Outcomes of teaching medical students core skills for women's health: the pelvic examination educational program

Utility of Gynecological Teaching Associates

Introduction Gynecological teaching associates (GTAs) are trained to teach the pelvic exam using themselves as models, and it has been hypothesized that their use can improve learners' confidence and interpersonal skills. This study aims to gain greater insight into whether the use of GTAs is associated with increased medical students' confidence when performing the pelvic exam during clinical rotations. Methods An email survey was distributed to medical students in two different classes at a single United States Medical Licensing Examination (USMLE)-accredited medical school: one that learned the pelvic exam using GTAs and one that did not. A Fisher's exact test was performed to determine associations between the use of GTAs and confidence in performing the pelvic exam, with a p-value of <0.01. Results Out of the 85 survey participants, 68 had performed a pelvic exam in the clinical setting and thus rated their confidence level. Of the 38 students who learned using a GTA, 66% (p<0.0024) reported a confidence level of four or five (out of five) compared to 50% of the 30 students who were not able to practice using a GTA. There was a statistically significant difference in the confidence levels of students who practiced on GTAs compared to those who did not. Discussion Our findings demonstrated that students who were able to learn the pelvic exam using GTAs reported higher confidence levels when subsequently performing a pelvic exam in a clinical setting. Conclusion Our findings support investment in GTA programming for teaching the pelvic exam in medical school curricula.

Improving Medical Student Comfort and Competence in Performing Gynecological Exams: A Systematic Review

PURPOSE

Performing a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams.

METHOD

The authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments.

RESULTS

The search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams.

CONCLUSIONS

The literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.

The association of standardized patient educators (ASPE) gynecological teaching associate (GTA) and male urogenital teaching associate (MUTA) standards of best practice

Gynecological Teaching Associates (GTAs) and Male Urogenital Teaching Associates (MUTAs) instruct healthcare professional learners to perform accurate and respectful breast, speculum, bimanual vaginal, rectal, urogenital, and prostate examinations. During such sessions, the GTA/MUTA uses their own body to instruct while providing real-time feedback. While GTAs/MUTAs fall under the broader umbrella of Standardized Patient methodology, the specificity of their role indicates need for establishment of Standards of Best Practice (SOBP) for GTA/MUTA programs. On behalf of the Association of Standardized Patient Educators (ASPE), the Delphi process was utilized to reach international consensus identifying the Practices that comprise the ASPE GTA/MUTA SOBP. The original ASPE SOBP was used as the foundation for the iterative series of three surveys. Results were presented at the ASPE 2019 conference for additional feedback. Fifteen participants from four countries completed the Delphi process. Four of the original ASPE SOBP Domains were validated for GTA/MUTA programs: Safe Work Environment, Instructional Session Development, Training GTAs/MUTAs, and Program Management. Principles and Practices were shaped, and in some instances created, to best fit the distinct needs of GTA/MUTA programs. The ASPE GTA/MUTA SOBP apply to programs that engage GTAs/MUTAs in formative instructional sessions with learners. Programs that incorporate GTAs/MUTAs in simulation roles or in summative assessment are encouraged to reference the ASPE SOBP in conjunction with this document. The SOBP are aspirational and should be used to shape Practices within the program's local context. The ASPE GTA/MUTA SOBP will continue to evolve as our knowledge-base and practice develop.

Hybrid simulation of pediatric gynecologic examination: a mix-methods study of learners' attitudes and factors affecting learning

BACKGROUND

Children and adolescents with reproductive health issues may require immediate or emergency care, however in many countries availability of the pediatric and adolescent gynecology (PAG) service is low. That being said, teaching PAG examination to OBGYN, pediatrics and emergency medicine residents seems reasonable, and cannot be underestimated. In order to provide residents with opportunity to learn PAG examination, a high-fidelity hybrid simulation workshop was implemented in our institution.

METHODS

The study aimed to investigate learners' attitudes towards the high-fidelity simulation (HFS) hybrid model as compared with task trainer-SP (simulated patient)-voice model in the HFS environment and the factors connected to learners' attitudes towards the hybrid model that could influence learning in high-fidelity simulation (HFS). The concept of attitude was used as the theoretical framework and the mixed method approach to study design was utilized with simultaneous collection of quantitative (original questionnaires) and qualitative data (semi-structured interviews).

