title: Teaching and practising rectal examination in Pakistan.
abstract: BACKGROUND
  Digital rectal examination (DRE) is an integral part of physical examination. The teaching and practising of DRE should start early in medical school for mastering the skills to perform DRE by the time of graduation. In recent years it has been observed that medical students are reluctant to learn and practise DRE because of a perception of the reduced importance of DRE as compared with other modalities of investigation. We evaluated the knowledge and attitude of medical students and interns towards the teaching and practising of DRE.
  
  
  METHODS
  We conducted a cross-sectional survey of four medical institutions in Karachi, Pakistan.
  
  
  RESULTS
  Of the 398 participants included in the study, almost half were medical students. Almost all (98%) of the participants appreciated the importance of DRE. Only half of the participants reported having been formally taught about DRE before reaching the final year of medical school. Only 16 per cent reported the use of manikins as an aide to demonstrate and practise DRE. The median number of times respondents had performed DRE was one. Patients' refusal to grant consent was the most common reason given for not performing DRE. Students are reluctant to learn and practise DRE because of a perception of its reduced importance
  
  
  CONCLUSIONS
  Teaching sessions on DRE using manikins are suggested to begin early in medical school. It is also suggested that a minimum number of DREs should be performed under supervision before the completion of the internship.
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Asif
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Noman
authors.identifier: http://orcid.org/0000-0001-8125-1554
authors.initials: N
authors.lastname: Shahzad
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Madeeha
authors.initials: M
authors.lastname: Ali
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D051517:Digital Rectal Examination / Q000379:methods / Q000592:standards; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D010154:Pakistan; D012002:Rectal Diseases / Q000175:diagnosis; D012007:Rectum; D013337:Students, Medical / Q000523:psychology; D013663:Teaching / Q000379:methods