Reproductive-aged female patients often seek medical visits for pelvic pain in various healthcare settings from primary care, urgent care and emergency departments. Determining the cause of pelvic pain can be difficult as the symptoms may vary and may be indicative of a variety of underlying conditions, such as ovarian torsion, ectopic pregnancy, urinary tract infection and acute appendicitis, among others.

Due to the broad differential in evaluating pelvic pain, this common yet sensitive evaluation often requires the need to exclude other factors before determining a correct diagnosis. Since Pelvic Inflammatory Disease (PID) should be suspected in any young female who presents abdominal discomfort, medical students must acquire comprehensive knowledge and skills to evaluate a female patient displaying pelvic pain and PID.

To demonstrate the effectiveness of these one-on-one patient interactions, Assistant Professors Jennifer Pearson, MD, Amy Greminger, MD, Emily Onello, MD, and Sandy Stover, MD, in the Department of Family Medicine & Biobehavioral Health at the University of Minnesota Medical School, Duluth Campus, published their collective teaching methods on a novel simulation case, featured in the MedEdPORTAL - the Journal of Teaching and Learning Resources, targeting medical students just before starting their clerkships. 

“All medical students are taught how to perform sensitive exams on both male and female patients, but often, there are limited opportunities to reinforce these skills before students perform exams on real patients,” Dr. Pearson said. “Other studies have shown that opportunities for reinforcement can both decrease student anxiety and increase clinical knowledge when encountering these real-life patient situations.” 

With its unique mission to be a leader in educating physicians dedicated to family medicine to serve the needs of rural and Native American populations, the Medical School, Duluth Campus offers an ideal learning environment for medical students to further their understanding of how to evaluate future female patients. Leveraging the hands-on learning climate, the faculty members expanded upon basic pelvic exam skills to establish forward-looking methods and tools, including multiple elements of history taking, female pelvic examination skills with the swab-sample collection and point-of-care ultrasound. This comprehensive method achieves the goal of reinforcing sensitive exam skills as well as developing further clinical thinking and skills to make a diagnosis, such as PID. 

While the overall number of cases in the U.S. has decreased, PID continues to be a common issue in clinical practice. “There is no single test that identifies this diagnosis,” Dr. Stover said. “Obtaining a good physical history, an appropriate medical exam and application of clinical thinking helps to determine the cause. Untreated cases or those late to treatment can have significant complications, including infertility. While some underserved communities lack access to health education regarding prevention, individuals getting regular health checks and communities prioritizing public health education can make a difference in occurrence and management of this disease.”

For students on a path toward future practice in rural and Indigenous communities, it is essential for students to succeed at learning basic science and applying the understanding to patients. “Rural physicians typically handle a very wide variety of patient concerns. As a result, physicians in remote areas need to be competent to accurately recognize, diagnose and treat the causes for pelvic pain,” Dr. Onello said. “In rural places, there isn’t always a specialist available to assume care for the patient, such as an obstetrician or gynecologist. The practicing rural doctor, often a family physician, needs to be skilled in managing many gynecological conditions, including PID.”

This unique simulation training experience also encourages medical students to consider the human emotions of their patients during a sensitive examination. “Many will encounter patients in a significant amount of pain whom they need to evaluate but should also provide empathy and relief from suffering,” said Dr. Pearson. “Addressing pain and demonstrating empathy in situations such as this are important components of the practice of medicine.” 

The team’s published findings are backed by the success of medical student feedback dating back to 2011 when the interdisciplinary approaches were integrated into the Hormone and Reproductive Medicine course, training 65 medical students annually. The faculty members gathered 48% of student responses who participated in the simulation case from 2018 to 2020 from completing a feedback survey. Ultimately, the feedback showed that 96% of respondents agreed that the simulation provided a knowledge-enhancing experience. 

“Overwhelmingly, the consistent theme from the students’ responses was that they valued the ability to incorporate hands-on learning with a pelvic exam, cervical sampling and a transvaginal ultrasound into this experience,” Dr. Pearson said.

The publication recommends integrating the pelvic pain simulation scenario into the curricula of medical education institutions as scheduling allows.

“Our faculty applied their expertise and introduced the innovation by integrating the technology with the learning in simulation, ultimately to benefit the student’s future patients,” said Peter Nalin MD, MBA, professor and Department Head of Family Medicine and Biobehavioral Health.