a prospective study was conducted among family medicine, internal medicine, and surgery residents at a large academic medical center. Residents attended a 30-minute TIC-focused DRE didactic session. Surveys were administered at baseline, immediately after the session, and at 6 weeks. Outcomes included confidence using TIC principles and identifying pathology, changes in comfort performing the DRE, and frequency of deferring examinations.

A total of 136 residents participated; 99 (73%) had paired post-session responses, and 45 (33%) completed all 3 surveys. Six weeks after the session, participants reported higher average confidence employing TIC (5.09 to 6.79, scale 1-10), greater comfort performing the DRE (4.63 to 6.36), and improved confidence identifying anal (4.07 to 6.00) and rectal pathology (3.65 to 5.47), with all comparisons P<.001. At baseline, 88 of 130 residents (68%) reported deferring clinically indicated examinations at least sometimes, and, among these residents, only one resident (5%) reported doing so during the follow-up period.

A brief, low-resource educational session incorporating TIC principles significantly improved resident confidence and comfort employing TIC and performing the DRE.