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Guldner G, Wells J, Ayutyanont N, Iyengar R, Sprenger S, Siegel JT, Kashyap R. COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents. MEDICAL EDUCATION ONLINE 2023; 28:2143307. [PMID: 36369921 PMCID: PMC9665094 DOI: 10.1080/10872981.2022.2143307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.
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Affiliation(s)
- Gregory Guldner
- Graduate Medical Education, HCA Healthcare, Brentwood, TN, USA
| | - Jessica Wells
- Graduate Medical Education, HCA Healthcare, Brentwood, TN, USA
| | | | - Rahul Iyengar
- Southern Hills Medical Center, TriStar Division, HCA Healthcare, Nashville, TN, USA
| | - Steven Sprenger
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN, USA
| | - Jason T. Siegel
- Department of Behavioral and Organizational Science, Claremont Graduate University, Claremont, CA, USA
| | - Rahul Kashyap
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN, USA
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Flanagan OL, Cummings KM. Standardized Patients in Medical Education: A Review of the Literature. Cureus 2023; 15:e42027. [PMID: 37593270 PMCID: PMC10431693 DOI: 10.7759/cureus.42027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
The concept of standardized patients (SPs) was first introduced in the 1960s by Dr. Howard Barrows of the University of Southern California and has been applied in medical school education since that time. This practice has allowed medical students to practice skills on live persons who are teachers rather than on real patients, who may be endangered by their emerging skills. Previous studies supported the use of SPs but did not measure whether they improved clinical competence or students' confidence in their skills. This literature review evaluated whether current medical education literature supports or refutes the use of SPs compared to other modalities such as simulated patients (SiPs) and virtual reality (VR) in the improvement of student confidence, clinical performance, and interpersonal communication skills. The research questions posed for this review were as follows: do medical students in their first two years of education who have practiced skills using SPs have more self-confidence in their ability to perform skills on real patients than those students who did not use SPs, do medical students in their third and fourth years of medical school have higher clinical competency with sensitive patient examinations after using SPs in their first two years of medical education than those students who did not use SPs, and do medical students who have used SPs for discussing sensitive issues have better interpersonal skills when they encounter real patients in the clinical setting than those who have not used SPs? The methodology for this descriptive, systematic review of the literature was organized using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart to describe how articles were collected and synthesized to evaluate the variables under study. The results of this study revealed that students learned the most when SPs were used because they were able to teach students the skills that they needed in a safe learning environment. Medical students performing sensitive patient examinations with SPs learned not only how to perform the examinations but also how to improve their communication with patients. Students and residents reported increased confidence and clinical competence when performing new skills with SPs rather than with peer practice, virtual reality, or real patients in a clinical setting. Although the utilization of SPs has been studied in multiple ways and found to be a powerful tool in the education of undergraduate medical students and interns, there is still much study to be done to address the human needs of real patients. Gaps in this literature included small sample sizes, a lack of standardized assessment tools, and the need to include a multidisciplinary approach that addresses cultural awareness and appreciation. The authors found limited studies analyzing the effect the coronavirus disease 2019 (COVID-19) pandemic had on the use of SPs in medical school education. Continued scientific inquiry in post-pandemic medical education is an essential component for dissemination as most schools have reintroduced the use of SPs, which strengthens the concept that their use is superior to the other simulation methods used when SPs were not available.
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Affiliation(s)
- Octavia L Flanagan
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine (LECOM), Elmira, USA
| | - Kristina M Cummings
- Department of Family Medicine, Lake Erie College of Osteopathic Medicine (LECOM), Elmira, USA
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3
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Politis M, El Brown M, Huser CA, Crawford L, Pope L. 'I wouldn't know what to do with the breasts': the impact of patient gender on medical student confidence and comfort in clinical skills. EDUCATION FOR PRIMARY CARE 2022; 33:316-326. [PMID: 36443928 DOI: 10.1080/14739879.2022.2129460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous research has found a relationship between students' gender and attitudes surrounding peer physical examination, but relationship between patient gender and confidence/comfort is less clear. We explored whether patient gender affects medical students' levels of confidence and comfort in clinical examination skills. METHODS An electronic survey and focus groups were conducted with medical students from one UK institution. Students reported levels of confidence/comfort when carrying out clinical examinations on men/women. An inductive thematic analysis was performed. RESULTS Of a total of 1500 students provided with the opportunity to participate, ninety (6%) responded. For cardiovascular and respiratory examinations, confidence/comfort were higher when examining male-presenting patients. The opposite was true for mental state examinations. Barriers to confidence/comfort included perceiving males as a norm, difficulty navigating breasts, tutors' internalised gendered attitudes and a wider sociocultural issue. Facilitators of confidence/comfort included students relating to patients, embodying a professional role, gender blindness, and authentic clinical environments. Fewer than 20% (n = 18) of students felt they had enough opportunity to practice clinical skills on women, versus 90% (n = 82) on men. CONCLUSION Our study identified an area where students' confidence and comfort in clinical examinations could be enhanced within medical education. Changes were implemented in the institution under study's vocational skills teaching, which is rooted in general practice. Information on gender and clinical skills was provided within course handbooks, time was scheduled to discuss gender and clinical skills in small group settings, and equitable gender representation was ensured in clinical assessment.
