Measuring Medical Student Anxiety Toward the Male Genitourinary Rectal Examination

Background: Medical educators agree that the male genitourinary rectal (GUR) exam, is the most anxiety-evoking intimate examination, and can evoke a state of anxiety for medical students that adversely affects their learning and performance of the examination. Further, researchers have demonstrated that medical students with high anxiety when learning to perform the male GUR exam may experience long-term, adverse effects that influence their success in performing the examination as practicing physicians. The development of a rating scale used to measure medical student anxiety toward the male GUR exam and an in-depth evaluation of validity evidence is required before extensive research in the area can be performed. Methods: A novel rating scale used to measure medical student anxiety toward the make GUR exam (A-GUR) was developed. A total of 468 student participants were recruited from two Midwestern urban medical universities during their institution’s clinical GUR examination programs. From University A, a state funded school, 169 second-year students [male = 88 (48.3%), female = 96 (51.7%)] participated. From University B, a private school, a combined total of 337 first and second-year medical students [male = 182 (54.0%), female = 155 (46.0%)] participated. Prior to performing the exam on a “patient,” students completed the 5- point, 47-item A-GUR scale. The Many-Facet Rasch measurement approach was used to evaluate evidence relevant to content, substantive, structural, generalizability, and external aspects of validity. Results: Findings of this study offer validity evidence that supports content and substantive and external aspects of validity, but evidence relevant to structural aspect of validity was inconsistent. Although evidence supported the Rasch model’s assumptions of mononotonicity and local independence, results of principal component analysis and evaluation of AIC and BIC did not support unidimensionality. Evidence also did not fully support generalizability, and suggested that ethnicity and gender may contribute to findings. Conclusion: Although findings of this study offered some forms of validity evidence, the impact of gender and ethnicity have on medical student anxiety should be researched further before making inferences about the measures from the instruments with confidence.