Well Man
Sub-Unit of the Medical Skills Program
MDCN 420
CORE DOCUMENT
Class of 2016
2014-2015 Academic Year
©2014
Table of Contents
Introduction ................................................................................................................................ 3
Well Man Unit Objectives ........................................................................................................... 5
The Physical Examination .......................................................................................................... 8
Detailed Plan of the Axillary Exam and Examination of the Male BreastError! Bookmark not
defined.
Examination of Inguinal region and Groin ........................................................................... 9
Detailed Plan of the Examination of the Male Genitalia ........................................................ 10
Examination of External Genitalia ....................................... Error! Bookmark not defined.
Male Genital Self Examination (GSE) ............................................................................... 12
Detailed Plan of the Digital Rectal Examination .................................................................... 14
References ............................................................................................................................... 16
Evaluation Forms ..................................................................................................................... 17
STUDENT PERFORMANCE CHECKLIST ........................................................................... 17
STUDENT EVALUATION OF THE LEARNING EXPERIENCE ............................................ 20
CERTIFICATE OF PARTICIPATION .................................................................................... 21
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The Well Man Unit
Sub-Unit Chair
Dr. Luc Berthiaume
Phone: 403-943-4467
Luc.Berthiaume@albertahealthservices.ca
Introduction
The Well Man teaching unit has been created by a multidisciplinary subcommittee of the
Clinical Skills Course to complement the Well Woman teaching unit. Special thanks to Hal
Kerbes, Lead Well Man SP and Dr. Mal Kaminska, Sub-Unit Chair for their valuable help in
creating the most recent version of the core document.
The examination of the male genitalia and rectum is part of a complete physical examination
and equal in importance to other clinical skills. It is essential that students learn a systematic,
thorough approach to this part of the physical examination while displaying a sensitive,
professional manner that addresses and reduces the potential anxiety and embarrassment of
the patient.
GOALS: The Well Man teaching unit will provide students with an approach to:
1. Performing a complete, detailed examination of the male genitalia and rectum.
2. Conducting an examination of the male patient in a manner that conveys respect and
sensitivity.
FOCUS: The focus is on the healthy, normal patient and his response to an examination. The
course does not intend to teach pathophysiology or the psychosocial aspects of abnormalities.
Although this teaching unit runs after Course 1 (GI/Blood) and during Course 4 (Renal/Endo),
students are not expected to display extensive knowledge regarding genital, anorectal, and
sexual problems. However, it is important to be able to enquire about these areas and
recognize when a problem exists that may require further attention.
One strength of these teaching sessions is the opportunity for direct and candid feedback from
patients who are also trained to coach these valuable skills. Recognize that they have
tremendous experiences as people, patients, and professionals. However, do not expect the
Well Men SPs (WM SP) to be fonts of medical knowledge – their focus is process, not
medicine.
PRE-REQUISITES: Prior to the sessions, students must:
1. Review the material contained within the Well Man Core Document.
2. Review the relevant material from the Course 1, Course 4 and/or from relevant
textbooks.
3. View the physical examination video related to this unit, available in the Medical Skills
Centre. Due to the sensitive content of these videos, they cannot leave the Medical
Skills Centre (i.e., you cannot “borrow” them). Note: The physical examination video
contains a section on sexual and reproductive history-taking. Students are encouraged
to watch this part of the video, but they will not be asked to take a sexual and
reproductive history during their sessions. These topics will be covered at various times
during the three phases of the Communication course.
Note: Students are expected to prepare adequately for the Well Man teaching sessions in
order to gain maximum benefit from this learning experience. The Student Performance
Checklists serve as a guide to the level of preparation expected by students.
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It is mandatory to review the core document and to have viewed the Well Man DVD prior to
your Well Man session.
Failure to complete the above tasks prior to your teaching session will result in having to
rebook the teaching session (either later in the same day or another day, depending on how
much time is needed for the student to get “up to speed” and also depending on the availability
of the Well Men SPs).