RESULTS

Residents valued the HFS hybrid model higher over task trainer-SP-voice model in regards to all three attitude components: cognitive (95%), affective (87.5%) and behavioral (83.7%). Analysis of qualitative data revealed six themes important to learners and informing learning of PAG examination in HFS. Further analysis of the themes allowed to develop a conceptual model, in which six factors connected to attitude components influenced learning. These factors were: task difficulty, attention, emotional realism of the simulation, patient's emotions, physical realism of the simulation, and technical issues.

CONCLUSIONS

Participants of our study appreciated learning experience with the HFS hybrid model more, based on attitude questionnaire. Moreover, findings revealed that multiple, various factors connected to attitude may influence learning of PAG examination in HFS with hybrid model, and we propose a conceptual model illustrating relationships between those factors.

Resident Competency in Pelvic Exam Skills Not Predicted by Early Assessment

Introduction

Pelvic examination training and competency-based assessment are expensive and time consuming. Our goal was to use the results of skill evaluation early in residency to identify residents who required training.

Methods

Incoming residents performed pelvic examinations with gynecological teaching assistants. Faculty observed residents performing examinations with clinic patients to assess for competency. Written assessment of residents by teaching assistants and faculty were completed. A regression-based software tool was used to determine items in early resident performance to best predict subsequent competency.

Results

Sixty-eight residents were evaluated. Thirty-eight (56%) residents were not able to demonstrate competency in three clinical exams and therefore received more observation. One third of evaluations were completed by faculty performing ≤1 evaluation per year. Two items were found most likely to identify a resident who required further training ("identifies cervix" and "properly assembles equipment"). The model based on these items had a sensitivity of 100% (95% confidence interval [CI]=86-100%) and specificity of 36.8% (95% CI=22-54%).

Conclusions

A model using early skills assessments was not sufficiently specific to identify residents who needed more training. Next steps include limiting the number of faculty assessors, faculty development to improve discriminatory capacity, and creating separate processes for (1) providing feedback and identifying learning needs in new residents, and (2) documenting competency in performance of pelvic exams.

Pelvic and breast examination skills curricula in United States medical schools: a survey of obstetrics and gynecology clerkship directors

BACKGROUND

Learning to perform pelvic and breast examinations produces anxiety for many medical students. Clerkship directors have long sought strategies to help students become comfortable with the sensitive nature of these examinations. Incorporating standardized patients, simulation and gynecologic teaching associates (GTAs) are approaches gaining widespread use. However, there is a paucity of literature guiding optimal approach and timing. Our primary objective was to survey obstetrics and gynecology (Ob/Gyn) clerkship directors regarding timing and methods for teaching and assessment of pelvic and breast examination skills in United States medical school curricula, and to assess clerkship director satisfaction with current educational strategies at their institutions.

METHODS

Ob/Gyn clerkship directors from all 135 Liaison Committee on Medical Education accredited allopathic United States medical schools were invited to complete an anonymous 15-item web-based questionnaire.

RESULTS

The response rate was 70%. Pelvic and breast examinations are most commonly taught during the second and third years of medical school. Pelvic examinations are primarily taught during the Ob/Gyn and Family Medicine (FM) clerkships, while breast examinations are taught during the Ob/Gyn, Surgery and FM clerkships. GTAs teach pelvic and breast examinations at 72 and 65% of schools, respectively. Over 60% of schools use some type of simulation to teach examination skills. Direct observation by Ob/Gyn faculty is used to evaluate pelvic exam skills at 87% of schools and breast exam skills at 80% of schools. Only 40% of Ob/Gyn clerkship directors rated pelvic examination training as excellent, while 18% rated breast examination training as excellent.

