Education

Touching your teacher

Intimate and professional

To perfect their trade, doctors need to practice their technique – especially when it comes to vaginal examinations. So, medical students practice on their own teachers. ‘Remove your finger!’
By Lucia Grijpink / Photo Reyer Boxem / Translation by Sarah van Steenderen

Just imagine letting strangers look at your vagina – touch it, even. Now, imagine that those strangers are your students. The whole situation is very unusual, very intimate. But it’s how gynaecologists learn their trade.

So, Annelies Berends comes to the rescue. Nine years ago she came across an advertisement searching for a gynaecological examination teacher (GET) – and she’s been training future practitioners ever since.

She was just looking for a new experience. She had a full-time job as an intensive care nurse at the UMCG, but she wanted to scale back her duties so she could try different things. A job in a cute shop, perhaps? But then she found the advert for the GET position. ‘Better you than me’, colleagues said when she told them about it. ‘But it’s amazing that you’re doing this!’

Healthy

She and the other GETs received two months of theoretical training. She also had to see a gynaecologist for a check-up, because GETs have to have good vaginal health. ‘It’s for the benefit of both you and your students’, Berends explains. ‘Students need to learn the basics, so our vaginas need to be in good working order.’

Well, it’s not for me, but kudos to you for doing that.’

Yvonne is a GET, too. While she was training to become a midwife, she attended a GET session – and decided to become a GET herself. She was intrigued because in her line of work she saw that gynaecological exams weren’t always done respectfully. ‘This one time I was with a woman who was giving birth in the hospital. I had told the doctors that she was uncomfortable with internal vaginal examination, but they just ignored that.’ The experience motivated her to sign up as an instructor.

No underwear

The GETs provide instruction for medical students, midwives, and general practitioners two to six times a month.The training sessions last for three hours. They work in pairs with two or three students at a time.

‘The students are almost always curious about how we ended up here’, Berends says. ‘They wonder what kind of woman wants to do this kind of work. I always get a kick out of that question.’

Their greatest motivation? Yvonne: ‘I just love the opportunity to pass on knowledge. I also really like the coaching aspect of the job.’

They wonder what kind of woman wants to do this kind of work

After discussing the case, one of the teachers takes off her underwear and sits down in the examination table. It’s always an uncomfortable moment, even after nine years. Berends: ‘But once I’m on the table it’s like any other medical examination, just like someone checking out a bum knee.’

Cool with it

Berends isn’t surprised when people have difficulty understanding why she does this work. ‘It is kind of funny if you think about it: three people taking a peek at my vagina. But it’s a clinical setting, so it doesn’t feel weird to me.’

Yvonne nods. ‘I knew what I could expect, because I trained for it myself. To me it’s purely educational, so I’m cool with it.’

The teachers first show how the vaginal examination is done, both with a speculum and by digital examination. After that, it’s the students’ turn to practice on their teacher, who can provide guidance along the way. ‘It’s really great for students’, says Berends. ‘Most patients don’t give feedback unless you’re really hurting them.’

Clitoris

In the end, they evaluate the lesson. What did the students think? What went well and what could be improved? ‘Students often tell me how much they enjoy examining an actual woman’, LiesbethKoenderink, education coordinator, says. ‘They have manikins to practice on in the clinical training centre, but that doesn’t prepare them for reality.’

The teacher told me: ‘remove your finger!’

And that’s exactly why Annelies Berends chose this job. ‘It might sound silly, but it feels really good when your students are grateful. It’s nice to see people go home feeling proud of what they’ve done.’

First-year intern Aniek Jonkers says it really does help in practical education. ‘It was really educational, and I think it’s great that these women do this work’, she says.

Whenever she examines a real patient, she keeps in mind what she’d been told during her training. ‘I learned, for instance, that I’m not allowed to touch the clitoris during the GET training, but my thumb would sometimes touch it by accident. The teacher immediately told me: “Remove your finger!”’

‘It was a little uncomfortable at times. I looked at the clock and realised I had spent forty-five minutes with my hand up my teacher’s vagina.’

Pay check

Berends laughs: ‘I’ll sometimes run into students who have examined me, like in a restaurant or something. You can see them trying to figure out how they know they know me. But that’s fine with me.’

The GETs are paid for their work, but their salary is no higher than that of a ‘normal’ teacher. Berends uses the money as a nice little extra. ‘My intensive care pay went to my family, but I used my first GET pay check to visit Australia for five weeks.’

I used my first GET pay check to visit Australia for five weeks

The UMCG employs ten GETs with different backgrounds and different ages. ‘The youngest is thirty, and the oldest is what she herself calls a sixty-something’, Yvonne jokes. Some of the women have a medical background, but one GET is a teacher at a high school.

Relationship

The main objective is to teach students to be professional and respectful during examinations. As Berends puts it,‘they can learn the technical aspects anywhere, but we try to teach them to treat patients properly. We need to create a comfortable atmosphere for them. The students have to feel comfortable enough to make mistakes and ask questions, and the GET shouldn’t feel intimidated.’

If that relationship is not properly established, GETs can terminate the session at any time. But this has only happened once in the past five years.

These days, every single Dutch medical faculty provides this type of training. The University of Utrecht employs male teachers for examination as well. But the UMCG is the only facility where the training is so intimate. Berends: ‘I heard that at some universities there are eight students for each teacher. I wouldn’t like that. I’d feel like I was a kijkdoos.’
(Editor’s note: A kijkdoos is a miniature diorama in a shoe box that elementary schoolchildren make. You peer into from a small hole. Doos is also a Dutch slang word for vagina.)

For privacy reasons, the name Yvonne is fictitious. The editorial staff know this person’s real name.

Nederlands

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