It is also mandatory to wear a white coat and your ID badge for the sessions with Well
Men SPs.
EVALUATION: Attendance at the Well Man teaching session is mandatory. Upon completion
of the learning experience, a certificate will be forwarded by the instructors to the
Undergraduate Medical Education office. Satisfactory completion of this unit is one of the
requirements to be eligible to sit the Medical Skills II Evaluation.
ORGANIZATION: In the formally structured portion of the course, student pairs will work with 2
Well Men SPs. The session will begin with the Well Men SPs observing and coaching the
student pair while each student performs parts of the examination on the pelvic simulators.
When this task is complete each student will, in turn, perform the genitalia and rectal exams on
one of the Well Men. The process for the examinations is the following:
1. Everyone except WM SP A will remain in the room to allow WM SP A to go into the
examining room to gown for physical exam.
2. All participants will reconvene; student A will begin physical exam with WM SP A
3. Student B will observe & support Student A
4. WM SP B will monitor examination and checklist.
5. When the first physical exam has been completed, students will leave the examining room
while WM SP A dresses, leaving WM SP B to gown for the second physical examination.
The Well Men SPs will provide verbal feedback and guidance throughout the physical
examination.
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Well Man Unit Objectives
 Demonstrate how to perform the male genital self-examination (GSE)
□ Explain the rationale for GSE
 Demonstrate an effective rapport with an adult male patient, which includes the ability
to
□ Explain the procedure of genital and digital rectal examination to the patient.
□ Allay any concerns and worries about examination procedures.
□ Work aloud, while avoiding the use of jargon, by interactively discussing
procedures and findings with the patient (e.g. teaching the patient testicular selfexamination, describing the reason for penile palpation, etc.).
□ Use language that avoids judgmental, sexist or patriarchal terms and concepts.
 Demonstrate an examination of the male breast
□ Axillary Lymph Node Exam
□ Inspection of breast
□ Palpation
 Demonstrate an examination of the male genitalia
□ Inguinal Region and Groin
□ External Genitalia
 Reflexes
 Scrotum/testicles
 Penis
 Epididymis
 Spermatic Cord
 Demonstrate the Digital Rectal Examination
Preliminary Considerations
A physical examination can be laden with anxiety-provoking elements for most people, but
nothing is as likely to create as much experiential discomfort for a male patient as the direct
examination of his genitals. Boys and adolescents (and even adults) may worry about whether
their genitals are normal.
From adolescence onward, men may fear getting an erection during a physical examination;
student physicians may be equally concerned about the possibility of the patient having an
erection during the examination.
But while this is possible (due to simple reflex activation), it is a rare occurrence. A man will
usually be nervous under the circumstances, and will not normally see the situation as sexual –
so it’s rare for the patient to become sexually aroused. If the examination is performed in an
objective, professional and cooperative manner, it should not be a source of stimulation to the
patient, or a concern for the examiner. And should that rare occurrence happen, identify it for
what it is … an involuntary physical response that is no cause for alarm or embarrassment.
Provide the patient with a brief period of privacy to allow them to relax, then continue the
examination.
The most important component can be the student physician’s attitude and ability to
communicate. You can reassure the apprehensive patient and minimize their anxiety.
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Minimizing the Patient’s Anxiety
Your attitude and ability to communicate can reassure the apprehensive patient. Some
important elements to remember:
1. Know the language. It is inappropriate to talk down to anyone, but you and the patient
must understand each other. You may not be entirely comfortable with some of the
common words and phrases you may hear from the patients, but common language
may be appropriate in certain circumstances. You will not lose your dignity if you
maintain your composure and you succeed in communicating effectively. Know the
language and use it effectively, without apology, and in a non-demeaning manner. This
might also be a good time to teach your patient the medically appropriate terms if these
are unknown to him.
2. Never make jokes. Light, casual talk or jokes about genitalia or sexual function is
always inappropriate, no matter how well you know the patient. Feelings about one’s
own sexuality run deep and are frequently well masked. You don’t wish to inadvertently
cause stress or trauma.
