- The Washington Times - Monday, January 15, 2001

TAMPA, Fla. The pockets of their white lab coats stuffed with new stethoscopes, a gaggle of earnest young medical students fidgeted as they waited their turn outside a suite of examining rooms. One thumbed through her examination handbook, another filed a fingernail.

Inside the rooms, a handful of volunteers heard the snap of rubber gloves, the instructions to lean over and relax. They felt a doctor check the prostate gland to make sure it wasn't enlarged.

For most men, the only good thing about a rectal exam is that it happens just once a year.

Recently, John Grannan and several other men endured it about 20 times, at the hands of 20 doctors-in-training.

"I got to admit, the money was good. But I also felt that I was doing something that would help others, too. I knew they had to practice on someone," said Mr. Grannan, 53, who volunteered for the exam four times.

He is one of about 30 men and women who each year serve as surrogate patients, providing real-life practice for prostate, genital, hernia, breast and pelvic exams for second-year medical students at the University of South Florida.

Some will undergo 10 to 15 pelvic or prostate exams in one day, up to three days in a row. They are paid $37.50 an hour.

"I felt like it was real important for them to learn to do these exams and be comfortable doing them," said Mr. Grannan, who works at the Louis de la Parte Florida Mental Health Institute at USF. "The prostate exam is something most men don't want to go through."

The genital-urology exams take place each fall for two weeks during an expansive course called physical diagnosis. It lasts 18 months and is designed to help medical students make the transition from studying books to examining people. They learn to check the eyes, feel for the condition of internal organs and muscles, listen for common heart and lung ailments.

Usually they can practice on each other or on real patients with known ailments who are willing to sit still while the students learn how to detect, for instance, a heart murmur.

But for the sensitive task of genital-urology exams, when the patient and the student both may feel a bit uneasy, paid surrogates are best, said Dr. Daniel J. Van Durme, associate professor of family medicine and the course's director.

"They're invaluable. There's no other way that we have that students can really learn and master those skills," he said. "The biggest challenge for the students is really getting over the psychological aspect. They're 22, and this may be the first time they've felt someone's genitals before."

Beth Hyde-Hood, the education coordinator for the course, said it's difficult to find volunteers, and she's always looking for more. Most surrogates are USF students or staff who answer her calls for volunteers and who can use the extra cash. Others sign up because a family member or friend had a disease, such as testicular cancer or breast cancer, that went undiagnosed for too long, and they want to have a part in better training tomorrow's physicians.

Each patient is sequestered in a small examining room with three or four students and a doctor, who demonstrates the exam first. If the students do it differently than the doctor, the surrogate is advised to say so.

"Many of our patients do it repeatedly, and they will tell the students, 'You're being too rough, or you need to push harder here,' " Dr. Van Durme said. "The surrogates are not just a piece of meat for the students they teach them."

The patient's input is key because the doctor can't easily tell whether the student really has found the prostate or has located the right spot to check for a hernia. "I can always tell, because I flinch," Mr. Grannan said.

Hiring surrogates is common at the nation's 125 accredited medical schools as is the use of so-called "standardized," or programmed, patients, who are assigned an illness and then act it out. The goal is to teach the student to extract information from the patient, which is often difficult, then use it to determine what may be ailing them, Mrs. Hyde-Hood said.

Mr. Grannan said he was nervous the first time he volunteered. "I didn't know what it would be like to have one done after another," he said. "I had 10 done yesterday, plus the two doctors, so 12. It wasn't bad. I don't think I'd want to do it more than two hours."

During the female exams, the surrogate patients were understanding about their inexperience, and instructive, students said. "Most patients are very kind and show us what's wrong," said Sherene Shalhub, 28, of Tampa. "We appreciate it. It's awesome they want to do it."

• Distributed by Scripps Howard


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