Exam & procedures
10 procedures6 with video
The sequences a clerk assists with, at the level of a clerk: what happens, in what order, and what to watch for. Consent and trauma-informed practice are written into each procedure, not stapled to the front.
Before any intimate examination
- Explain what the examination involves, why it is proposed, and what the alternatives are, in plain language, before anyone undresses.
- Ask for permission, and make clear the patient can stop at any point, by saying so or by raising a hand. Stopping is honoured immediately, without persuasion.
- Offer a chaperone and record the offer and the response; a student never examines without the supervising clinician present and the patient's specific agreement to the student's involvement.
- Privacy: a door that locks or a sign, a sheet, undressing only what is needed, time to undress and dress alone.
- Trauma-informed: assume a history you have not been told. Explain each step before it happens, keep talking, avoid sudden touch, ask about pace, and notice dissociation or distress and pause.
- Never examine a patient under anaesthesia for teaching without their specific prior consent to that examination.
- Speculum examinationSeeing the cervix and vaginal walls: for screening, discharge, bleeding, rupture of membranes and the cervix in labour by inspection.6 steps · video65:35
- Bimanual pelvic examinationFeeling the uterus and adnexa between two hands: size, position, mobility, tenderness, masses.6 steps · video66:54
- Leopold's manoeuvresFour hand positions on the abdomen that give the lie, presentation, position and engagement of the fetus from about 28 weeks.5 steps · video51:31
- textCervical examination in labour and the Bishop scoreDilatation, effacement, station, consistency, position, the presenting part and the membranes, in one careful examination.5 steps5none
- Cervical screening sample (cytology and HPV)A sample from the transformation zone, taken well, is what makes the screening programme work.4 steps · video46:37
- Colposcopy and cervical biopsyMagnified inspection of the cervix after acetic acid, to find and biopsy the lesion an abnormal screen predicts.5 steps5none
IUD insertionThe most effective reversible method, placed at the fundus with a sound and an inserter, in a few minutes.6 steps · video66:49- textEndometrial biopsyAn office sample of the endometrium with a flexible suction cannula, for abnormal bleeding when hyperplasia or cancer is the question.4 steps4none
- Assisting a normal vaginal birthThe second and third stages, hands and words: guiding the head, checking the cord, delivering the shoulders, and the active third stage.6 steps · video63:17
- textPerineal trauma: classification and repair principlesFirst to fourth degree, by what is torn. First and second degree are repaired in the room; third and fourth in theatre by an experienced operator.6 steps6none