"There is no standard vulva": Sanitized vs. contextualized instruction of hands-on medical skills.

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Author: Bex MacFife
Date: Mar. 2022
From: Social Science & Medicine(Vol. 297)
Publisher: Elsevier Science Publishers
Document Type: Report; Brief article
Length: 256 words

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Abstract :

Keywords Standardization; Gynecological teaching associates; Medical education; Patient diversity; Context; Pedagogy; Embodiment Highlights * Standardized medical education leads to sanitized, generic patient representations * Feminist health movement interventions have been co-opted by institutions * Curricula are shaped to supposedly help students avoid discomfort * Educators resist by bringing in context, often through personal details * Discussing a wide range of normal contributes to inclusion and diversity Abstract Medical education overlooks bodily variation by presenting a de-contextualized patient. This standardization perpetuates inequality and stigma. Initially a feminist project in the US, Gynecological Teaching Associates (GTAs), or specially trained educators who teach while receiving vaginal/pelvic and breast/chest examinations, are understudied despite how common they are in MD programs. GTAs have been subject to standardization when incorporated into medical school training, but opportunities to challenge the status quo remain. I conducted interviews with 25 GTAs across the United States. Thematic, iterative coding reveals two overlapping genres of GTA engagement. Through sanitized instruction, GTAs stick to 1.) professionally distanced, 2.) (supposedly) politically neutral, and 3.) student-protective methods. Alternatively, through contextualized instruction, GTAs 1.) are open to personal disclosure, 2.) present a wide range of normal and bring in sticky topics, and 3.) try to prepare students for a messy reality. Contextualizing instructors describe tactics for centering physiological and social diversity, such as framing non-normative factors (identity, sexual practices, underrepresented bodies, etc.) as clinically relevant. Author Affiliation: University of Oregon Sociology, United States Article History: Received 10 December 2021; Revised 30 January 2022; Accepted 10 February 2022 Byline: Bex MacFife [bexm@uoregon.edu]

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Gale Document Number: GALE|A696649690