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Affiliation(s)
- Marina Politis
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Megan El Brown
- Buckingham Medical School, Buckingham Medical School, University of Buckingham, Buckingham, UK.,Medical Education Innovation and Education Centre (MEdIC), Imperial College London, London, UK
| | - Camille Am Huser
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Lynsay Crawford
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Lindsey Pope
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
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Hornor G. Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners. J Pediatr Health Care 2022; 36:489-499. [PMID: 35987556 DOI: 10.1016/j.pedhc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Gail Hornor
- Gail Hornor, Forensic Nurse Specialist, International Association of Forensic Nurses, Hilliard, OH.
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den Harder C, van den Eertwegh V, Jongen F, Hageraats E, Nelissen S, Waterval D. Learning the breast examination with Physical Exam Teaching Associates: development and evaluation of the teaching setup. An action research approach. Women Health 2022; 62:502-512. [DOI: 10.1080/03630242.2022.2085846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C. den Harder
- Skillslab, Maastricht University, Maastricht, The Netherlands
| | | | - F. Jongen
- Skillslab, Maastricht University, Maastricht, The Netherlands
| | - E. Hageraats
- Skillslab, Maastricht University, Maastricht, The Netherlands
| | - S. Nelissen
- Skillslab, Maastricht University, Maastricht, The Netherlands
| | - D. Waterval
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Diaz CM. Beyond the Classroom: Inspiring Medical and Health Science Students to Learn Surface Anatomy. MEDICAL SCIENCE EDUCATOR 2022; 32:361-370. [PMID: 35223141 PMCID: PMC8860260 DOI: 10.1007/s40670-022-01521-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 05/05/2023]
Abstract
This qualitative and quantitative study offered students the opportunity to participate in engaging and inspiring activities "outside the classroom", to extend their experience and knowledge of surface anatomy. Medical and health science students benefit from studying surface anatomy as it is relevant to their future professions that deal with patients and clients. Surface anatomy is an essential part of the learning process that allows students an opportunity to identify anatomical structures on living people and to develop their palpation and tactile skills for physical examinations of patients. Body painting is a student-centred, engaging, and motivating approach to learn surface anatomy in anatomy practical classes. In this study, anatomy learning was extended "beyond the classroom" through extra-curricular body painting projects. These projects were run by student teams consisting of a student model, student artists (4-5), and a student photographer, under the direction of the chief investigator. A total of sixteen body painting projects were carried out from 2010 to show the skeletal system, the muscular system, pregnancy, respiratory and gastrointestinal systems, and the neurovascular systems of the entire body. A SurveyMonkey of 31/41 active participants suggested that participants enjoyed the projects (94-100%), found them relevant to their future profession (80-87%), and considered them to assist with deeper understanding (94%) and long-term memory (93%) of anatomy. Learning anatomy outside the classroom through extra-curricular body painting projects was a successful way to engage, motivate, and inspire participants and first year anatomy students to study surface anatomy and to develop their physical examination skills.
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Affiliation(s)
- Claudia M Diaz
- School of Dentistry and Medical Sciences, Charles Sturt University, Albury, NSW 2640 Australia
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Rutledge M, Link K, Zapata I, Carter S. Medical student confidence when training for a female genitourinary exam using models and standardized patients. J Obstet Gynaecol Res 2022; 48:1466-1474. [PMID: 35272394 DOI: 10.1111/jog.15222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study is to investigate what factors make students feel confident and competent when performing a female genitourinary exam (FGUE) with normal, nonpathologic findings. We anticipated that students would increase their confidence and perceived competence from the first year to the second year of medical school, would prefer the use of specialized standardized patients (SSPs) over models, and that the results would vary by student demographics. METHODS Student confidence and perceived competence were measured using voluntary survey methods pre- and postinterventions. Interventions were defined as learning the FGUE on models alone for first-year medical students and learning the FGUE on SSPs with prior experience using models for second-year students. Survey responses were evaluated via generalized linear mixed models for numeric responses. RESULTS The results demonstrated that first- and second-year medical students of racial and ethnic minorities rated themselves as more confident and competent than Caucasian counterparts, which was in many cases more extensive than the effect of an additional year of medical education. Students felt that using SSPs alone was the best mode of learning the exam than either models alone or the combination of models and SSPs. Students' current specialty of choice did not correlate with increased confidence or perceived competence. CONCLUSION This study highlights how cultural differences have an impact on confidence and perceived competence in medical students as they prepare for performing a procedure as intimate to the patient as the FGUE.