3. Your face is easily seen. Remember that your face is easily seen by the patient when
you are examining the genitalia. An unexpected finding may cause a sudden change in
your expression. Be mindful of your nonverbal communication.
4. Do not be defensive or apologetic for your gender. This is historically an ordinary
event, when a man examines a woman or a woman examines a man. Here again, you
communicate much by demeanor and hesitancy in speech and action. Do not be
apologetic in any obvious or subtle way. Remember that you are a professional, doing
the job of a professional.
5. Approach the task with utmost respect. Because of the intimate and invasive nature
of the genitalia and anorectal examinations, approach the task with utmost respect for
the patient. Protecting him from emotional as well as physical discomfort throughout the
examination should be a major concern at all times.
6. Involve your patient. Involve your patient in the examination by talking aloud as you
work, describing your actions, their purpose and your findings (when/if appropriate). A
few preliminary comments inviting your patient to tell you of any discomfort or anxiety he
may experience can help to give him permission to comment on your work with him.
Whenever possible, observe your patient’s face and hands for signs of discomfort, such
as tense facial muscles or clenched fists.
Although students are expected to carry out a complete physical examination during this unit,
in actual clinical practice there may be times where to do so on the first visit would be
inappropriate. Some men find intimate questioning and/or examination too uncomfortable until
such time as a physician earns their trust. In such situations, if possible, the physician would
delay, but never omit, parts of the examination.
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The Physical Examination
Prior to starting either the genital or rectal examination, the examiner should be aware of:
o Whether this is the first genital and/or rectal examination for the patient?
o Are there any concerns associated with previous exams?
o Is the patient aware of the reasons for the examinations?
o The level of knowledge of the patient with medical terminology used during the
examinations.
Preparation for the genital rectal exam should include checking the policy of the health care
facility concerning chaperone attendance.
Set up the examination room.
Ensure that the examination room/area:
o Is clean.
o Has good lighting.
o Allows for privacy.
o Is equipped with a sink and soap.
o Has a functional table.
 It is important to become familiar with how to operate the table prior to having a
patient sit on it.
Equipment needed.
Collect the following equipment prior to starting the examination:
o Non-sterile disposable gloves.
o Drapes.
o Gowns.
o Box of tissues/baby wipes.
o Lubricant.
o Kidney dish.
o Alcohol wipes.
o Tongue depressors.
o Light for transillumination.
o Hemoccult strips and developing chemical.
Position.
The examination begins with the patient seated on the examining table. By lowering the gown
from one shoulder, the axillary exam can be performed on that side, then the procedure
repeated on the other. Once the gown is back in place, the patient can lay down on the table
and the exam can proceed with the breast exam, hernia/ femoral exam, reflex tests, genital
exam, explanation of GSE and then finish inguinal hernia exam. Positioning for DRE will be
detailed later in this document.
Sequence of Examination.
The genital/rectal examination is embedded in a larger exam (chest, abdomen/pelvis), with the
Sequence of Examination as follows:
o Examination begins with the axillary exam
o Proceeds to male breast and proceeds down the body to the genitalia.
o Compare bilateral structures, examining normal or unaffected side first.
o Genital examination begins with reflex testing, proceeds through palpation.
o Digital Rectal exam is the final component of the physical examination.
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NOTE: There will generally be no abnormal or unusual findings with WMSPs; any that exist
(such as repaired hernias) will be specifically identified by the WMSP .
Introduction
 Introduce yourself (and, if working with one, your chaperone) to the patient.
 Establish what the patient prefers to be called.
 Explain the sequence of the examination.
Begin with Axillary exam
o Patient is seated on table
o Gown is lowered from one shoulder so axillary exam can be performed
o Have patient replace gown, then repeat procedure on other side
 The axillary exam should not be done through the gown.
 Refer to your Physical Exam course Core Document for details on how to conduct
an axillary lymph node exam, but the highlights are noted below:
- Place the left hand in the right axilla (or the right hand in the left axilla) with palm
toward chest wall.
