Quantifying palpation techniques in relation to performance in a clinical prostate exam.

This paper seeks to quantify finger palpation techniques in the prostate clinical exam, determine their relationship with performance in detecting abnormalities, and differentiate the tendencies of nurse practitioner students and resident physicians. One issue with the digital rectal examination (DRE) is that performance in detecting abnormalities varies greatly and agreement between examiners is low. The utilization of particular palpation techniques may be one way to improve clinician ability. Based on past qualitative instruction, this paper algorithmically defines a set of palpation techniques for the DRE, i.e., global finger movement (GFM), local finger movement (LFM), and average intentional finger pressure, and utilizes a custom-built simulator to analyze finger movements in an experiment with two groups: 18 nurse practitioner students and 16 resident physicians. Although technique utilization varied, some elements clearly impacted performance. For example, those utilizing the LFM of vibration were significantly better at detecting abnormalities. Also, the V GFM led to greater success, but finger pressure played a lesser role. Interestingly, while the residents were clearly the superior performers, their techniques differed only subtly from the students. In summary, the quantified palpation techniques appear to account for examination ability at some level, but not entirely for differences between groups.

Using a prostate exam simulator to decipher palpation techniques that facilitate the detection of abnormalities near clinical limits.

INTRODUCTION: Prostate carcinoma (and other prostate irregularities and abnormalities) is detected in part via the digital rectal examination. Training clinicians to use particular palpation techniques may be one way to improve the rates of detection. METHODS: In an experiment of 34 participants with clinical backgrounds, we used a custom-built simulator to determine whether certain finger palpation techniques improved one's ability to detect abnormalities smaller in size and dispersed as multiples over a volume. The intent was to test abnormality cases of clinical relevance near the limits of size perceptibility (ie, 5-mm diameter). The simulator can present abnormalities in various configurations and record finger movement. To characterize finger movement, four palpation techniques were quantitatively defined (global finger movement, local finger movement, average intentional finger pressure, and dominant intentional finger frequency) to represent the qualitative definitions of other researchers. RESULTS: Participants who used more thorough patterns of global finger movement (V and L) ensured that the entire prostate was searched and detected more abnormalities. A higher magnitude of finger pressure was associated with the detection of smaller abnormalities. The local finger movement of firm pressure with varying intensities was most indicative of success and was required to identify the smallest (5-mm diameter) abnormality. When participants used firm pressure with varying intensities, their dominant intentional finger frequency was about 6 Hz. CONCLUSIONS: The use of certain palpation techniques does enable the detection of smaller and more numerous abnormalities, and we seek to abstract these techniques into a systematic protocol for use in the clinic.