Imagine you are a young doctor performing a procedure crucial to women’s health—a pelvic exam. Now picture yourself doing it poorly, completely missing the top of the uterus, the area near the ovaries, even the cervix.
You wouldn’t be alone, according to Carla Pugh, a Stanford-affiliated surgeon who estimates that one-third of new physicians never touch a woman’s cervix during their first pelvic exam. Even more—perhaps 50 percent to 60 percent—fail to palpate the fundus, or top of the uterus, through a patient’s abdomen.
The problem, Pugh says, is that this exam is tough to teach. It’s difficult for instructors to evaluate the quality of medical students’ pelvic exams just by watching them. “There’s no clinician who hasn’t gone home and wondered if the students felt what they were supposed to feel,” she says.
So Pugh, PhD ’01, developed a teaching tool called e-Pelvis—a model of a female pelvis fitted with sensors and connected to a computer—that provides instant feedback about pelvic exams to both students and teachers.
The e-Pelvis grew out of a project for a Stanford class about human-computer interactions that Pugh took in 1998 while earning a doctorate in education. The prototype consisted of a toilet paper roll stuffed with clay and a “cervix” made from the head of a badminton birdie.
Today’s manufactured e-Pelvis looks like the body of a woman from mid-chest to upper thigh. Inside, sensors are strategically placed at the cervix, the adnexa, which contains the ovaries, and the fundus. A laptop with special software attaches to the model and lets both student and instructor know if the right part is being touched. The program also indicates how much pressure is being applied—important for learning bedside etiquette. Interchangeable interiors give students a chance to test their ability to find different pathologies, such as uterine or ovarian tumors.
Pugh has patented both the e-Pelvis and the broader idea of combining computers, mannequins and sensors to simulate other medical exams (at present, she is working on prostate- and breast-exam simulators). So far, two medical schools—Stanford and King’s College in London—are using the e-Pelvis, and Pugh expects others will be able to purchase it for $6,000, including a laptop. The National Board of Medical Examiners has given her a grant for further research that may result in the device being used for gynecologic licensing exams.
But the biggest reward for Pugh is the reaction of students who use her invention. Stanford MD/PhD student George Scott says he and his classmates appreciated the chance to practice on the e-Pelvis before examining a human patient: “It was best for the ability to help me match what I was feeling for to an image of the anatomy that I had in my mind.” In London, Pugh overheard an even stronger endorsement. One student said to another, “Can you believe for a whole month we’ve been doing this exam wrong?”