- Point the fingers obliquely toward the apex of the axilla.
- Hold the patient's elbow with your other hand and adduct the patient’s upper arm
to help relax the muscles.
- Palpate firmly for the following lymph nodes:
o Central.
o Lateral.
o Medial.
o Anterior.
o Posterior.
Positioning:
Locations:
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Preparation / Draping for next phase of Physical Examination
 Have patient lay on their back on the examining table
 Use a drape to cover the patient from the waist down, ensuring that the drape is tucked
under the feet.
 Lift the drape slightly at the waist; ask patient to pull his gown up to his shoulders to
expose the chest area.
 Replace the drape so patient is again covered to the waist.
Chest Exam
 Inspection
o Deformity.
 Masses.
o Nipple retraction.
 A patient who previously had a nipple that
“sticks out” and who comes in with a now
inverted nipple should raise suspicion.
o Nipple discharge.
 Look for crusting on the nipple which might suggest that there is
discharge.
 Palpation
o Use the “lawnmower” (back & forth) pattern all the way across the chest
o Using the pads of your middle two or three fingers (i.e., index, middle and
ring finger) of your dominant hand, palpate the breast.
 The pads of your fingertips are the most sensitive part of your hand.
 Use dime-sized circular movements.
 Your fingers should remain in contact with the skin at all times.
o Palpate
 Tenderness.
o Ask your patient to let you know if any spots are sore.
o Assess watching your patient’s facial expression for any non-verbal
clues suggesting pain.
 Lumps or masses.
Examination of Inguinal region and Groin
Preparation / Draping
 As your examination continues down the body, lower the patient’s gown such that only the
region you are examining is exposed.
 For this next section, the drape should be folded down to the pubic symphysis.
Inspection
 Distribution of hair - male pattern, including pubic hair (hair on inner thighs as opposed to vshape in women)
 Hygiene of pubic hair, including infestations
 Swellings in inguinal region
 Integrity of skin in lower abdomen and groin
 Hernias:
o From the end of the examining table (at the patient’s feet), while observing the
inguinal region ask patient to turn his head to the side and cough.
o You may see a sudden bulge on one side or the other – a discernible
asymmetry – possibly indicating an inguinal hernia.
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Palpation
 Rest hands on lower abdomen in “butterfly” position or alternatively use three fingers such
that middle finger rests on inguinal ligament and adjacent fingers are positioned over
locations for potential inguinal or femoral hernia.
o Ask patient to turn head and cough. Presence of hernia may be indicated by
slight pressure on one side or other
 Roll fingers along the inguinal ligament to determine presence of inguinal adenopathy.
o Small (0.5cm) freely mobile lymph nodes are often present in this area because
lymphatics from the perineum, legs and feet drain into this area.
o Presence of hard or immobile nodes would require further investigation
 Palpate for Femoral Pulse; compare with radial
Detailed Plan of the Examination of the Male Genitalia
NOTE: it is especially important that inspection of the genitalia is done while reflex testing and/or palpation
of the genitalia is being performed.
Palpation
 Reflexes
o Scrotal Reflex
 Elicited by application of a cold object (kidney dish) on upper inner thigh.
o Scrotum will retract (response can range from immediate to delayed on first side,
generally delayed or non-responsive on second side.)
o Cremasteric Reflex
 Elicited by quick, firm flick along inner side of the thigh with a blunt point (tongue
depressor).
 Scrotum will retract on the test side. Response times will vary.
o Anal Wink

Ask patient to hold his scrotum & penis up to give you a clear view of perianal
region

Firm stroke upward in the perianal region with blunt object (from anus toward
testicles)
 Should cause external anal sphincter to quickly and visibly contract
o Bulbocavernosus Reflex
 If patient is uncircumcised, have them retract their foreskin
 Give a firm, brisk bilateral squeeze to the penis just beneath the head of the glans
 This should cause a quick, visible contraction of the anus.
 Penis
o Glans
 External urethral meatus should be located centrally at the tip of the glans penis.