CONCLUSIONS

Pelvic and breast examinations are most commonly taught during the Ob/Gyn clerkship using GTAs, simulation trainers and clinical patients, and are assessed by direct faculty observation during the Ob/Gyn clerkship. While the majority of Ob/Gyn clerkship directors were not highly satisfied with either pelvic or breast examination training programs, they were less likely to describe their breast examination training programs as excellent as compared to pelvic examination training-overall suggesting an opportunity for improvement. The survey results will be useful in identifying future challenges in teaching such skills in a cost-effective manner.

The effectiveness of gynaecology teaching associates in teaching pelvic examination to medical students: a randomised controlled trial

OBJECTIVES

To assess whether teaching female pelvic examinations using gynaecological teaching associates (GTAs); women who are trained to give instruction and feedback on gynaecological examination technique, improves the competence, confidence and communication skills of medical students compared to conventional teaching.

STUDY DESIGN

Randomised controlled trial.

SETTING

Ten University of Birmingham (UoB) affiliated teaching hospitals in the UK.

POPULATION

492 final year medical students.

METHODS

GTA teaching of gynaecological examination compared with conventional pelvic manikin based teaching at the start of a five week clinical placement in obstetrics and gynaecology (O&G).

MAIN OUTCOME MEASURES

Student's perception of their confidence was measured on a 10cm visual analogue scale (VAS). Domains of competence were measured by a senior clinical examiner using a standardised assessment tool which utilised 10cm VAS and by a GTA using a four point Likert scale. Assessors were blinded to the allocated teaching intervention.

RESULTS

407/492 (83%) students completed both the intervention and outcome assessment. Self-reported confidence was higher in students taught by GTAs compared with those taught on manikins (median score GTA 6.3; vs. conventional 5.8; p=0.03). Competence was also higher in those taught by GTAs when assessed by an examiner (median global score GTA 7.1 vs. conventional 6.0; p<0.001) and by a GTA (p<0.001).

CONCLUSIONS

GTA teaching of female pelvic examination at the start of undergraduate medical student O&G clinical placements improves their confidence and competence compared with conventional pelvic manikin based teaching. GTAs should be introduced into undergraduate medical curricula to teach pelvic examination.

Validation of the Fear of Pelvic Examination Scale (F-PEXS)--measuring students' fear of performing a pelvic examination

INTRODUCTION

Medical students of both genders often show signs of fear before they perform their first pelvic examination. This situation puts a novice in a special setting of intimacy never experienced before and where different emotions may emerge. A specially designed questionnaire, the Fear of Pelvic Examination Scale (F-PEXS) has been developed to assess fear in this context. The aim of this paper is to describe the validation of the F-PEXS.

METHODS

Undergraduate medical students (N = 100) answered the F-PEXS one week before, prior to and after a learning session with professional patients to assess levels of anxiety towards performing the pelvic exam. The validity of the scale was examined using item analysis, reliability assessments and analysis of the construct validity in comparing the F-PEXS with the Spielberger State and Trait Anxiety Inventory and Beck's Anxiety Inventory.

RESULTS

The F-PEXS has very good reliability (Cronbach's alpha 0.96) and good construct validity. The mean score on the F-PEXS did not differ between gender either before or after the learning session.

CONCLUSIONS

The F-PEXS can be used to assess students' fear of performing the pelvic examination, to evaluate new strategies for learning the pelvic exam and to evaluate the outcome of such interventions.

Women's experiences of working as a Clinical Teaching Associate teaching sensitive examinations: a qualitative study

BACKGROUND

Increasingly, professional patient programs are used for training medical students to perform pelvic examinations, yet we know little of the experiences of women who teach medical students these sensitive examination skills.

AIM

To describe the experiences of women working as Clinical Teaching Associates (CTAs) teaching medical students the technical and communication skills required to perform pelvic examinations.

METHODS

Twelve women employed as CTAs participated in semi-structured interviews. Individual interviews were used to identify major themes in women's experiences of teaching sensitive examinations to medical students.

RESULTS

CTAs identified unique difficulties in their work including negative attitudes from others towards their role and the unpleasantness of the examination, although other challenges (such as teamwork issues or providing negative feedback to colleagues) were characteristic of many work situations. Effective communication was identified as central to the CTA role and the women described growth in their communication skills and assertiveness that they applied to other aspects of their work and personal lives. CTAs were motivated to join the program and remained in the program because of an interest in women's health and a desire for meaningful work, which they believed improved the examination and communication skills of future doctors. Positive interactions with work colleagues were a valued part of the role and a primary motivator to remain in the program.

