A gynecological exam: the 15-minute checkup that many women spend a year dreading. Some hate it so much that they put off seeing a gynecologist for years, even though medical experts recommend annual pap smears to catch cervical cancer in the early stages and regular pelvic examinations to maintain good health.

But a pelvic exam shouldn't be painful -- or even embarrassing -- if done correctly, say women's health activists, who took the reins into their own hands in the 1970s to show how it should be performed. Prodded partly by the women's health movement and partly by medical faculty looking for a better teaching technique, the majority of U.S. and Canadian medical schools now employ trained women patients to teach medical students "from the table" how to make the exam more comfortable and less intimidating.

On an evening in the spring at George Washington University Medical Center, second-year medical students practiced their first pelvic exam -- which usually involves a woman lying down with her legs in rigid metal stirrups while the physician inserts metal instruments into her vagina. But for these students, the patients were women instructors from Women's Health Consultants of Rockville, a group of about 20 part-time instructors on contract with the medical school.

"Don't flail your fingers. Just point," instructor Patricia Dubroof, a visual artist, told a second-year medical student who was performing a manual exam on her vagina. As the student carefully withdrew the speculum, a metal instrument used to open the vaginal walls during an examination, Dubroof reminded her, "Don't linger at the end. It's very uncomfortable." When the student was finished, she received a commendation: "Very good, that's exactly the technique."

Throughout the exam, Dubroof maintains an authoritative tone as she critiques and praises the three students examining her. The scene looks very different from the traditional gynecological exam. Instead of lying on her back, Dubroof sits up, facing the medical student with an encouraging smile. She has a hand-mirror by her side so she can view difficult-to-see genital areas.

"As physicians, we learn from the patient every time we take a history. But it's never formalized {so that} the health care consumer is teaching the doctor," said Lila A. Wallis, an internist and clinical professor of medicine who founded a similar course, known as the teaching associate program, at Cornell University Medical College in 1979. "This is . . . consumer philosophy being taught in medical school."

The success of the technique has inspired medical schools to expand it to a wide range of doctoring skills. "Standardized patients," lay persons who act the role of a patient based on a true case, are now used to teach students how to interview patients, how to perform a general physical and how to recognize medical and emotional problems in specialties from neurology to pediatrics.

Seventy percent of medical schools in the United States and Canada use standardized patients to some extent, according to a 1990 survey by Paula Stillman, curriculum dean at the University of Massachusetts Medical Center in Worcester, Mass., and a leading authority on the technique. Pelvic and breast exams remain the most popular use of the technique -- at more than 60 percent of schools, according to the survey.

The growth of standardized patient programs is one response to research showing that patients are often treated brusquely by doctors -- sometimes to the detriment of an accurate diagnosis. Patients on average have only 18 seconds to tell their problems before being interrupted by the doctor, and more than 80 percent of doctors do not hear all of the patient's complaints, Richard M. Frankel and Howard B. Beckman, associate professors of medicine at the University of Rochester School of Medicine and Dentistry, found after studying more than 1,000 patient-physician encounters.

Some experts think traditional medical school training is to blame. "The most intense experience a first or second-year student is likely to have with a patient is with a cadaver," Frankel said. "It's very important in the first two years to give students parallel experiences with living, breathing patients so that students are not encouraged to reduce the patient to a series of parts."

At classes conducted by Women's Health Consultants, for example, instructors remind the students that many women see their gynecological exam as their only opportunity to bring up medical concerns -- even of a non-gynecological nature. "After you've built this level of trust, don't blow it," Dubroof tells her students. "Give {the patient} an opportunity to ask a question" at the end of the visit.

Unlike standardized patients, who usually memorize a case history chosen by medical school faculty, Women's Health Consultants insists upon sole control over the curriculum and instruction. Faculty members are not present during the organization's two classes in breast and pelvic examination.

"What we communicate is the woman's experience. It was not agreeable to us just to be models . . . We wanted to redefine the experience," said Sara Grusky, a coordinator and instructor for Women's Health Consultants. "Medical education is by and large focused on the technical aspects. Students are not taught to talk to people, particularly in the touchy, personal gynecological exam."