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Affiliation(s)
- Mallory Rutledge
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| | - Kelsey Link
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University, Parker, CO, USA
| | - Susan Carter
- Office of Simulation in Medicine and Surgery, Rocky Vista University, Parker, CO, USA
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Mallinson T. An exploratory study into the teaching of clinical examination skills in advanced practice. ACTA ACUST UNITED AC 2021; 30:712-720. [PMID: 34170723 DOI: 10.12968/bjon.2021.30.12.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical examination skills are vital for the accurate assessment and diagnosis of patients. These skills also allow clinicians to differentiate between pathology requiring investigation or treatment and normal anatomy or physiology. This allows clinicians to avoid unnecessary tests and to be able to reassure a patient that their symptoms do not require treatment. However, an incomplete or faulty clinical examination can lead to missed diagnoses and patient harm. Although comprehensive clinical examination skills training is provided in the undergraduate curriculum of medical schools in the UK, little is known in relation to the teaching provided for nurses and allied health professions working in advanced practice roles. This survey sought to explore this phenomenon and uncover clinicians' experiences with regard to being taught a selection of specific clinical examination skills in theory and in practice, those skills being the core system examinations (respiratory, cardiovascular and peripheral vascular, abdominal, central and peripheral nervous systems) and a number of focused examinations (digital rectal and examination, thyroid, breast and genital examination for males and females). The findings demonstrate a concerning variability of educational experiences and a lack of educational coverage of some of the basic clinical examination skills in both theoretical and practical terms. These findings provide an insight into areas of future higher education curricula development as well as workplace mentoring and learning.
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Affiliation(s)
- Tom Mallinson
- Prehospital Doctor, British Association for Immediate Care Scotland, Aberuthven, Auchterarder
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Hopkins H, Weaks C, Webster T, Elcin M. The association of standardized patient educators (ASPE) gynecological teaching associate (GTA) and male urogenital teaching associate (MUTA) standards of best practice. Adv Simul (Lond) 2021; 6:23. [PMID: 34154661 PMCID: PMC8215835 DOI: 10.1186/s41077-021-00162-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Holly Hopkins
- Eastern Michigan University School of Nursing, 311 Marshall Building, Ypsilanti, MI 48197 USA
| | - Chelsea Weaks
- Eastern Virginia Medical School Sentara Center for Simulation and Immersive Learning, 651 Colley Avenue, Norfolk, VA 23501 USA
| | - Tim Webster
- University of Manitoba Rady Faculty of Health Sciences, 250 Brodie Centre, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5 Canada
| | - Melih Elcin
- Department of Medical Education and Informatics, Hacettepe University Faculty of Medicine, Sihhiye Campus, 06100 Ankara, Turkey
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Pearson J, Greminger A, Onello E, Stover S. Teaching the Evaluation of Female Pelvic Pain: A Hands-On Simulation to Reinforce Exam Skills and Introduce Transvaginal Ultrasound. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11080. [PMID: 33511274 PMCID: PMC7830760 DOI: 10.15766/mep_2374-8265.11080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/08/2020] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Reproductive-age female patients commonly seek evaluation for pelvic pain in a variety of health care settings. Thus, teaching medical students how to effectively evaluate female pelvic pain is a necessary part of medical education. There are limited opportunities, however, to reinforce the needed skills for this common but sensitive presentation that can be anxiety-producing for preclinical students. METHODS The case involved a 23-year-old female presenting with lower abdominal/pelvic pain. Students performed the necessary history, physical examination, cervical sampling, and transvaginal ultrasound evaluation to make the diagnosis of pelvic inflammatory disease (PID) complicated by a tubo-ovarian abscess. The 30-minute simulated patient encounter was followed by a 30-40 minute faculty-led debrief. RESULTS This simulation case has been sustained in the curriculum since 2011 for 65 students per year. Through use of a faculty critical action checklist, debrief discussion, examination performance, and student evaluation feedback, this simulation has demonstrated effectiveness. Of students, 93 of 193 students (48%) who participated in the simulation case from 2018-2020 completed a survey in which they rated the degree of agreement with statements about the simulation based on a 5-point Likert Scale (1 = strongly disagree, 5 = strongly agree). All questions had a mean response of 4.5-4.8 in 2018-2020, demonstrating the consistent agreement by students of the clarity, fidelity, and knowledge-enhancing value of the simulation. DISCUSSION This simulation provided a useful opportunity and a safe environment for preclinical medical students to acquire knowledge and skills necessary to evaluate a female patient with pelvic pain and PID.