CONCLUSIONS

Highlighting the experiences of women working as CTAs validates the significant teaching role these women perform and, from a pragmatic perspective, may increase understanding of the best way to attract and retain women to these important teaching roles.

Simulated learning in musculoskeletal assessment and rehabilitation education: comparing the effect of a simulation-based learning activity with a peer-based learning activity

BACKGROUND

Musculoskeletal disorders and diseases are leading causes of pain, physical disability, and doctor visits throughout the world. Health professionals must be trained to assess, treat through rehabilitation and monitor patients with these disorders. Yet, due to overcrowded curricula, some health education programs struggle to accommodate more than minimal training in musculoskeletal conditions. Consequently, educators in these professions must consider how traditional instruction could be complemented effectively to enhance students' preparation for the diverse musculoskeletal disorders and pathologies they may encounter. The purpose of this study was to explore the benefits that can be obtained from laboratory practice in musculoskeletal conditions with a standardised patient, rather than a peer patient, in a condensed time frame.

METHODS

Two groups of students were assigned to either a standardised or a peer patient condition for 2 × 2 hours musculoskeletal assessment and rehabilitation lab sessions. All students completed a pre-post matched questionnaire measuring their clinical knowledge, confidence in clinical skills and motivation for further learning. Their clinical skills were tested at the end. Students and standardised patients' perceptions of the simulated learning environment to practise musculoskeletal assessment and rehabilitation were also elicited.

RESULTS

A t-test for independent samples revealed that students working with standardised patients displayed significantly higher standards of practical clinical skills than those working with peer patients (p=0.018). Using MANOVAs with repeated measures, no interaction effect for clinical knowledge, confidence in clinical skills, and motivation for future learning were found, both groups displaying significantly enhanced cognition and motivation. Three positive and two negative themes emerged from the analysis of students' perceptions of the simulated learning environments. These were consistent with the simulated patients' perceptions.

CONCLUSIONS

The findings of this study provide support for the value of using standardised patients to enhance clinical skills in musculoskeletal assessment and rehabilitation when the timeframe for laboratory practice is limited. Students' perceptions of their experience contributed to explain why confidence in clinical skills might not necessarily improve when practising with standardised patients. Suggestions are made for optimising learning with standardised patients and for addressing the economic challenge on health education programs of hiring standardised patients.

Can physicians be replaced with gynecological teaching women to train medical students in their first pelvic examination? A pilot study from Northern Sweden

OBJECTIVE

The main objective was to gain a deeper understanding of how medical students perceive and experience learning from gynecological teaching women (GTW) instead of physicians in their first pelvic examination. A second aim was to describe how the women experience their roles as GTW.

METHODS

Data were collected from individual interviews with 24 medical students from a medical school in Sweden and with 5 GTW. Discourse analysis was performed to acquire a deeper understanding of the informants' experiences and to understand social interactions.

RESULTS

Five themes revealed in the medical students' experiences: "Hoping that anxiety will be replaced with security," "Meeting as equals creates a sense of calm," "Succeeding creates a sense of security for the future," "Wanting but not having the opportunity to learn more," and "Feeling relieved and grateful." One theme revealed in the GTW experiences: "Hoping to relate in a trustworthy way."

CONCLUSION

To replace physicians with GTW may facilitate the learning process and may also help medical students improve their communicative skills. Using GTW will hopefully further improve students' basic medical examination techniques and physician-patient relationships.

PRACTICE IMPLICATIONS

Since GTW seems to increase self-confidence and skills of medical students performing their first pelvic examination we recommend that the use of GTW is considered in the training of medical students.

The paradox of vaginal examination practice during normal childbirth: Palestinian women's feelings, opinions, knowledge and experiences

Background

Vaginal examination (VE), is a frequent procedure during childbirth. It is the most accepted ways to assess progress during childbirth, but its repetition at short intervals has no value. Over years, VE continued to be plagued by a nature that implies negative feelings and experiences of women. The aim of this exploratory qualitative study was to explore women’s feelings, opinions, knowledge and experiences of vaginal examinations (VE) during normal childbirth.

