Digital Rectal Examination for Prostate and Rectal Tumour, Study Guides, Projects, Research of Technology

Download Digital Rectal Examination for Prostate and Rectal Tumour and more Study Guides, Projects, Research Technology in PDF only on Docsity! West African Journal of Medicine Vol. 28, No. 5 September–October 2009 Digital Rectal Examination for Prostate and Rectal Tumour: Knowledge and Experience of Final Year Medical Students Toucher rectal pour les tumeurs de la prostate et du rectum: Connaissance et expérience des étudiants en dernière année en médecine A. K. Eziyi*, A. O. Ademuyiwa‡, J. A. E. Eziyi†, A. A. Salako† WEST AFRICAN JOURNAL OF MEDICINE ORIGINAL ARTICLE ABSTRACT BACKGROUND: It is most pertinent that medical students are taught the necessary skills for digital rectal examination (DRE) before they become doctors. OBJECTIVE: The study is to assess the knowledge and experience of final year medical students regarding DRE for prostate and rectal tumours. METHODS: Well-structured questionnaire were administered to each of the final year medical students of Ladoke Akintola University of Technology a week to their final examinations. RESULTS: Response was received from 127 (60%) of the students, 124 (97.6%) agreed that they have been taught DRE. Most of the students, 102 (80.3%), have done one to five DRE, three (2.4%) and have never performed DRE while none of the students have done more than ten DRE. Only in 49 (38.6%) of cases were the findings of the students on DRE always confirmed by a doctor. Nine students (7.1%) have never felt a clinical BPH and none had felt it more than five times. Sixty- six (52.0%) have never felt a malignant prostate and none of the students have felt it up to three times. Most of the students, 106 (83.5%), have never felt a rectal tumour on DRE Only five (3.9%) felt very confident of their ability to give an opinion based on their findings on DRE while 105 (82.7%) felt reasonably confident CONCLUSIONS: The students have been taught DRE and a good number of them have performed it. Few of the DRE done by the students were cross-checked by a doctor. Most of the students have problems differentiating BPH from cancer of the prostate and many of them were not very confident of their findings on DRE. WAJM 2009; 28(5): 318–322. Keywords: Digital rectal examination, medical students, prostate, rectal tumour. *Urology Unit, Department of Surgery Ladoke Akintola University of Technology Teaching Hospital (LTH), Osogbo, Nigeria, ‡Department of Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria. †Department of Surgery Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, Correspondence: Dr A.K. Eziyi, Urology Unit, Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. E-mail: eziyi1@yahoo.com Phone no: 07033958606, 08077279755,07027417556 Fax: Nil Abbreviations: CEA, Carcinoedm; LAUTECH, Ladoke Akintola University of Technology; OSCE, Objective Structure Chemical Examination; PSA, Prostate Specific Antigen; RTA, Rectal Teaching Associate; SPETA, Standardized Physical Examination Teaching Associates. RÉSUMÉ CONTEXTE: Il est plus pertinent que les étudiants en médecine apprennent les compétences nécessaires à l’examen par toucher rectal (DRE) avant de devenir médecins. OBJECTIF: L’étude est d’évaluer les connaissances et l’expérience des étudiants de dernière année de médecine en ce qui concerne DRE de la prostate et les tumeurs du rectum. MÉTHODES: questionnaire bien structuré ont été administrés à chacun de la dernière année des étudiants en médecine de Ladoke Akintola Université de technologie par semaine à leurs examens finaux. RÉSULTATS: La réponse a été reçue à partir de 127 (60%) des étudiants, 124 (97,6%) ont accepté que leur ont été enseignées DRE. La plupart des étudiants, 102 (80,3%), ont fait une à cinq DRE, trois (2,4%) et n’ont jamais fait DRE alors qu’aucun des étudiants ont fait plus de dix DRE. Ce n’est que dans 49 (38,6%) des cas ont été les conclusions des étudiants sur DRE toujours confirmé par un médecin. Neuf étudiants (7,1%) n’ont jamais senti une HBP clinique et aucun n’avait senti plus de cinq fois. Soixante-six (52,0%) n’ont jamais senti une prostate malignes et aucun des élèves l’ont ressenti jusqu’à trois fois. La plupart des étudiants, 106 (83,5%), n’ont jamais ressenti une tumeur rectale DRE sur cinq seulement (3,9%) se sentait très confiants dans leur capacité à donner un avis fondé sur leurs conclusions sur DRE tandis que 105 (82,7%) a estimé raisonnablement confiant. CONCLUSIONS: Les élèves ont appris toucher rectal et un bon nombre d’entre eux l’ayant effectué. Peu de DRE effectué par les étudiants ont été contre-vérifiée par un médecin. La plupart des élèves ont des difficultés de différenciation HBP d’un cancer de la prostate et beaucoup d’entre eux n’étaient pas très sûrs de leurs conclusions sur les DRE. WAJM 2009; 28 (5): 318-322. Mots-clés: toucher rectal, étudiants en médecine, de la prostate, une tumeur rectale. West African Journal of Medicine Vol. 28, No. 5 September–October 2009 A. K. Eziyi and Associates Digital Rectal Examination for Prostate and Rectal Tumour INTRODUCTION Prostate cancer is the fourth most common male malignant neoplasm worldwide.1 African American men have the highest reported incident of 1.6 per 100,000 