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Affiliation(s)
- Jennifer Pearson
- Assistant Professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth
- Corresponding author:
| | - Amy Greminger
- Assistant Professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth
| | - Emily Onello
- Assistant Professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth
| | - Sandy Stover
- Assistant Professor, Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth
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Al Asmri MA, Ennis J, Stone RJ, Bello F, Haque MS, Parle J. Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:414-421. [DOI: 10.1136/bmjstel-2020-000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/18/2020] [Indexed: 11/03/2022]
Abstract
BackgroundDigital rectal examination (DRE) is a challenging examination to learn.ObjectiveTo synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.Study selectionEMBASE, Medline, CINAHL, Cochrane, Web of Knowledge (Science and Social Science), Scopus and IEEE Xplore were searched; the last search was performed on 3 April 2019. Included were original research studies evaluating TES to teach DRE. Data were abstracted on methodological quality, participants, instructional design and outcomes; a descriptive synthesis was performed. Quality was assessed using a modified Medical Education Research Study Quality Instrument. The study design domain was modified by scoring the papers based on (1) evaluation of risk of bias for randomised controlled trials, (2) description of participants and (3) assessment of robustness and degree of simulation fidelity of the assessments used to evaluate learning.Findings863 articles were screened; 12 were eligible, enrolling 1507 prequalified medical/clinical students and 20 qualified doctors. For skill acquisition, role player was statistically significantly superior to a static manikin (2 studies). For knowledge acquisition, manikin use was significantly superior to role player (1 study); 2 studies showed no difference. For confidence, manikin use was significantly superior to no manikin (4 studies). For comfort, manikin use was significantly superior to no manikin (2 studies). For anxiety, role player was significantly superior to manikin (1 study).Median overall quality score (QS) was 48% (27–62). Highest median QS was 73% (33–80) for data analysis; lowest median QS was 20% (7–40) for the validity of instrument. Six papers scored over 50% of the maximum score for overall quality.ConclusionsTES training is associated with improved DRE skills and should be used more widely.
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Sabet F, Zoghoul S, Alahmad M, Al Qudah H. The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:98. [PMID: 32234037 PMCID: PMC7110726 DOI: 10.1186/s12909-020-02002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex. METHODS A cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students' perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students' confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis. RESULTS One hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student's clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13-3.79) and as high as 3.06 (1.53-6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27-0.88) for cardiovascular and 0.39 (0.21-0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04-0.28) and vaginal examinations 0.22 (0.02-1.98) and more male students conducting prostate examinations OR 11.00 (1.39-87.03) and male genitalia examinations OR 16.31 (3.75-70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all. CONCLUSIONS In our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching. TRIAL REGISTRATION Non interventional thus not required.
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Affiliation(s)
- Farnaz Sabet
- Formerly at Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohaib Zoghoul
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Murad Alahmad
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba Al Qudah
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Abstract
We live in an era of increased societal awareness of sexual harassment and frequent reporting by patients of inappropriate conduct. In this article, we reflect on traditional teaching of physical examination involving full exposure and intimate examinations, and whether this is still necessary, or appropriate, in clinical practice today. We discuss the balance between appropriate physical examination and inappropriate patient exposure resulting in perceived or actual harassment. We argue that ethical values and societal values change with time, and there is an onus on medical educators to reflect societal sensitivities in their teaching.
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Affiliation(s)
| | - Louis Koizia
- Imperial College Healthcare NHS Trust, London, UK
| | - Melanie Dani
- Imperial College Healthcare NHS Trust, London, UK
| | - Michael Fertleman
- Cutrale Perioperative and Ageing Research Group, Imperial College London, London, UK
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Woods JL, Hensel DJ. Improving Male Genital Examinations in Adolescent Patients: Creation and Preliminary Validation of an Assessment Tool. MEDICAL SCIENCE EDUCATOR 2019; 29:977-986. [PMID: 34457574 PMCID: PMC8368327 DOI: 10.1007/s40670-019-00785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Providers cite lack of training and knowledge as reasons for omitting male genitourinary (GU) examinations. Also, no standard tools exist for assessment of male GU exams despite instruments for female pelvic exams. The objective of this project was to create and validate a male GU assessment instrument to evaluate trainee skill level. METHODS A first-author created 18-item assessment instrument (addressing preparation, exam, communication) was reviewed by a seven-member expert panel of adolescent medicine providers who reviewed items using a 4-point Likert scale. Adolescent medicine faculty completed the instrument (n = 48) for trainees, and differences in assessments were analyzed utilizing chi-square (SPSS, v. 24.0 p < .05). Exempt status was granted by the Institutional Review Board. RESULTS Nineteen trainees (13 female, 6 male) completed the instrument; no significant differences existed in assessments by gender. Trainees who completed the assessment > 2 times inspected the glans/meatus (p = .045), palpated the inguinal canals (p = .02), and informed of exam steps (p = .04) well compared to their first assessment. There were differences between provider assessments washing hands (p = .001); inspecting pubic hair (p = .000), glans (p = .001), and penis shaft (p = .002); palpating inguinal canals (p = .000); explaining exam steps (p = .000); being professional (p = .000); and explaining exam findings (p = .000). Excluding the creator, only professionalism was rated differently among providers (p = .023). CONCLUSIONS The male genital exam assessment tool was preliminarily validated as highly relevant to the male GU exam, was not affected by learner gender, and showed learner improvement over time. There are differences between faculty, indicating individual perception of exam items and need for increased discussion before implementing the assessment instrument into practice.
