Women’s Health Educator – Making Women’s Health Exams More User-Friendly
Written by Hannah Heller
I never planned to work in the field of gynecology or women’s health, but life has a way of getting you to where you need to be, even when you don’t see it coming.
In the fall of 2000, my now late husband Craig was diagnosed with cancer of unknown primary. He died of this disease in the summer of 2002 when our daughter was 12 and our son was 7. As a young widow with two school-aged children, I needed a more flexible work schedule. I found a part-time office job which offered me a lot of flexibility, although the salary was not great. My sister, a full-time editor at Johns Hopkins University School of Medicine, found out about a program she thought would be a good fit for me to supplement my income. The Standardized Patient Program is an essential part of most medical, nursing and physician assistant schools. Functioning as actors, we work as practice patients with fictional names and conditions. We evaluate students on interpersonal skills and on techniques of the physical exam related to the fictional patient’s condition. It was and continues to be a great experience. Little did I know that this would lead to something else I would never have imagined doing in my life.
Being an outgoing and social person, I made a lot of new friends among my co-workers in the standardized patient world. As a result of these connections, I found out about a specialty within this program called GUTA, Genitourinary or Gynecological Teaching Associate, also known as a Women’s Health Educator. Women in this program function as both instructors and patients, teaching the exam and having students demonstrate the exam on them as live, practice patients. The pay rate was considerably more than that of a regular standardized patient. The money was attractive, but I wanted to do this for an even more important reason than the much-needed funds. Since I became a widow, I had been challenged and found myself doing things I never would have thought I could do and I found within me strengths I never knew I had. This appeared to be another opportunity for me to grow.
Training took several months. There were many qualifications, both physically and intellectually, that I had to pass. Some of the details of this
training were overwhelming to me at first. When some of my colleagues reached out to help me break down the content into an organized and simplified format, I became more comfortable with learning the details. After working as a GUTA for more than fifteen years, I have fine-tuned my presentations, clarified some of the information, and kept up to date on new developments in the field.
An annual gynecology exam is something many women fear and dread. Our job as GUTAs/Women’s Health Educators is to train medical students not only on how to perform the procedure, but also in the areas of interpersonal skills and helping patients to feel more comfortable in this invasive but necessary annual exam. While there is some physical discomfort during the exam, the hardest parts of it are the feelings of confusion and fear, not knowing what is going on and what the medical provider is doing. We train the students about what they can say to patients and the ways that they can offer to have the patient become an active part of their health care instead of feeling like an object on an examination table.
Language is an important part of this exam. We refer to sheets as drapes, avoid using the word ‘bed’ in referring to the exam table and say footrests rather than stirrups (we are not horses are we?!). We talk about offering the patient a mirror so they can see what is going on and what the medical provider is checking. I teach using both diagrams and my body, so that students see what the typical presentation looks like and how that can differ with each person.
As part of this process, I found out that I have a retroverted uterus. This explained why many doctors had difficulty finding my cervix and uterus. I learned techniques for guiding the students in this area. My having given birth twice, once vaginally and once by C-section, also gave me more of a background in talking about gynecological experiences. Now that I am postmenopausal, I have even more changes to share. The breast exam, while detailed, does not
take that long to do on me, as I have small breasts. I learned the different patterns and techniques, which I am able to present to the students. I learned about the purpose of the speculum, the differences between plastic and metal ones, and the different styles of metal specula. I spend a great deal of my session teaching about the techniques for using the speculum and ways to avoid patient nervousness and make it a lot less scary than it appears to be.
Do I know every single detail there is to know about breast and pelvic exams? Of course not! What I do know is how to present this exam to a patient, how to ease any anxieties and how to encourage patients to make this appointment every year.
Most of the students in medical, nurse practitioner and physician assistant programs are obligated to participate in a GUTA session, no matter what field of medicine they are pursuing. The interpersonal skills they practice are valuable for so many fields of medicine, as well as other areas of their careers. Developing and constantly improving in the area of sensitivity to the needs of a patient is so important in any medical field. It is easy to get so overwhelmed and wrapped up in technical and scientific details and overlook this very important aspect of medical care.
In keeping up with current norms, we now talk about being sensitive to transgender patients and others in the LGBTQ community. We also talk about being sensitive to those who have experienced trauma in their lives. We are paving the way for a brighter future in the medical world and helping others to feel more reassured about medical providers.
Changing the style of care in Women’s Health is something that has been long overdue. I am proud to be part of this mission. When we become more active in taking care of our health, we are able to be fully present and tuned in to guiding medical practitioners in meeting our needs.
Changing the style of care in Women’s Health is something that has been long overdue.
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