population compared with men in the United States.1 It, usually present along with more aggressive disease in African American than from other ethnic groups.2,3 The hospital incidence of prostate cancer in Nigeria, the largest concentration of indigenous black patients in the world, is 127/100,000 with a national prostate cancer risk of 2% of patients4 and presently the commonest cancer in males in Nigeria from 50 years and above.5 Symptoms of anorectum and urogenital tract account for 5 to 10% of all consultations in general practice.6 Up to two-thirds of patients that present this way undergo no rectal examination before specialist referral.1 This is difficult to understand as approximately in 90% of cases rectal cancer can be felt digitally.7 Galic et al 8 showed that an abnormal findings on DRE points to the diagnosis of cancer of the prostate in 54.2% of cases. DRE can easily be done even in areas where facilities for prostate specific antigen (PSA), carcinoembroyonic antigen (CEA) and ultrasound are not available. DRE should be performed in every male after 40 years and in men of any age that present for urological evaluation.9 It is pertinent to note that medical students are taught the necessary skills for DRE before they become doctors. Although many of them are taught the basic rudiments but10,11 many still are not confident of their findings on DRE. We carried out this study to find out the knowledge and experience of final year medical students regarding the ability to diagnose prostatic and rectal tumours from DRE. SUBJECTS, MATERIALS, AND METHODS A self-administered questionnaire was given to all the 215 final year medical students of LAUTECH one week before their final examinations in February 2007 with 60% completing the questionnaire. Involvement in this study was voluntary and did not constitute part of the summative assessment. school. Sixty five (51.2%) students spent eight years, 40 (31.5%) students spent nine years, three (2.4%) students spent seven years, another set of three (2.4%) students spent ten years in medical school while 16 (12.6%) students did not state the number of years they spent in medical school. One hundred and twenty four (97.6%) agreed that they had been taught DRE either in the ward or in the clinic. Three (2.4%) of the students had never performed DRE while 102 (80.3%) had done one to five DRE, 13 (10.2%) had done six to ten DRE and none of the students had done more than ten DRE while nine (7.1%) did not respond to the question, Figure 1. There is a weak correlation between the number of years spent in medical school and the number of DRE done by each student with Spearman’s rho equals 0.268. One hundred and nineteen (93.7%) of the students knew that DRE is usually done in the left lateral position while two (1.6%) each responded that lithotomy and dorsal positions were the positions that DRE should be done and one (0.8%) said it is usually done in the knee-elbow position. Three (2.4%) of the students did not respond. Forty-nine (38.6%) answered that their findings on DRE were always confirmed by a doctor while 41 (32.3%) responded that it was confirmed by a doctor more than half of the time, 13 (10.2%) said less than half of the time, and 11 (8.7%) said never while in 13 cases (10.2%) there was no response, Figure 2. Twenty (15.7%) have always felt an enlarged prostate, 34 (26.8%) says more than half of the time, 40 (31.5%) says less than half of the time while 23 (18.1%) have never felt an enlarged prostate and 10 (7.9%) had no response. Nine (7.1%) have never felt a clinical BPH, 49 (38.6%) have felt clinical BPH on one or two occasions, 13 (10.2%) in three to five times, none had felt it more than nine times and 56 students (44.1%) had no response. Sixty- one (48.0%) agreed that an enlarged prostate in BPH should be firm, two (1.6%) did not agree while 64 (50.4%) had no response, Table 1. Sixteen (12.6%) agreed that one can get above an enlarged prostate in BPH, 37 (29.1%) did not agree while 74 (58.3%) did not respond. Nine (7.1%) responded that an 9210 120 100 80 60 40 20 0 Figure 2: Number of times Students’ findings on DRE were confirmed by a Doctor. 1, always confirmed by doctor; 2, confirmed more than 50% of times; 3, confirmed less than 50% of times; 4, never confirmed; 5, no response. 319 1 2 3 4 5 N u m b e r N u m b e r 1 2 3 4 Figure 1: Number of Rectal Examinations performed by student. 1, Never perfor- med; 2, performed more than 5 times; 3, performed 6–10 times; 4, no response. Information obtained included personal data, understanding about the technique of DRE, ability to differentiate tumours of the prostate, and rectal cancers on DRE and level of confidence in the ability of the students to perform DRE. The data obtained was analyzed using SPSS statistical software 15.0, 2006 to obtain percentages, means, median and standard deviation. Ethical clearance and informed consent were obtained. RESULTS A total number of 127 students were in the study, with a male to female ratio of 1:1. The ages ranged from 21 to 35 years with a median of 28 years. The minimum number of years each of these students spent in medical school was seven years while the maximum was 10 years and 16 of them did not state the number of years each person has spent in the medical