Teaching associates use their bodies to guide med students

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By Drew Harwell

For her next lesson, the teacher, a petite, dark-haired woman named Anna C. Sosa, shrugs off her red robe, kicks her striped socks into the footrests and steels herself for yet another potentially disastrous pelvic exam.

Medical student Anastasia Samaras performs an exam with actor/trainee Jim Sandloop, a 69-year-old retired salesman and Army veteran, who specializes in a “guided tour of the male genital examination.” (Photo for The Washington Post by Jay Westcott)

Medical student Anastasia Samaras performs an exam with actor/trainee Jim Sandloop, a 69-year-old retired salesman and Army veteran, who specializes in a “guided tour of the male genital examination.” (Photo for The Washington Post by Jay Westcott)

It’s a sweat-soaked summer morning outside Eastern Virginia Medical School’s Sentara Center for Simulation and Immersive Learning, and inside this mock hospital room, three medical students in starched white lab coats stand wordlessly between Sosa’s feet.

The room feels microscopic, with fluorescent lights and functional carpet, its beige walls sterile and sparse save for three mounted boxes of latex gloves. Then there’s Sosa, who breaks the silence by hoisting a pair of speculums like six-shooters into the frigid, antiseptic air.

These cliched “medieval torture devices” are nothing to be afraid of, she says. In fact, this duckbilled tool, with all the sleekness of a caulking gun, is a thing of wonder, she says: the guide to the gateway of all human creation, that staggeringly important part of the body most women will never see.

“This may not be the first time you capture the live cervix,” Sosa says, smiling encouragingly, “but either way, we’re in this together. Go, team cervix!”

Sosa is a gynecological teaching associate, and she holds one of modern medicine’s most awkward jobs, using her body to guide med students through some of its most delicate, dreaded exams. Every week, she lies back for dozens of the next medical generation’s first pelvic and breast screenings, steering gloved fingers through the mysteries of her own anatomy and relaying the in-depth feedback they’ll need out in the wild.

She is not, in the traditional sense, a medical professional herself: A 31-year-old theater actor, she has also worked recent jobs at a bakery and Barnes & Noble. Yet what she lacks in faculty prestige, she and her compatriots — including a squad of male urological teaching associates, who teach genital and prostate exams — make up for in humor, candor and endurance. For nervous students, she is like an enthusiastic surgical dummy, awake through the operation and cheering them on.

To lighten the mood

Christina Starks Hall, a 36-year-old student on her last day of physician-assistant school, pulls a stool close and gently lifts the white drape crumpled across Sosa’s waist. Starks Hall has worked on hospital rotations before, but the speculum is still, as she says, “a complicated li’l piece of equipment,” and this is still a stranger’s anatomy she is about to explore.

“You’re going to feel my hands on your tissue, and it’s going to be cold gel and lots of pressure,” she tells Sosa, who spectates via a small hand mirror with a cartoon girl on the back. Starks Hall aims the speculum, saying, “I want you to take a deep breath ... and exhale.”

Sosa breathes out and says, “Very appropriate verbalization and a safe, smooth insertion,” and only then does Starks Hall exhale, too.

Sosa attempts to lighten the mood, telling the three students not to “hold speculums gangster-style” but rather to, as some texts recommend, “hold it like a cigar, which is a horrible reference.”

But it is a nerve-racking experience, nonetheless. In Starks Hall’s first exam, two years ago, she forgot to release the speculum during its removal, leading the patient to jolt with pain — and Starks Hall to wake up on a stretcher, headed for the hospital, having fainted.

For anyone familiar with these tests’ indignities — the snapping of a latex glove, the frosty surprise of a speculum, the barks to “bend over” — what these teachers do may seem almost messianic, like a sacrifice for the betterment of the rest of us, taking hundreds for the team. That doesn’t necessarily make it any easier for the teachers and students in these tense exam chambers, where questions seem to echo off the walls: Does this hurt? Am I doing this right?

And the one the teachers hear the most: What kind of person does such a thing?

Learning from life

There is no true substitute for the squishy grotesquerie of the imperfect human form. Blemished and unsculpted, it is rife with surprises, each lump and bump like a tiny opportunity for the learner to explore.

But the live body is a recent addition to the medical classroom, and its placement there is preceded by a dark and awkward history. Some doctors today began their careers practicing pelvic exams on patients zonked on anesthetics, many of whom were poor walk-ins to outpatient clinics, never asked to give consent. In the late ‘60s, realizing passed-out guinea pigs didn’t offer the best critiques, medical schools started recruiting untrained pelvic models, including prostitutes. Improvements to the program’s ickiness and patient feedback were negligible, at best.

The practice of training and paying gynecological teaching associates, or GTAs, is only a few decades old, and for years it went unnoticed even at the highest levels of the medical world. Gayle Gliva-McConvey, a former president of the Association of Standardized Patient Educators, remembers trying to spread the word at an American College of Physicians conference in the ‘90s, blocking off space with a velvet curtain and asking passing doctors, “Would you like to refine your breast and pelvic examination skills?”

“Nobody even knew what GTAs were,” she said. “I got one guy who looked me up and down and said, ‘Sounds intriguing.’"

The programs have grown rapidly over the years, including at Eastern Virginia, considered a pioneer. Its simulation center now employs 130 “standardized patients,” the broader group of workers who fake medical ailments for education’s sake.The school also routinely crowds its GTAs and male urological teaching associates, or MUTAs, into vans and planes for sessions at 65 medical schools from North Carolina to New York.

In New York and Los Angeles, the simulated patients are often actors; here, in eastern Virginia, they are part-time or former professors, baristas, retail workers and house spouses, all contract workers paid by the session, and not extraordinarily so.

Gliva-McConvey, the program director, said wages were confidential but added, “All I can say is, we don’t pay them enough.”

But Temple West, a former GTA who started as a standardized patient when she was 60 on a recommendation from her Jazzercise instructor, called her first discovery of her body’s inner workings “just about the neatest thing I’d ever done.”

That reaction is surprisingly common. Students who have only read about the cervix in medical texts, teachers said, have been brought to tears or exclaimed, “It’s so beautiful!” or “Oh my god!”

As GTA Alexandra Duncan wrote in an essay on BuzzFeed, “At this point in my life, my uterus has made more people cry than I have.”

Last modified: September 22, 2015
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