 Use thumbs to spread apart urethral meatus to inspect mucosa.
 Opening should be a healthy pink color.
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
There should be no evidence of discharge (if there is discharge, direction of
palpation of the penis will be important).
o Shaft
 Note skin texture, mobility of prepuce and skin of shaft
 With thumb and first two fingers, palpate down the shaft from the external meatus
toward the pubis to appreciate the corpus cavernosa, looking for abnormalities
such as fibrous plaques in corpora.
 palpate the urethra through the corpus spongiosum from base of the penis up to
the glans (in practice, if a discharge has been noted this will “milk” a specimen for
testing).
 the uncircumcised patient should now be asked to replace his foreskin.
 Patient can now raise his penis, which can also be tucked under the edge of the
gown.
 Scrotum
o
o
o
o
o
o
Establish presence of two testicles.
Palpate bilaterally – thumbs on top, index fingers on bottom of scrotum.
Normal testicles have a firm, smooth, rubbery consistency – no nodules present.
Size should be approximately 2-3 cm at greatest diameter.
Compare testicles for symmetry, texture, shape, weight
Epididymis
 Locate and palpate the epididymis, located on the posterior aspect of testicle
 It is extremely sensitive to trauma (debilitating pain when a male struck in the
genital area)
o Spermatic Cord
 Trace path of spermatic cord from epididymis upward through the inguinal
canal to abdominal ring
 If there is difficulty in locating spermatic chord, draw the top of the scrotum
between thumb and forefinger
 The most prominent structure in the spermatic cord is the vas deferens, which
will feel similar to “al dente” spaghetti.
Inspection (done while performing reflex testing and palpation)
 General observations
o Pigmentation.
o Penile discharge.
o Lesions/Ulcerations.
o Skin integrity and contour.
o Odors.
 Scrotum
o Presence of two testicles; one is normally visibly lower.
o Swellings.
 Distended veins.
 Penis
o Length and girth of shaft (abnormal only if extremely small, i.e. microphallus)
o Integrity of skin
o In uncircumcised men, note:
 Ease of retraction (Primroses: foreskin cannot be retracted, preventing
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examination of the glans)
 Presence of smegma (cheesy substance collecting under foreskin)
o Urethral Meatus (opening of the penis)
 Discharge.
 Inflammation.
 Stenosis.
 Foreign body.
 Abnormal location
 Hypospadias – meatal opening on the ventral surface
 Epispadias – meatal opening on the dorsal surface (less common)
Additional notes on palpation
 An absent vas deferens on one side is often associated with an absent kidney on the same
side. Palpate abnormal masses (may be more tender than testicles on light pressure)
 If you appreciate a large mass during palpation of the scrotum, transilluminate to indicated
whether it is a solid mass or accumulation of fluid.
 If a large scrotal mass that does not transilluminate is present, an indirect inguinal hernia may
be present in the scrotum.
 Auscultation of the mass may be used to determine whether bowel sounds are present in the
scrotum, a sign useful in diagnosing an indirect inguinal hernia.
Male Genital Self Examination (GSE)
 All men are at risk of testicular tumors, especially young men
 All men that are sexually active are at risk of sexually transmitted infections (STI)
o Educate your patient about symptoms associated with STIs such as pain or burning on
urination or discharge from the penis; if the patient has any of the above signs or
symptoms, he should see a health care provider.
 A GSE should be a regular part of routine self health care practices.
o Teaching GSE can be easily incorporated into the routine examination of the patient,
and may be introduced after the physician has performed the genital examination, but
before the rectal examination
 Procedure
o Perform while bathing or showering since the warmth tends to make the scrotal
skin thinner and more pliable.
o Take the penis in hand and examine the head; If uncircumcised, patient should
first pull back (retract) the foreskin to expose the head (glans penis)
o Urethral meatus should be examined for any discharge
o Inspect and palpate the entire head of the penis in a clockwise motion, then
entire shaft of the penis while looking for any bumps, sores, blisters or warts on
the skin.