Methods

We interviewed 176 postpartum women using semi-structured questionnaire in a Palestinian public hospital in the oPt. Descriptive statistics were conducted; frequency counts and percentages for the quantitative questions. The association between the frequency of VE and age, parity, years of education, locale and the time of delivery was tested by Chi-squared and Fisher’s Exact test. The open-ended qualitative questions were read line-by-line for the content and coded. The assigned codes for all responses were entered to the SPSS statistical software version 18.

Results

As compared with WHO recommendations, VE was conducted too frequently, and by too many providers during childbirth. The proportion of women who received a ‘too high’ frequency of VEs during childbirth was significantly larger in primipara as compared to multipara women (P = .037). 82% of women reported pain or severe pain and 68% reported discomfort during VE. Some women reported insensitive approaches of providers, insufficient means of privacy and no respect of dignity or humanity during the exam.

Conclusions

Palestinian women are undergoing unnecessary and frequent VEs during childbirth, conducted by several different providers and suffer pain and discomfort un-necessarily.

Practice implications

Adhering to best evidence, VE during childbirth should be conducted only when necessary, and if possible, by the same provider. This will decrease the laboring women’s unnecessary suffering from pain and discomfort. Providers should advocate for women’s right to information, respect, dignity and privacy.

Pelvic examination skills training with genital teaching associates and a pelvic simulator: does sequence matter?

INTRODUCTION

Introducing the pelvic examination to novice learners has been a challenging task for medical educators. The purpose of this study was to evaluate an educational intervention adding the use of a pelvic examination simulator (SIM) to the use of genital teaching associates (GTAs) in a pelvic examination skills curriculum for second-year medical students.

METHODS

Each student participated in a session with the pelvic simulator and with the GTA. Students were randomized to the training sequence. Outcome measures include the Fear of Pelvic Examination Scale (F-PEXS), blood pressure measurement, and instructor evaluation of learning performance.

RESULTS

For students who learned with a GTA in the first session, the mean F-PEXS score decreased significantly, and the learning performance score was significantly higher from sessions 1 to 2. There was no significant change in either measure when the pelvic simulator was used first. For both learning sequences, men had a significantly higher F-PEXS score.

CONCLUSIONS

When using simulation to teach the pelvic examination to novices, standardized patients seem to be the better initial training experience, reducing student anxiety and improving learner engagement with subsequent mechanical simulation practice of psychomotor skills.

Maximising student preparation for clinical teaching placements

BACKGROUND

With the increasing emphasis on ambulatory health care, clinical educators need to ensure that students are sufficiently prepared to maximise learning opportunities during placements in ambulatory settings.

CONTEXT

This study focuses on third-year medical students entering urban or rural clinical placements at an Australian graduate entry medical school.

INNOVATION

All rural and a subset of urban students received intensive training in taking Papanicolaou (Pap) smears prior to starting the clinical placement. Training involved gynaecological teaching associates, active practice and real-time feedback. Evaluation included workshop feedback, reflection on effectiveness during the placement, and comparison of trained and untrained students' recorded clinical experience of taking Pap smears.

IMPLICATIONS

Students given pre-placement training praised their learning experience, and on average took more Pap smears during their placement than did their untrained peers. The difference, however, did not reach statistical significance. The pre-placement teaching workshop on a difficult skill was popular and worthy of further study regarding other challenging clinical skills.

Evaluating pelvic examination training: does faculty involvement make a difference? A randomized controlled trial

BACKGROUND

As medical schools continue to strive to deliver high quality education with diminishing resources, the need to evaluate long-standing teaching techniques becomes imperative. The use of gynecological teaching associates to teach pelvic exam skills to medical students is an example of an education intervention that deserves thorough evaluation.

PURPOSE

The objective was to evaluate effects of two pelvic examination training methods on OB/GYN clerkship students with respect to costs, students' performance, and perception.