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Affiliation(s)
- Jennifer L. Woods
- Section of Adolescent Medicine, University of Colorado/Children’s Hospital Colorado, Aurora, CO USA
| | - Devon J. Hensel
- Division of Adolescent Medicine and Department of Sociology, Indiana University School of Medicine, 107 S Indiana Ave, Indianapolis, IN 47405 USA
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Mishori R, Ferdowsian H, Naimer K, Volpellier M, McHale T. The little tissue that couldn't - dispelling myths about the Hymen's role in determining sexual history and assault. Reprod Health 2019; 16:74. [PMID: 31159818 PMCID: PMC6547601 DOI: 10.1186/s12978-019-0731-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/02/2019] [Indexed: 11/10/2022] Open
Abstract
Conclusions about women's and girls' sexual history are made in some settings based on assumptions about the hymen, a small membranous tissue with no known biological function, which typically occupies a portion of the external vaginal opening in females. Clinicians, however, continue to refer to changes in the hymen to assess for a history of consensual or nonconsensual sexual intercourse. We reviewed published evidence to dispel commonly held myths about the hymen and its morphology, function, and use as evidence in cases of sexual violence.An examination of the hymen is not an accurate or reliable test of a previous history of sexual activity, including sexual assault. Clinicians tasked with performing forensic sexual assault examinations should avoid descriptions such as "intact hymen" or "broken hymen" in all cases, and describe specific findings using international standards and terminology of morphological features.We call on clinicians to consider the low predictive value of a hymen examination and to: 1) avoid relying solely on the status of the hymen in sexual assault examinations and reporting; 2) help raise awareness of this issue among their peers and counterparts in law enforcement and the judicial system; and 3) promote fact-based discussions about the limitations of hymenal examinations as part of clinical education for all specialties that address the sexual or reproductive health of women and girls.
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Affiliation(s)
- Ranit Mishori
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC, USA.
| | - Hope Ferdowsian
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Karen Naimer
- Physicians for Human Rights, Program on Sexual Violence in Conflict Zones, Boston, MA, USA
| | - Muriel Volpellier
- Sexual Assault Referral Centre, The Havens Paddington, Kings College Hospital NHS Trust, London, UK
| | - Thomas McHale
- Physicians for Human Rights, Program on Sexual Violence in Conflict Zones, Boston, MA, USA
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Tseng FY, Chang YT, Yu CJ, Chang SC. Advanced physical examination training course improves medical students' confidence in physical examination. J Formos Med Assoc 2019; 118:1416-1422. [PMID: 30612884 DOI: 10.1016/j.jfma.2018.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Physical examination (PE) is a basic diagnostic tool in clinical settings. It is important to enhance medical students' skills and confidence in PE. SUBJECTS AND METHODS Our medical students begin learning PE in the fourth medical year (M4). They undergo hands-on clinical training in the fifth medical year (M5). To improve the teaching of PE, we implemented an advanced PE training course (APETC) for M5 students. In APETC, PE skills for chest (CH), cardiovascular system (CV), and abdomen (GI) domains were demonstrated by senior specialists. Under tutors' supervision, students performed PE on selected patients with positive signs. To evaluate the effect of this training course, we designed a checklist to evaluate students' confidence level in PE before and after APETC. Average confidence scores of PE in CH, CV, and GI domains among different years and genders were compared using ANOVA tests. RESULTS M5 students' confidence in PE for individual items on the CH, CV, and GI checklists increased significantly after the APETC, in both 2014 and 2015 (all p < 0.0001).The average post-course confidence scores of all items in CH, CV, and GI domains increased significantly over average pre-course confidence scores. The average post-course confidence score in PE was higher in the year 2015 than that in the year 2014. Male students tended to have higher confidence scores in PE than female students. CONCLUSION APETC enhanced medical students' confidence in PE. Long-term effects of the training course and the impact of students' gender on learning outcomes remain to be investigated.
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Affiliation(s)
- Fen-Yu Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Chang
- Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taipei, Taiwan.
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Kumar A, Kent F, Wallace EM, McLelland G, Bentley D, Koutsoukos A, Nestel D. Interprofessional education and practice guide No. 9: Sustaining interprofessional simulation using change management principles. J Interprof Care 2018; 32:771-778. [DOI: 10.1080/13561820.2018.1511525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Arunaz Kumar
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - Fiona Kent
- Faculty of Allied Health, Monash University, Melbourne, Australia
| | - Euan M. Wallace
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - Gayle McLelland
- School of Nursing of Midwifery, Monash University, Melbourne, Australia
| | - Deirdre Bentley
- Faculty of Medicine, Monash University, Melbourne, Australia
| | | | - Debra Nestel
- School of Rural Health, Monash University, Melbourne, Australia
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Panebianco N, Shofer F, O'Conor K, Wihbey T, Mulugeta L, Baston CM, Suzuki E, Alghamdi A, Dean A. Emergency Department Patient Perceptions of Transvaginal Ultrasound for Complications of First-Trimester Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1965-1975. [PMID: 29380893 DOI: 10.1002/jum.14546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/10/2017] [Accepted: 11/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Emergency department (ED) transvaginal ultrasound (US) is underused in clinical practice. This study assessed pregnant women's perceptions of ED transvaginal US in terms of pain, embarrassment, anxiety, and willingness to receive the procedure. Secondary variables include physicians' perceptions of patients' experiences. METHODS Women undergoing US examinations for complications of first-trimester pregnancy were prospectively surveyed before any US and after ED and/or radiology transvaginal US. Patients' and physicians' assessments of pain, embarrassment, and anxiety were measured with visual analog scales (0-100). RESULTS A total of 398 women were enrolled. In the pre-US survey, the median anxiety score was 14 (interquartile range, 3-51), and 96% of patients were willing to have an ED transvaginal US if necessary. Of those who had ED transvaginal US, 96% would agree to have another examination. Patients reported minimal pain/embarrassment, and there was no difference if performed in the ED versus radiology (median pain, 11.5 versus 13; P = .433; median embarrassment, 7 versus 4; P = .345). Of the 48 who had both ED and radiology transvaginal US, 85% thought the ED transvaginal US was worthwhile. Physicians accurately assessed patient's embarrassment and pain (mean differences, 3.5 and -1.9, respectively; P > .25 for both); however, they overestimated them relative to the pelvic examination (mean difference for embarrassment, 12.8; P < .0001; pain, 8.0; P = .01). CONCLUSIONS Pregnant ED patients report low levels of anxiety, pain, and embarrassment, and after ED transvaginal US, 96% would agree to have the examination again. There is no difference in pain/embarrassment between ED and radiology transvaginal US. Emergency department physicians accurately assessed patients' pain and embarrassment with ED transvaginal US but overestimated them compared to the pelvic examination.