William R. Ayers, associate dean for undergraduate education at Georgetown School of Medicine, where the class is required in the second year, said he is comfortable with that unique degree of autonomy. "That's why all the women are willing to do it," he said. In return, "we get someone who has an interest in seeing it is done right and imparts not just the mechanical but the personal aspect."

Students say they're grateful for the training. "I'll never know what it's like to be exposed in the stirrups," said Robert Jackman, a second-year medical student at George Washington. "It teaches us how to be sensitive to the patient -- how vulnerable the patient feels."

Some instructors at Women's Health Consultants said they were attracted by the money -- about $30 per hour. Artist Dubroof, who joined the program in 1981 after hearing about it from a fellow artist, had a longstanding interest in medical self-help and experience as an artist's model.

For other women, though, embarrassment at exposing their bodies in such an intimate fashion posed an initial hurdle. "The first time you do it you're terribly nervous. But when you realize the students are more nervous than you are and {that} you're the one in charge, it becomes very simple," said MaryLou Leonard, one of the first women to be recruited for the program in 1977.

Through the 1970s, medical students typically practiced their first gynecological exam on a clinic patient, who was often unaware that these men in white coats were novices. Some medical schools used anesthetized patients or cadavers to introduce the pelvic exam to their students.

Women generally suffered the results of such training from their gynecologists in silence. "You can jam the hell out of the ovaries on a cadaver and she isn't going to sit up and scream at you. So you jam around on the ovaries of a live woman, who lies there clenching her teeth but who doesn't yell at you because you're a doctor," said Ava Torre-Bueno, a psychotherapist who teaches pelvic exams to third-year medical students at the University of California at San Diego.

In the 1960s, Robert M. Kretzschmar, a gynecologist at the University of Iowa Medical School, was disturbed by what he viewed as the exploitation of clinic patients under the traditional system. Moreover, he considered the students' training "abysmal," because the professor had no idea what a student was feeling while doing the examination. Kretzschmar decided to try something different. In the late 1960s, he asked a nurse's aide to act as a "live mannequin" for his students, and she gradually developed enough expertise to share her reactions with the students. Then, in 1970 he hired two female graduate students to give his students more detailed feedback on what they felt during an exam.

In the 1970s, the idea that a woman would willingly expose her body in such a manner was shocking to many male medical professors. When Lila Wallis first proposed the idea at Cornell in 1979, she said other faculty members strongly opposed it. "I heard how unnatural it was, how the teaching associates must be perverts," she recalled.

Some institutions hired prostitutes to act as living models. At the University of Oklahoma, this solution proved unsatisfactory because the prostitutes were too inarticulate, too expensive and sometimes had infectious diseases, according to a study reported in 1984 in the Journal of the American Medical Women's Association.

Among medical schools today, there is wide variation in the degree of authority wielded by gynecological patient-instructors. At the University of Florida College of Medicine in Gainesville, a professor demonstrates the exam on a live model and continues to instruct while students practice on the model. J. Lee Dockery, who started the program as a professor in the Department of Obstetrics and Gynecology in 1976, said that without a professor in charge he was concerned that students would become preoccupied with the sexual "ambience of the encounter as opposed to what they should be doing." But to Lila Wallis, programs relying on live models "kill the purpose of the program, where non-MDs are the advocates and command respect."

At Tulane University School of Medicine, a 12-year veteran gynecological teaching associate, Josie Hasle, has achieved the status of a full-time faculty member as educational coordinator and designer of one of the most extensive such programs. Patient instructors are required to undergo 60 hours of training, compared with the approximately 17 hours plus an apprenticeship required by Women's Health Consultants. Tulane medical students receive instruction not only in their second year but also in their third year before starting ob-gyn rotations. First-year residents take refresher courses that critique their personal manner with patients.

Prompted by concerns that doctors are insufficiently trained in dealing with patients as people, the National Board of Medical Examiners is experimenting with using standardized patients in the national exam taken by medical students prior to state licensing.

In a pilot test at two medical schools this year, students spend a day seeing 16 mock patients for 15 minutes apiece and writing down their observations. The standardized patients, in turn, rate students on diagnostic ability and personal skills. A standardized patient component could be incorporated into the exam as early as 1995 if the experiments prove to be a valid method of testing, according to Daniel Klass, a University of Manitoba professor of medicine who directs the study for the Board.