o Bumps and blisters may be red, light colored or resemble pimples;
o Genital warts may look similar to warts on other parts of the body; may initially
be small bumpy spots but left untreated could develop a fleshy cauliflower-like
appearance.
o Examine the entire shaft of the penis, being sure to include the underside of
the shaft, and look for the same signs and symptoms (a mirror may be helpful)
o Separate the pubic hair at the base of the penis; carefully examine the skin
underneath for same signs.
o Examine skin of the scrotum. Including underneath, again for same signs.
o Hold each testicle gently and palpate, being alert to any lump, swelling,
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soreness or irregularities in the testicle.
NOTE: There will generally be no abnormal or unusual findings with WM SPs; any that exist
(such as repaired hernias) will be specifically identified by the WM SP.I
 Inguinal Hernia
o Place small (pinky) finger of the right hand, volar surface (pad) downward, nail upward,
in the scrotum above the left testis.
o Using as much scrotal skin as possible, use this finger, invaginate the scrotal skin
upward along the inguinal canal to reach the external inguinal ring (superior and lateral
to the pubic tubercle).
o The procedure should be painless when done properly; excessive speed, pressure
or an incorrect angle of entry could cause serious discomfort to the patient.
o Once the external ring is appreciated, ask the patient to turn his head to the side and
to cough. You should feel a slight “tap” against the tip of the finger. Strong pressure
could indicate presence of a hernia.
o After the left side is evaluated, repeat the procedure on the other side, using the
opposite hand wherever possible to avoid drawing the hand directly over the patient’s
genitals.
Detailed Plan of the Digital Rectal Examination
A rectal examination provides important information and is a core part of a thorough physical
examination. If performed in a calm, professional, relaxed and gentle manner, with a step-bystep explanation of the procedure, it need not cause pain, serious discomfort or be an
embarrassing experience for the patient.
NOTE: you must be gloved for the DRE
Special Considerations
Infants and Children
o Rectal examination is not performed on infants and children unless there is a specific indication.
o It is imperative that you respect the child’s modesty and apprehension.
o Careful explanation of each step in the process is necessary for the child who is old enough to
understand.
Older Adults
o The examination procedure and findings for the older adult are much the same as those of the younger
adult but important to remember that the older patient may be more limited in ability to assume a
position other than the left or right lateral.
Position
Unless otherwise indicated by patient history or stated preference, recommended position is:
Right decubitus - patient lying on right side, facing physician
o allows for eye contact and better communication between examiner and patient
o the volar surface of index finger arrives right on the prostate gland
o enables physician easier entry to the rectum and less invasive palpation of the prostate
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Under very specific circumstances, the rectal examination can be performed with the patient in
various positions:
Left decubitus – patient laying on left side, facing away from physician
o creates more awkward angle of entry for physician
o sweep of anal wall more challenging due to awkward angles
Standing - patient facing the examining table, legs apart, elbows flexed and resting on
table.
o not normally used except for older men with history of military service
o more awkward for physician to accomplish examine efficiently & comfortably
Prone – patient laying on their back
o generally used only if patient is unconscious or unresponsive and a DRE is required.
Inspection
o With patient in position, raise drape to expose the sacrococcygeal (pilonidal) and
perianal areas.
o Ask the patient to assist by using his hand to lift his top buttock.
o The skin around the anus will appear coarser and more darkly pigmented.
o The skin should be smooth and uninterrupted; inspect for lumps, rashes, inflammation,
lesions, excoriations, scars, skin tags, warts, external hemorrhoids, fistulas, fissures,
rectal prolapse.
o Look for pilonidal dimpling and tufts of hair at the pilonidal area.