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Affiliation(s)
- Nova Panebianco
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Frances Shofer
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Katie O'Conor
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Tristan Wihbey
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Lakeisha Mulugeta
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Cameron M Baston
- the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Evan Suzuki
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Adel Alghamdi
- Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Anthony Dean
- Department of Emergency Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
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19
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Parikh T, Czuzak M, Bui N, Wildner C, Koch B, Leko E, Rappaport W, Adhikari S, Gordon P, Gura M, Ellis S. Novel Use of Ultrasound to Teach Reproductive System Physical Examination Skills and Pelvic Anatomy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:709-715. [PMID: 28960370 DOI: 10.1002/jum.14408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To determine whether integration of ultrasound (US) into a reproductive system examination clinical skills lab can increase confidence in palpating key reproductive structures during testicular and bimanual pelvic examinations, reduce anxiety about conducting testicular and bimanual pelvic examinations, and improve performance on multiple-choice questions based on structure identification using US images. METHODS Second-year medical students enrolled in the Life Cycle preclinical course participated in this cross-sectional study. A single learning activity was developed to pair the teaching of the reproductive system physical examination with the use of US in the clinical skills lab. The evaluation of the teaching session consisted of a pre-post analysis of student self-reported knowledge, confidence, and anxiety. RESULTS The response rate for the pre survey was 82% (n = 96), and the rate for the post survey was 79% (n = 93). Students' confidence in their ability to identify reproductive system structures on US images increased from pre to post survey. Their confidence in their ability to palpate the epididymis, uterus, and ovary during a physical examination improved, and their anxiety about conducting testicular and bimanual pelvic examinations decreased. Student satisfaction with the session was high. Students' performance on multiple-choice questions based on structure identification using US images was at 96% or higher. CONCLUSIONS Our study findings support the integration of US into a reproductive system examination clinical skills lab. Medical students acquire competency and confidence in reproductive system physical examination skills with US integration.
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Affiliation(s)
- Tejal Parikh
- Departments of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
| | - Maria Czuzak
- Departments of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
| | - Naomi Bui
- Office of Curricular Affairs, University of Arizona School of Medicine, Tucson, Arizona, USA
| | - Corinna Wildner
- Arizona Center for Rural Health, University of Arizona, Tucson, Arizona, USA
| | - Bryna Koch
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA
| | - Elizabeth Leko
- Departments of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
| | - William Rappaport
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Srikar Adhikari
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Paul Gordon
- Departments of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
| | - Mike Gura
- Arizona Center for Rural Health, University of Arizona, Tucson, Arizona, USA
| | - Susan Ellis
- Arizona Center for Rural Health, University of Arizona, Tucson, Arizona, USA
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20
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Eltayeb YH, Salih AJM, Atkins DB. Low fidelity custom-made inguinoscrotal model: educational and a social indication. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017; 3:124-125. [DOI: 10.1136/bmjstel-2016-000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/04/2022]
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21
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Mau EE, Leonard MP. Practical approach to evaluating testicular status in infants and children. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:432-435. [PMID: 28615391 PMCID: PMC5471079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To review the differences between normal, retractile, ectopic, ascended, and undescended testes and to describe the optimal way to perform a testicular examination to distinguish one from the other, as well as to demonstrate that ultrasound imaging is not necessary and to clarify when to consider specialist referral. SOURCES OF INFORMATION This paper is based on selected findings from a MEDLINE search on undescended testes and orchiopexy referrals, and on our experience at the Urology Clinic at the Children's Hospital of Eastern Ontario in Ottawa, including review of referrals to our clinic for undescended testes and the resultant findings of normal variants versus surgical cases. The MeSH headings used in our MEDLINE search included undescended testicle, retractile testicle, ectopic testicle, ascended testicle, referral and consultation, and orchiopexy. MAIN MESSAGE An undescended testis is defined as the true absence of one testis (or both testes) from normal scrotal position. Ectopic and ascended testes will likewise be absent from the scrotum, the latter having been present at one point in development. Differentiating among testicular examination findings is important, as descended and retractile testes are managed conservatively, while prompt surgical intervention should be offered for ascended, ectopic, and undescended testes. Uncertainty surrounding the diagnosis of an undescended testis causes anxiety, might lead to unwarranted imaging, and might increase the wait list for specialty assessment. For this reason, avoidance of ultrasound in the evaluation of undescended testes was included in the recent Choosing Wisely Canada campaign. We seek to clarify the physical examination findings in the evaluation of possible undescended testes, the suggested referral parameters, and the subsequent management. CONCLUSION Undescended testes and their variants are common. As decision for referral is based on the primary care physician's physical examination findings, we clarify distinguishing between normal and abnormal findings on testicular examination to aid in appropriate referral for subspecialist evaluation. Consultation, if needed, should be sought at 6 months' corrected gestational age, or at detection if later than 6 months, without delay for ultrasound imaging, as surgical management is recommended for those patients with undescended, ectopic, or ascended testes.
