Texture and approach: technique for consistent cervical examinations.

You are a busy family physician with a practice that includes obstetrics and teaching medical students. Cervical examinations are a routine part of your on-call duties. You have medical trainees with you, and they have often struggled with the cervical examination. One night on call, your trainee admits a patient in active labour and reports the cervical dilation to be 7 cm. However, she is uncertain about the accuracy of the examination. She has noticed that findings of her cervical assessments can vary from those of staff by as much as 2 to 3 cm. “I’m not certain if it was the cervix that I was feeling,” she reports. When you arrive on the floor, your assessment reveals cervical dilation of 3 cm. You realize that your trainee likely just examined the posterior fornix and not the cervix. You wonder, How might I better describe my cervical assessment approach so that it is understood by trainees? A review of the literature reveals that no one has addressed this issue previously. You realize that the crux of the problem is difficulty steering clear of the posterior fornix and recognizing the different textures. You also realize that the texture of tissue in artificial models is not close enough for simulated training. The solution? You teach your trainee to recognize the appropriate textures by comparing them to the corresponding oral tissues. Using a gloved hand, your trainee examines the following oral tissues: