Training medical students in intrauterine procedures using papayas.

摘要

Context and setting The papaya is an excellent uterine model because of its shape, cervix-like stem end and interior texture, which is similar to that of the endometrium. We use the papaya to introduce Year 3 medical students to uterine anatomy, endo-metrial biopsies, intrauterine contraception, and uterine aspiration, with enthusiastic reception. Why the idea was necessary The workshop gives the students hands-on experiences in gynaecological procedures they usually only observe. The papaya workshop is a fun, inexpensive and easily replicable model for teaching intrauterine procedures. What was done During the second week of the Year 3 obstetrics and gynaecological (ob-gyn) clerkship, students participate in the papaya workshop. Firstly, we poke holes in the stem-ends of the papayas to mimic a cervical os, then review basic uterine anatomy and bimanual examinations. We then present 3 patient cases. The first, concerning a woman in need of an endometrial biopsy, allows us to teach paracervical block, tenaculum placement and endometrial biopsy, which the students practise on the papayas. The second case is about intrauterine contraception (IUC). The students learn about the 2 forms of IUC and the evidence-based contraindications, and then practise placing IUC devices in their papayas. The final case concerns a woman with a missed abortion who requires uterine aspiration. The students dilate and aspirate their papayas, often successfully retrieving papaya seeds, and curette the papayas to make sure they are empty, thus experiencing the gritty feeling of the interior of a uterus. As we discuss each case, we review pre-procedure evaluation and counselling, 'no touch' technique, and the use of local, cervical anaesthesia.