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Affiliation(s)
- Elke E Mau
- Clinical Assistant Professor in Pediatric Urology at the Royal University Hospital in Saskatoon, Sask.
| | - Michael P Leonard
- Professor of Surgery in Pediatric Urology at the Children's Hospital of Eastern Ontario in Ottawa
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Kailavasan M, Abdul-Rahman A, Hanchanale V, Rajpal S, Rogawski K, Palit V, Myatt A, Jain S, Biyani CS. The Validation of the Clinical Male Pelvic Trainer Mk 2-Advanced Models for Scrotal Examination Simulation. JOURNAL OF SURGICAL EDUCATION 2017; 74:423-430. [PMID: 27825660 DOI: 10.1016/j.jsurg.2016.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/24/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To validate the use of a novel physical model, the "Clinical Male Pelvic Trainer (CMPT) Mk 2-Advanced," for scrotal examination simulation and evaluate its use for surgical education. MATERIALS AND METHODS A total of 7 CMPT Mk 2-Advanced scrotal models were used for teaching: normal, varicocele, testicular tumor, epididymal cyst, hydrocele, epididymo-orchitis, and indirect inguinoscrotal hernia. At 4 surgical courses in the West Yorkshire Foundation Deanery, UK, between 2015 and 2016, trainees were asked to assess their clinical experience, confidence levels in diagnosing scrotal pathology and simulation properties of the scrotal models on a 5-point Likert Scale. Expert responses were used to validate these findings. RESULTS In total, 65 trainees and 12 experts (including 3 senior residents) participated in the study (n = 77). There was a positive-tailed distribution in responses from experts for realistic simulation of scrotal contents and pathology; only 1.5% and 14.4% of all responses by experts were scored as a "1" (strongly disagree) or "2" (disagree). The intraclass coefficient (κ) was 0.86 among experts. No significant differences between experts and trainees in assessment of simulation were observed. Following use of the models, there was a significant increase in confidence scores matched by trainee (p < 0.001). Approximately 92.9% and 100% of trainees and experts were in favor of using the models for assessment and future training respectively. CONCLUSIONS Our study demonstrates that the CMPT MK 2-Advanced models have high "face validity" and may be a valuable tool for surgical education. The use of these models should be explored for use in the curriculum at medical school.
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Affiliation(s)
- Mithun Kailavasan
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - Ahmad Abdul-Rahman
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
| | - Vishwanath Hanchanale
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Sanjay Rajpal
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Karol Rogawski
- Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | - Victor Palit
- North Tees and Hartlepool NHS Trust, Stockton-on-Tees, United Kingdom
| | - Andy Myatt
- Hull & East Yorkshire NHS Trust, Hull, United Kingdom
| | - Sunjay Jain
- St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, United Kingdom
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Dugoff L, Pradhan A, Casey P, Dalrymple JL, Abbott JF, Buery-Joyner SD, Chuang A, Cullimore AJ, Forstein DA, Hampton BS, Kaczmarczyk JM, Katz NT, Nuthalapaty FS, Page-Ramsey SM, Wolf A, Hueppchen NA. Pelvic and breast examination skills curricula in United States medical schools: a survey of obstetrics and gynecology clerkship directors. BMC MEDICAL EDUCATION 2016; 16:314. [PMID: 27986086 PMCID: PMC5162080 DOI: 10.1186/s12909-016-0835-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 12/01/2016] [Indexed: 05/07/2023]
Abstract
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.
