LAUSR

CONTEXT Certain clinical pelvic examination (PE) teaching methods have been critiqued for prioritizing student learning over patient autonomy and for not accurately representing diverse patient communities. As such, patient-centered and culturally competent approaches to the PE may need further emphasis in the medical curriculum - in particular, in content delivered to students before patient interaction. Classroom materials serve as students' first exposure to the sensitive procedure. This research explores how patients are represented in these materials. METHODS A situational analysis was conducted on 10 purposively sampled PE learning materials for the 2019/2020 academic year from five undergraduate medical schools in Canada. Situational analysis focuses on analyzing discourse but is epistemically aligned with post-structuralism (most notably Foucault's theories involving discursive power) and allows for specific consideration of 'silences' in the data. Collected data was analyzed using cartographic approaches according to this methodology, with particular attention paid to the tenets and frameworks of patient-centered and culturally competent care. RESULTS Overall, content in these materials mis- and under-represented patients. Materials contained both outdated and unnecessarily sexualized language, in addition to a lack of patient diversity. Clinical authority was often centered over patient agency, and several updated PE techniques known to improve patient experience were absent. Patient-centered and culturally competent approaches were therefore inadequately highlighted in most of the materials. CONCLUSION Depictions contained in these materials may be perpetuating stereotypes and biases in medicine and working to maintain teaching practices that cause harm to patients (standardized and regular) who students interact with in both clinical and educational settings. Efforts may be needed to improve classroom materials on the pelvic exam so that they more adequately center patients and provide opportunities to discuss culturally competent approaches to the procedure that 1) may not be covered in other parts of the PE curriculum and 2) can reduce known health disparities.