In the Words of GTAs

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An Original Gynecological Teaching Associate in New York City
–by Genie Reece

In the early 1970’s, some time before becoming a GTA, I worked in a women’s health clinic. Doctors rotated through the clinic from an affiliated hospital. Though they were typically competent, sadly enough, some were not particularly kind or compassionate. I felt many of the doctors dealt with breasts and pelvises, and not so much with the women themselves. We women who staffed this clinic were part of the Women’s Movement of that time, and most of us would have defined ourselves as “feminists” to one extent or another. We had weekly meetings between the staff and doctors in which we often had to confront difficult personalities and situations. For example, we frequently observed doctors doing rough and/or painful pelvic exams. We heard doctors speak about patients as if they were not present. Once, while doing a pregnancy termination, a doctor described the tiny body parts of a fetus as he removed them. The patient was under local, not general anesthesia. On one occasion, I was literally backed into a corner by an angry doctor who felt we women had no right to say anything to him about his attitude or performance. Those days were hard!

During that time, I was volunteering as a rape crisis intervention counselor with Bronx Women Against Rape (Bronx WAR). I supported many survivors through emergency room exams for evidence collection. Since most rape survivors came into the emergency room at night, an on-call doctor was not always immediately available. Further, rape survivors didn’t usually take priority in a busy ER. There were often long waits for doctors who may have been stressed, overworked and tired. Not many doctors liked being called upon to perform these “rape kit” exams. I am also not sure how much training the doctors had in doing these specialized exams. Under these circumstances, my being at the “head” of the woman, holding her hand and watching her face as she lay on the exam table, often became crisis intervention on its own as I found myself a liaison between survivor and doctor. No rape survivor should be subjected to negative or judgmental attitudes or less than comfortable exams.

It was while training new Bronx WAR counselors that our group was approached by the head of the OB/GYN department of a nearby teaching hospital, Albert Einstein College of Medicine. He had heard of the Gynecological Teaching Associate (GTA) programs at several other teaching hospitals in the city and wanted to have GTAs working in his medical school. Although GTA work was pretty new at the time, it sounded like a great thing to be able to get in on the “ground floor” of medical students’ GYN education.

I went through the training, and was fascinated by how much I learned about my own body, and the breast and pelvic exams themselves. I was also excited by the idea of working with students. I was already familiar with self-exams, having participated in Our Bodies, Ourselves workshops at my clinic where we practiced self-exams with plastic specula. I have always felt comfortable with my body, though this new presentation of my body did prove to be a little challenging in the beginning. I wouldn’t say I was embarrassed about my breasts and genitalia; initially, it just felt an odd thing to be doing, and I found myself concerned about what the students must have thought of us. This was partly because I knew, from early history, that prostitutes had once been hired for student practice exams. I even sometimes said to myself, “What am I doing in front of this group of people?” albeit only three students at a time! Yet, this was a revolutionary new way for women to be in control of their breasts and vaginas! The nature of the work was so professional and clinical that I quickly got over any fears I had and entered into the spirit of the teaching, which I found rewarding.

Early on, some students—and residents in particular—saw us as adversaries, those “raging feminists” who were telling them how to do their jobs. Sessions often started with challenges to our credentials, our training, and our knowledge. I just knew the participants were thinking “Who are these women and how can they do this?” But over time our workshop became a required course for the physical diagnosis curriculum in medical schools and part of many residency programs in New York City. With the endorsement of the medical schools and the directors of residency programs, and having proved the value of our work, we rarely experience a negative reception these days.

Over all these years I have rarely left a teaching session in which I did not feel something really important had occurred. For the second year medical students, the experience can be quite intense, and we help them get through a first breast and pelvic exam with confidence and the assurance that both we and they will be okay. As we guide the students, we are able to keep the exams comfortable for ourselves. The students need careful, thoughtful and kind guidance, as most are scared to death. Still, all are grateful at the end of the session and almost always want to know how we got into doing this work. They candidly let us know that it was “not as bad as they thought it was going to be!” Students often say the workshop is one of the best experiences they have had in medical school thus far.

Within the last 10 years, a program called SAFE (Sexual Assault Forensic Examiners) has been established, whereby nurses who want to learn how to do the evidence collection exams for rape survivors are trained. These nurses are on call for emergency room treatment. The training they undergo is intensive, and a great deal of attention is given to the emotional needs of the survivors, as well as the physical exam and proper evidence collection. There has been a GTA component to this program from its inception. We allow the trainees to role-play an encounter with a survivor; to practice the exam; and to familiarize themselves with the many steps in the kit. These SAFE examiners want to do the exams and help the survivors through the entire process, not just “get it over with”. Each time I work with the trainees, I am so grateful for the program. The “before” (tired, overworked doctors) compared to the “after” (trained, sensitive nurses) has to make a world of difference to every rape survivor who finds her way to the ER for examination and counseling.

I have been doing GTA work for 25 years now. Looking back, at first it seemed almost voluntary, as the pay was so low. The pay is much better now, however, I don’t think people can do this job just for the money. There really needs to be a commitment to women’s health—and a feminist politic as well. I feel we are a special group of people and I am proud to have been one of the “originals”.

Why I do GTA Work
–by Quai Nystrom

My interest in GTA work is something that developed through a mixture of personal experience and talking to women about gynecological exams. As a woman and patient myself, I have felt disappointed in how I was treated during breast and pelvic exams. I spoke to many women who had similar experiences. While my disappointment was mostly related to the way exams were handled, I realized that for many women, anxiety begins before they even show up at a clinic or doctor’s office. I’ve had numerous conversations with women who discussed discomfort around the mere idea of someone examining the most intimate parts of their bodies. Some women told me they are so uncomfortable that they avoid breast and pelvic exams all together. I noticed that conflicting ideas and misinformation about women’s bodies seem to be the basis for some of the discomfort, which is often compounded by distressing experiences from previous exams. It is alarming to me that some women choose to forgo exams to avoid troublesome experiences. Those conversations, along with my own journey of learning about my health and my body left impressions on me. So I had aspirations of getting involved in some way to improve the gynecological experience for women before I even knew about GTA work.

But in my desire to improve exams for women, I thought about the fact that there is another side to all of this. I realized that if women’s healthcare was going to improve, the person performing the exam must also confront the discomfort. If many women are uncomfortable about the exam to begin with, it makes it challenging for the examiner to help the patient relax. I spent years with the idea in mind that improving women’s healthcare meant improving interactions between patients and examiners. So when I discovered Gynecological Teaching Associate work, I was immediately interested. At this point in my professional life I had a background in tutoring and counseling and thought I could apply those skills to this work. It felt like a natural fit. I was excited to focus on my desire to contribute to positive changes in women’s healthcare services for both the patient and the provider.

To me, part of what this work does is shed light on a great deal of preventable apprehension. I find it rewarding to share ideas with health care providers about how to empower their patients. From personal experience, I understand how restorative it can be to learn what is healthy for our own bodies, if growing up was not accompanied with sufficient information. But for me the rewarding nature of GTA work extends beyond the actual work. I am a part of a group of women for whom I have a lot of respect . Each one is interesting in unique ways, but I believe my fellow GTAs have something in common—a sense of peace with their bodies and voices that broaden recognition of the healthy diversity of women’s bodies