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Affiliation(s)
- Lorraine Dugoff
- University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, 2 Silverstein Building, Philadelphia, PA 19104 USA
| | - Archana Pradhan
- Department of Obstetrics and Gynecology, Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Petra Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN USA
| | - John L. Dalrymple
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Jodi F. Abbott
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Needham, MA USA
| | - Samantha D. Buery-Joyner
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine Inova Campus, Falls-Church, VA USA
| | - Alice Chuang
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | - Amie J. Cullimore
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON Canada
| | - David A. Forstein
- Department of Obstetrics and Gynecology, Greenville Health System University Medical Center, Greenville, SC USA
| | - Brittany S. Hampton
- Department of Obstetrics and Gynecology, Brown Alpert Medical School, Providence, RI USA
| | - Joseph M. Kaczmarczyk
- Department of Obstetrics and Gynecology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA USA
| | - Nadine T. Katz
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Francis S. Nuthalapaty
- Department of Obstetrics and Gynecology, Greenville Health System University Medical Center, Greenville, SC USA
| | - Sarah M. Page-Ramsey
- Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX USA
| | - Abigail Wolf
- Department of Obstetrics and Gynecology, Jefferson Medical College, Philadelphia, PA USA
| | - Nancy A. Hueppchen
- Department of Obstetrics and Gynecology, Johns Hopkins Medical Institutions, Baltimore, MD USA
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McBain L, Pullon S, Garrett S, Hoare K. Genital examination training: assessing the effectiveness of an integrated female and male teaching programme. BMC MEDICAL EDUCATION 2016; 16:299. [PMID: 27876033 PMCID: PMC5120523 DOI: 10.1186/s12909-016-0822-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Learning to undertake intimate female and male examinations is an important part of medical student training but opportunities to participate in practical, supervised learning in a safe environment can be limited. A collaborative, integrated training programme to provide such learning was developed by two university teaching departments and a specialist sexual health service, utilising teaching associates trained for intimate examinations in a simulated clinical educational setting. The objective of this research was to determine changes in senior medical students' self- reported experience and confidence in performing male and female genital examinations, before and after participating in a new clinical teaching programme. METHODS A quasi-experimental mixed methods design, using pre and post programme questionnaires and focus groups, was used to assess the effectiveness of the programme. RESULTS The students reported greatly improved skill, confidence and comfort levels for both male and female genital examination following the teaching programme. Skill, confidence and comfort regarding male examinations were rated particularly low on the pre-teaching programme self- assessment, but post-programme was rated at similar levels to the female examination. CONCLUSIONS This integrated female-male teaching programme (utilising trained teaching associates as simulated patients in a supervised clinical teaching environment) was successful in increasing senior medical students' skills and levels of confidence in performing genital examinations. There were differences between female and male medical students in their learning. Suggestions for improvement included providing more detailed instruction to some clinical supervisors about their facilitation role in the session.
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Affiliation(s)
- Lynn McBain
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington, Wellington South 6242 New Zealand
| | - Susan Pullon
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington, Wellington South 6242 New Zealand
| | - Sue Garrett
- Department of Primary Health Care & General Practice, University of Otago, PO Box 7343, Wellington, Wellington South 6242 New Zealand
| | - Kath Hoare
- Education Unit, Dean’s Department, University of Otago, Wellington, New Zealand
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Abdulghani HM, Haque S, Irshad M, Al-Zahrani N, Al-Bedaie E, Al-Fahad L, Al-Eid M, Al-Mohaimeed A. Students' perception and experience of intimate area examination and sexual history taking during undergraduate clinical skills training: A study from two Saudi medical colleges. Medicine (Baltimore) 2016; 95:e4400. [PMID: 27472734 PMCID: PMC5265871 DOI: 10.1097/md.0000000000004400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study explores the experiences of Saudi undergraduate medical students about intimate-area examination (IAE) and sexual history taking (SHT) skills and assesses the barriers and their impacts on students' learning. This survey-based study was performed at 2 Saudi university medical colleges and revealed that most of the students never performed IAE, that is, female breast, male genital, female genital, female pelvic, male rectal, and female rectal. We found that 42.3% students had never taken any sexual history during their course. Both, male and female students reported barriers of patient refusal, mismatched sex, cultural background, ethical factors, lack of supervision, lack of training, and lack of skills. Among the currently used pedagogical techniques, majority of the students were satisfied with real patient-based learning, followed by video and manikin-based learning. The study indicates that Saudi students do not have sufficient experience of IAE and SHT because of above-mentioned barriers along with religious issues. This study suggests that teachers provide positive support to students and that they develop novel, competent teaching-and-learning techniques to meet the skills training of students without compromising on religious, sociocultural, and ethical values of the kingdom.
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Affiliation(s)
- Hamza Mohammad Abdulghani
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
- Correspondence: Hamza M. Abdulghani, Professor & Consultant Family Physician, Head, Assessment & Evaluation Centre, Department of Medical Education, College of Medicine, King Saud University, PO Box: 230155, Riyadh 11321, Saudi Arabia (e-mail: ; )
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan
| | - Mohammad Irshad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Noor Al-Zahrani
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Eman Al-Bedaie
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Latifah Al-Fahad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Manar Al-Eid
- Department of Medical Education, College of Medicine, King Saud University, Riyadh
| | - Abdulrahman Al-Mohaimeed
- Department of Family & Community Medicine, College of Medicine, Qassim University, Qassim, Saudi Arabia
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