Male_GU_Statement_of_work.doc

03/24/2016

STATEMENT OF WORK

The Integrated Clinical Skills (ICS) Course includes direct student – “patient” physical examination encounters. To provide the initial training in the male genitourinary examination, we require the participation of trained teaching associates. These individuals serve as both the subject of the examination and the instructor as to technique and overall approach. Teaching associates must have appropriate training/experience in both examination and educational techniques to convey the required curriculum materials. All sessions are conducted at the Simulation Center located on the Walter Reed Annex in Silver Spring, Maryland; therefore, the contractor must be able to provide an onsite monitor and personnel transportation to that facility on the agreed upon dates and times.

Male Genitourinary (GU) Examination (ICS Course) – Module 6, Class of 2019 Services include:

1. Student to teaching associate ratio of no more than (model) 2:1 (except on noted dates, see below).

2. Model demonstration of the male genitalia examination including inspection and palpation of the inguinal area, penis, scrotum and its contents, and hernias.

3. Teaching patients the importance of testicular self-examinations.

4. Model demonstration of the male rectal and prostate examination including inspection and palpation of the anus, rectum, and prostate.

5. Individual student practicum on examination of the male genitalia and rectal examination.

6. Sessions should last approximately 60 minutes, or roughly 30 minutes per student.

7. Sessions should include didactics and practicum on proper draping techniques and attention to patient privacy

8. Provide an on-site monitor/administrator for each session.

9. Provide necessary supplies for each session (note: there is no capacity for on-site storage of supplies)

10. Provide services within the time limit specified (session times cannot be extended, awardee must supply adequate staffing to complete the session within the presented timeframe.

11. Contractor will inform teaching associates that a valid drivers license and proof of insurance is required to drive a vehicle onto the Forest Glen military installation. Contractor will also inform teaching associates that all vehicles entering the installation are subject to random vehicle inspections.

MALE GU EXAM DATES Summer 2016 – Class of 2019 (Graduate School of Nursing)

DURATION OF EXERCISE: 1:00 - 3:55 PM

# OF SESSIONS: 2 Daytime sessions

# OF STUDENTS: approximately 24 students per session; 2 students/TA (except where noted on schedule)

SESSION DURATION: 75 min. per student pair

SESSION TIMES:

1:00 – 2:15 PM

2:40 – 3:55 PM

12 Students: 2:40 – 3:55 PM (2 st/TA)

12 Students: 2:40 – 3:55 PM (2 st/TA)

MALE GU EXAM DATES Fall 2016 – Class of 2019 (School of Medicine)

DURATION OF EXERCISE: 6:00-8:45 PM

# OF SESSIONS: 8 Evening sessions

# OF STUDENTS: approximately 24 students per session; 2 students/TA (except where noted on schedule)

SESSION DURATION: 60 min. per student pair

SESSION TIMES:

6:00 –7:00/7:30 PM (depending on student #)

7:45 – 8:45 PM

12 Students: 7:45 – 8:45 PM (2 st/TA)

12 Students: 7:45 – 8:45 PM (2 st/TA)

12 Students: 7:45 – 8:45 PM (2 st/TA)

12 Students: 7:45 – 8:45 PM (2 st/TA)

12 Students: 7:45 – 8:45 PM (2 st/TA)

12 Students: 7:45 – 8:45 PM (2 st/TA)

12 Students: 7:45 – 8:45 PM (2 st/TA)

8 Students: 7:45 – 8:45 PM (2 st/TA)

MALE GENITO-RECTAL EXAMINATION SEQUENCE

DURATION OF EXERCISE:

60 MINUTE SESSIONS (2 students per GTA per session)

Time breakdown: GTA didactics -15 min; student 1 practice - 20 min; student 2 practice - 20 min; 15- 45 minutes between sets Patient is in room, gowned

Sexual history has been taken

Exam will proceed in context of a complete physical Preliminary (GTA time: 5 minutes)

1.

Knocks and waits for recognition, introduces self to patient, addresses patient by surname.

2.

Explains purpose and main steps of examination.

3.

Offers patient opportunity to void to decrease risk of discomfort during exam.

4.

Invites patient to ask questions now or at any time during the examination.

5.

Washes hands in presence of patient before beginning examination and puts on clean gloves.

6.

Reviews that universal precautions will be used during this examination.

7.

Addresses issue of potential sexual stimulation (only if it occurs).

8.

Discusses draping principles (balance between sensitivity to privacy versus adequate exposure) Abdominal/Genital Examination:

9.

Ensures patient has voided recently to decrease risk of discomfort during the exam.

10.

Percusses upper limit of bladder (symphysis pubis to umbilicus).

11.

Re-drapes lower abdomen and exposes genitalia.

12.

Palpates inguinal lymph nodes.

13.

Inspects pubic area and scrotum.

14.

Palpates shaft of penis including both corpora cavernosa and corpus spongiosum.

15.

Inspects and palpates the glans penis. Inspects under the coronal ridge (retracting prepuce or foreskin if present). Spreads urethral meatus then compresses gently to check for discharge.

16.

Palpates the scrotum and its contents. Checks for nodules, tenderness, etc. Notes any evidence of swelling.

17.

Isolates and palpates each testis (immobilize within scrotum).

18.

Locates and palpates each epididymis.

19.

Identifies each spermatic cord.

20.

Palpates each cord between thumb and fingers from the testis to superficial inguinal ring.

Hernia Examination:

21.

Observes scrotum with patient in upright position. If any change is noted, re-palpates and transilluminates.

22.

Checks for direct inguinal hernia (fingers flattened over inguinal area). Increases intra-abdominal pressure by asking patient to bear down or cough.

23.

Checks for indirect inguinal hernia (index finger in inguinal canal). Increases intra-abdominal pressure by asking patient to bear down or cough.

24.

Teaches patient testicular self-exam, when to do it and its importance.

Rectal Examination (upright and lateral decubitus positions):

25.

Asks patient which position they prefer (upright or lateral decubitus position)

26.

Inspects anus, sacrococcygeal and perineal regions, checking for abnormalities such as nodules, fissures, inflammation, rashes, etc.

27.

Alerts patient that the examination is about to begin.

28.

After placing lubricant on finger, exerts pressure anteriorly over external sphincter with pad of index finger. Asks patient to bear down, pauses for sphincter to relax, and gently inserts finger into anus, aiming toward umbilicus.

29.

Palpates prostate, left and right lobes and median sulcus.

30.

Palpates remaining surface of rectum, including right lateral, posterior and left lateral areas, by rotating finger through an arc (if necessary reassure patient about normalcy of flatulence or urination).

31.

Explains to patient that the examination is over and that you will be leaving the room while the patient cleans up and dresses.