“There is no standard vulva”: Sanitized vs. contextualized instruction of hands-on medical skills

Medical education overlooks bodily variation by presenting a de-contextualized patient. This standardization perpetuates inequality and stigma. Initially a feminist project in the US, Gynecological Teaching Associates (GTAs), or specially trained educators who teach while receiving vaginal/pelvic and breast/chest examinations, are understudied despite how common they are in MD programs. GTAs have been subject to standardization when incorporated into medical school training, but opportunities to challenge the status quo remain. I conducted interviews with 25 GTAs across the United States. Thematic, iterative coding reveals two overlapping genres of GTA engagement. Through sanitized instruction, GTAs stick to 1.) professionally distanced, 2.) (supposedly) politically neutral, and 3.) student-protective methods. Alternatively, through contextualized instruction, GTAs 1.) are open to personal disclosure, 2.) present a wide range of normal and bring in sticky topics, and 3.) try to prepare students for a messy reality. Contextualizing instructors describe tactics for centering physiological and social diversity, such as framing non-normative factors (identity, sexual practices, underrepresented bodies, etc.) as clinically relevant.