Palpation
o Take tissues for yourself, pass box of tissue to patient to clean the anus after the DRE
is complete.
o Thoroughly lubricate your index finger; place the pad of it against the anal opening
o Warn the patient that while you palpate the prostate, he may feel the urge to urinate
due to the prostate’s proximity to the bladder, but that he will not.
o Likewise, warn the patient that when you withdraw your finger, it may feel like he is
having a bowel movement, but that he is not; it’s simply the sensation of something
being evacuated from the rectum.
o Ask the patient to bear down or take deep breaths to relax the external sphincter.
o As relaxation occurs, with your hand in a pistol-grip position to allow greater mobility
(and comfort for patient) slowly slide your finger into the anal canal as far as possible,
aiming toward the navel.
o Feel for the prostate gland and palpate the posterior surface, noting the size, contour,
consistency and mobility. (a healthy prostate should have the resilience of a pencil
eraser, be firm, smooth and slightly movable, and be about 4 cm. in diameter)
o Identify the lateral lobes and median sulcus
o Palpate in sequence the lateral and posterior rectal walls, sweeping 180° in each
direction, noting any nodules, masses, irregularities, polyps or tenderness. Walls
should feel smooth.
o Clock referents are used to describe the location of anal and rectal findings: 12:00 is
15
o
o
o
o
in the ventral midline and 6:00 is in the dorsal midline.
Partially withdraw the finger and ask the patient to squeeze it with the sphincter; good
muscle tone is indicated by even tightening all the way around with no discomfort to
the patient.
Withdraw your finger completely; using the tissue give the patient’s anus a “courtesy
wipe” – away from the testicles.
Turn clockwise away from the patient and prepare a hemoccult test using fecal matter
that may be present on the gloved finger
Take used tissues in right hand, invert the right glove while removing it. Place glove
in left hand and invert left glove while removing it, such that it contains the used tissues
and other glove.
Additional Notes on the DRE:
 Palpation of the prostate can force secretions through the urethral orifice; any that appear at
the meatus may be cultured and examined microscopically.
 Because the anterior rectal wall is in contact with the peritoneum, you may be able to detect
the tenderness of peritoneal inflammation and the nodularity of peritoneal metastases. The
nodules, called shelf lesions, are palpable just above the prostate in males and in the cul-desac of females.
 Internal hemorrhoids are not ordinarily felt unless they are thrombosed.
 Bi-digital palpation, where you lightly press your thumb against the perianal tissue and bring
your index finger toward the thumb, is a useful technique for detecting a perianal abscess.
References
1. Mosby’s Guide to Physical Examination 2nd Edition, Seidel, Ball, Dains, Benedict, Mosby Year Book
Inc., Toronto, 1991
2. A Guide to Physical Examination and History Taking, 5th Edition, Bates, J.B., Lippincott Co.,
Philadelphia 1991.
3. Text Book of Physical Diagnoses, Swartz, M.H., W.B. Saunders
Co., 1989.
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Evaluation Forms
Well Man Teaching Unit
STUDENT PERFORMANCE CHECKLIST
CLASS OF 2016
STUDENT
Date
Well Man
I.
________________
Well Man __
INTRODUCTION
1.
Washes hands
2.
Introduces self
3.
Establishes what the patient prefers to be called
Satisfactory
Needs Work
Covered
Satisfactory
Needs Work
Covered
Satisfactory
Needs Work
Covered
4. Explains sequence of the examination.
Comments
II.
MALE BREAST EXAMINATION
1. Palpates for axillary adenopathy
Central
Medial
Lateral
Anterior
Posterior
2. Palpates for
Tenderness
Lumps/bumps
3. Inspects for
Deformity
Nipple Retraction
Nipple Discharge
Comments:
III.
GENITAL EXAMINATION
1. Inguinal Region and Groin
Assesses hair pattern/distribution
Inspects and palpates for inguinal hernias
Inspects and palpates for inguinal lymphadenopathy
2. Inspects the external genitalia
Skin
Scrotum
Penis
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3. Elicits following reflexes
Scrotal
Cremasteric
Anal Wink
Bulbocavernosus
4. Identifies urethral meatus, displays knowledge of Hypospadias and
Epispadias
5. Palpates glans and shaft of penis
The corpora cavernosa – two spongy chambers filling most
of the penis
the urethra and corpus spongiosum whiich surrounds it
6. Palpates testes
Distinguish epididymis and spermatic cord
trace course of spermatic cord from epididymis to superficial
inguinal ring
7. Describes size, shape and consistency of testes
identifies any masses or tenderness
transilluminate (if indicated)
8. Teaches male genital self-examination (GSE) and provide rationale
9. Palpates Inguinal canal and Inguinal Rings for Inguinal Herniae
Comments:
IV.
RECTAL EXAMINATION
Covered
Satisfactory
Needs Work
Covered
Satisfactory
Needs Work
1. Instructs patient in positioning and drapes appropriately
-
2.
3.
4.
5.
Shows knowledge of different positions and rationale for
their use
Takes tissues for own use, then provides tissue for patient's use when
exam is concluded
Lubricates entire finger of gloved hand
Spreads buttocks and inspects anus, perianal and sacro-coccygeal
areas
advises patient of possible sensations
burning sensation and/or impending urination during
palpation of prostate,
sensation of defecation when finger is removed
6. Places volar surface of index finger on anus, gets patient to breathe
deeply,
gently and slowly inserts index finger into anus
7. Palpates
Anal opening - masses, induration, tenderness, haemorrhoids
Prostate gland - size, shape, consistency, masses
Rectum - rotating examining finger to palpate rectal wall
External sphincter tone
8. Removes finger, gives courtesy wipe,
Places tissues in right hand
Redrapes patient and turns away
- demonstrates attentive and supportive behaviour
Comments:
V.
CLOSURE
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1.
Performs hemoccult test
inverts glove with tissue, places in other glove
inverts second glove, disposes
2. Helps patient to return to comfortable position
3. Exit room to allow patient to dress
Comments:
VI.
GENERAL BEHAVIORS
1. Was well prepared for session (knows format, reviewed video).
2. Accepts constructive criticism
3. Listens to instruction
4. Uses patient's name
5.
Provides explanation and feedback to patient throughout
6. Demonstrates respect and encourages active participation.
7. Demonstrates attentive and supportive behaviours (eg acknowledges
verbal and non-verbal responses to exam, provides reassurance)
8. Drapes appropriately.
9. Maintains eye contact when possible.
Comments:
Covered
Satisfactory
Needs Work
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Well Man Session - 2016
STUDENT EVALUATION OF THE LEARNING EXPERIENCE
Well Man ______________________
Date ______________________
Well Man ______________________
As we continually seek to improve this course, we would appreciate your feedback.
Your constructive comments are welcome. Please return this form to the Medical Skills
Centre.
Instructions: For each question circle “Yes” or “No”. Comments can be made after each
statement as needed.
This teaching session met my expectations in learning how to:
1. Perform a complete, detailed male genitalia examination.
Yes
No
2. Perform a rectal examination.
Yes
No
3. Conduct a sensitive exam in a manner that conveys
respect and sensitivity to the patient.
Yes
No
Yes
No
2. Inspired confidence in my ability to perform genitalia and
rectal examinations.
Yes
No
3. Provided constructive criticism.
Yes
No
4. Provided adequate opportunities for questions.
Yes
No
The Well Men SPs:
1. Demonstrated sensitivity to my feelings.
Please comment about how we can improve the course for future classes (e.g., core
document, videotape, artificial models, introductory whole-class lecture, etc.)
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Well Man Teaching Unit
CERTIFICATE OF PARTICIPATION
CLASS OF 2016
Please return this form to the Medical Skills Centre
Student
Date
This is to certify that the above named student has participated in the Well Man Unit of the
Medical Skills Course.
Genital Examination
Satisfactory
______
Satisfactory with deficiencies
______
Remedial Work Recommended
______
Rectal Examination
Satisfactory
______
Satisfactory with deficiencies
______
Remedial Work Recommended
______
Well Men:
Name
(print)
(print)
Signature
COMMENTS:
This is to certify that I, ______________________________
(print name)
have been made aware of this assessment.
Signature _________________________________________ Date _________________________________
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