METHOD

During the academic year 2007-08, 106 medical students were randomized to receive either pelvic examination training by a gynecological teaching associate (GTA) alone or a standardized patient (SP) accompanied by an obstetrics and gynecology faculty member. Students participated in an objective structured clinical exam (OSCE) and completed questionnaires regarding the educational intervention at the end of the clerkship.

RESULTS

The two training methods produced comparable OSCE scores, and students in both groups felt more confident after training and found the training sessions to be valuable. There was a significant cost-savings associated with using GTAs for pelvic exam training.

CONCLUSIONS

Faculty time and effort need not be utilized for pelvic exam training exercises, since using GTAs for pelvic exam training produces comparable results.

Patient involvement in teaching and assessing intimate examination skills: a systematic review

OBJECTIVES

There are recognised difficulties in teaching and assessing intimate examination skills that relate to the sensitive nature of the various examinations and the anxiety faced by novice learners. This systematic review provides a summary of the evidence for the involvement of real patients (RPs) and simulated patients (SPs) in the training of health care professionals in intimate examination skills.

METHODS

For the review, 'intimate examinations' included pelvic, breast, testicular and rectal examinations. Major databases were searched from the start of the database to December 2008. The synthesis of findings is integrated by narrative structured to address the main research questions, which sought to establish: the objectives of programmes involving RPs and SPs as teachers of intimate examination skills; reasons why SPs have been involved in this training; the evidence for the effectiveness of such training programmes; the evidence for measures of anxiety in students learning how to perform intimate examinations; how well issues of sexuality are addressed in the literature; any reported negative effects of involvement in teaching on the patients, and suggestions for practical strategies for involving patients in the teaching of intimate examination skills.

RESULTS

A total of 65 articles were included in the review. Involving patients in teaching intimate examination skills offers advantages over traditional methods of teaching. Objective evidence for the effectiveness of this method is demonstrated through improved clinical performance, reduced anxiety and positive evaluation of programmes. Practical strategies for implementing such programmes are also reported.

CONCLUSIONS

There is evidence of a short-term positive impact of patient involvement in the teaching and assessment of intimate examination skills; however, evidence of longer-term impact is still limited. The influences of sexuality and anxiety related to such examinations are explored to some extent, but the psychological impact on learners and patients is not well addressed.

Establishing an integrated multiprofessional skills training programme

BACKGROUND

Opportunities to learn and practice skills are becoming less with changes in the health care environment. Responses to this have included curriculum change and the development of skills programmes. Although the skills programmes, often taught in simulated settings in skills Centres have been frequently described, such a model may not be appropriate for all Universities or have the best outcomes. Firstly access to a centre may not be available and secondly, the training may not alter students' behaviour in the workplace in terms of applying and practicing these skills.

AIM

This paper offers tips for developing a centrally coordinated, integrated, multidisciplinary skills training programme.

METHODS

These 12 tips are based upon current literature, discussion with other skills training providers and reflection on local experiences of establishing and maintaining a skills training programme.

RESULTS

The programme, outlined here, used a multidisciplinary, multiprofessional group to design and run a skills programme, which was clearly linked back to clinical attachments, emphasising ongoing practice with feedback.

CONCLUSIONS

The twelve tips highlight the importance of broad ownership of the programme; separate funding and good evaluation are essential if the programme is to be continued in the absence of a specific Centre or a School to run it.

Learning intimate examinations with simulated patients: the evaluation of medical students' performance

BACKGROUND

For fifth-year's undergraduates of the medical school, a project with simulated patients (Intimate Examination Associates, IEA) was implemented in 2002 at the University of Antwerp. In this project, students from the new curriculum (NC) learned uro-genital, rectal, gynaecological and breast examination in healthy, trained volunteers and received feedback focused on personal attitude, technical and communication skills. Former curriculum (FC) students however trained these skills only during internship in the sixth year after a single training on manikins.

AIMS

This study assessed the effect of learning intimate examinations with IEA's by comparing students from FC and NC on four different outcome parameters.

