Researchers call for digital rectal exam revival

Rates of digital rectal examination (DRE) are low in clinical practice and levels of sufficient training in the technique may be in decline, the results of a US study suggest.

On average, physicians had performed only 41 DREs in the preceding year, which ranged from a mean of 29 per year for those with less than 4 years' postgraduate experience, to 123 in those practicing for over 20 years. When asked, only three in 10 physicians stated they were completely comfortable performing a DRE.

The authors believe theirs to be the first study of DRE in clinical practice, a technique that can be used in the diagnosis of many conditions, including prostate cancer, pelvic inflammatory disease, and fecal impaction.

"The findings suggest that a simple yet effective diagnostic bedside examination technique is underutilized and, for those with recent training, is becoming inadequately taught," say Reuben Wong (University of North Carolina, Chapel Hill, USA) and colleagues.

The study included 196 final-year medical students and 436 clinicians, specializing in gastroenterology, internal, and primary medicine. The researchers found a wide variation in the number of DREs performed in the past year by participants, ranging from seven in students to 173 in practicing gastroenterologists.

Senior physicians were more likely to perform DREs than their less experienced colleagues and were also more likely to say that they had received adequate training. For example, those who described their training as "a little" were on average 5.5 years out of medical school compared with 11.5 years for those who described their training as "completely sufficient."

The authors also found relationships between the sufficiency of training and confidence in making a diagnosis based on DRE. Furthermore, the more DREs a physician had performed in the past year, the more confident they were in diagnosis.

The authors highlight the utility of DRE in chronic constipation and prostate screenings, suggesting that many physicians may under appreciate its value.

They recommend that guidelines should be developed for a standardized method of performing DRE, to be included in the training of medical students and clinicians.

Writing in the American Journal of Gastroenterology, they conclude: "Together, these observations underscore the need to improve awareness of training of the DRE, especially among junior doctors, before it becomes a lost art."

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