METHODS

Three groups were compared: FC after internships without IEA training, NC after internships with IEA training and fifth year NC immediately after the IEA training. Four assessment instruments: an OSCE using checklists and global rating scales to assess the technical skills, a score list on students attitudes and performance filled in by the IEA's, a student questionnaire on self-assessed competence and a questionnaire on the frequency of performing intimate skills during internships.

RESULTS

Both NC groups scored globally better in the OSCE (significance for male examination). Sub-scores for 'completeness' and 'systematic' approach was significantly higher in both NC groups for male and female examinations. NC students reported better self-assessed competence and performance concerning gynaecological and urological clinical and communication skills during internship. The best results were obtained after IEA training and internship was done for the four outcomes. IEA's are influenced by the 'experienced' students after internship: FC and NC after internship both scored better than the fifth year NC who only received the IEA training so far.

CONCLUSION

Learning intimate examinations with IEA's has a positive effect on the performance of medical students. This beneficial effect is on its turn reinforced during internships.

Dealing with difficult sexual questions during consultations: a new training program

For over 30 years gynecological teaching associates have made a valuable contribution to undergraduate and postgraduate medical education, by allowing medical students to perform a pelvic examination on them. These women are skilled in giving detailed feedback to the medical students about their examination performance. In this study we describe a new training program: gynecological teaching associates act as simulated patients portraying a gynecological/sexual problem, in addition to allowing themselves to be examined by the students. This creates the opportunity of immediate feedback on the entire process of the consultation. Conditions are addressed that should be met to ensure the feasibility of this method.

Performing the first pelvic examination: female medical students' transition to examiners

OBJECTIVE

To gain a deeper understanding of how female medical students perceive and experience performing their first pelvic examination (PE).

METHODS

A qualitative study. In-depth interviews after the students' involvement in a learning session about the PE, with professional patients (PPs) as instructors and a gynaecologist as supervisor. The interviews were analysed according to the constant comparative method to acquire a deeper understanding of the students' experiences and the ongoing social processes.

RESULTS

"Transcending unspoken boundaries and taboos, a prerequisite for learning" was the essence of the entire material and was identified from two categories: "A didactic design facilitates the transition to examiner" and "Interactive support enables creative learning of interpersonal and palpation skills".

CONCLUSION

Through interactive guidance from the PPs, the students overcame affective obstacles and achieved the aim of becoming an examiner. The favourable learning experience heightened their awareness of their own bodies and promoted a deeper interest in PEs, both as examiners and as patients.

PRACTICE IMPLICATIONS

Engaging voluntary, healthy and knowledgeable women as instructors in the PE situation creates a safe learning environment and promotes interaction with students. Immediate feedback teaches students to integrate communicative and behavioural skills in a professional manner and to palpate the uterus.

Medical students learning the pelvic examination: comparison of outcome in terms of skills between a professional patient and a clinical patient model

OBJECTIVE

To compare two models of learning the pelvic examination (PE) for medical students, with professional patients (PP) or with clinical patients (CP), by measuring perceived distress and learning outcome in terms of skills.

METHODS

Prospective longitudinal study. Assessments of self-perceived distress on four occasions at the prospect of performing a PE. Evaluation of the learning session (LS) and clinical clerkship concerning outcome of palpation skills.

RESULTS

During the LS, students in the PP model (PP students) received enough guidance from their coaches, were certain they had palpated the uterus and at least one ovary, and were less distressed afterwards compared with students who were instructed using the CP model (CP students). During the clinical clerkship, the PP students performed twice as many PEs as CP students did and had more often confirmed palpating the uterus and an ovary.

CONCLUSION

PP students were more skilful in palpating the uterus and ovaries and performed more PEs during the clinical clerkship than did CP students.

PRACTICE IMPLICATIONS

Engaging healthy and voluntary women as PPs takes time and effort. It is, however, worthwhile as it increases the confidence of students who perform PEs, makes them more competent, and ultimately improves their skills in performing the examination during their clinical clerkship.

Intimate examination teaching with volunteers: implementation and assessment at the University of Antwerp

OBJECTIVES

Teaching intimate physical examinations in medical schools generates practical, didactical and ethical problems. At the University of Antwerp, a unique program with intimate examination assistants (IEA) was implemented for fifth year's undergraduate students. They learn gynaecological and urological skills in healthy volunteers. Technical, communicative and attitude aspects are taken into account.

METHODS

Description of the implementation of the project. Assessment of the project by questionnaires, written reflections and round table conferences.

RESULTS

The results provide detailed information about the student's perceptions of each component of the program as well as the perceptions of the IEA's and the teachers.

CONCLUSION

The multilevel evaluation of the program supports the surplus value of working with IEA's in medical education. The eye-catcher in this program is the integration of clinical skills with communicative skills and attention for students' attitude.

PRACTICE IMPLICATIONS

Working with IEA's for intimate examinations represents a benefit in medical education by lowering the student's threshold to perform the intimate physical examination on both men and women during their fulltime clerkships.

'A stronger and clearer perception of self'. Women's experience of being professional patients in teaching the pelvic examination: a qualitative study

OBJECTIVES

To identify and describe the experience of being a professional patient (PP) in teaching the pelvic examination (PE).

DESIGN

Qualitative study using in-depth interviews.

SETTING

Participant's home, place of work or other place of choice.

POPULATION

Thirteen female PPs who teach the PE to medical students and student midwives.

METHOD

Semi-structured interviews analysed with an interpretive phenomenological approach.

MAIN OUTCOME MEASURES

Five themes were identified during the analysis: 'embodied knowledge', 'promoting a proper approach', 'redrawing private boundaries', 'feeling confident' and 'doing something meaningful'. The essence 'experience of stronger and clearer perception of self' emerged from the themes and is the described structure of the lived experience of the women who are PP.

CONCLUSIONS

Being a PP in this setting was beneficial for the women. They acquired increased knowledge about their bodies and PE procedure, which led to a new awareness of their own body. Contributing to students' learning in such an intimate examination procedure was rewarding and increased self-esteem.

Graduate students' experiences with standardized patients as adjuncts for teaching pelvic examinations

PURPOSE

To explore graduate nurse practitioner students' perceptions of their experiences when learning to perform pelvic examinations in the laboratory and performing them in subsequent clinical rotations. One group was taught by faculty with voluntary peer examination, and the other two groups were taught by standardized patients (SPs).

DATA SOURCES

Surveys with open- and closed-ended (responses on Likert scales) items administered twice during 3 consecutive years to students enrolled in an advanced health assessment course.

CONCLUSIONS

All groups reported feeling anxious while learning pelvic exam techniques and in subsequent clinical experiences. SPs provided immediate feedback to students, decreased their feelings of anxiety, and increased their confidence in performing examinations. Students who were taught pelvic examination techniques by SPs rated their learning experiences more positively and reported a better understanding of exam techniques than students who learned to perform exams by voluntary examination of classmates.

IMPLICATIONS FOR PRACTICE

Graduate nursing programs should consider locating and using SP programs for teaching pelvic examinations in advanced health assessment courses. Although more cost-effective, voluntary peer examination was a less effective teaching method.

Using the Ages and Stages Questionnaire to teach medical students developmental assessment: a descriptive analysis

BACKGROUND

After a survey of medical graduates' skills found a lack of confidence in developmental assessment, a program was introduced with the broad aims of increasing medical student confidence and respect for the parents' role in childhood developmental assessment. Research has shown that parents' concerns are as accurate as quality screening tests in assessing development, so the program utilised the Ages and Stages Questionnaire, a parent completed, child development assessment tool.

METHOD

To evaluate the program, an interpretative analysis was completed on the students' reports written during the program and a questionnaire was administered to the parents to gain their perception of the experience. As well, student confidence levels in assessing growth and development were measured at the end of the paediatric term.

RESULTS

Although there was an increase in student confidence in developmental assessment at the end of the term, it was not statistically significant. However the findings indicated that students gained increased understanding of the process and enhanced recognition of the parental role, and the study suggested there was increased confidence in some students. Parents indicated that they thought they should be involved in the teaching of students.

CONCLUSION

The ASQ was shown to have been useful in an education program at the level of advanced beginners in developmental assessment.