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Kelly K, Wilder L, Bastin J, Lane-Cordova A, Cai B, Cook J. Utility of Gynecological Teaching Associates. Cureus 2023; 15:e40601. [PMID: 37469809 PMCID: PMC10353857 DOI: 10.7759/cureus.40601] [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: 06/18/2023] [Indexed: 07/21/2023] Open
Abstract
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.
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Affiliation(s)
- Katherine Kelly
- Department of Obstetrics and Gynecology, Prisma Health Richland Hospital, Columbia, USA
| | - Lauren Wilder
- Department of Obstetrics and Gynecology, Prisma Health Richland Hospital, Columbia, USA
| | - Jessica Bastin
- Department of Obstetrics and Gynecology, Prisma Health Richland Hospital, Columbia, USA
| | - Abbi Lane-Cordova
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - James Cook
- Department of Obstetrics and Gynecology, Prisma Health Richland Hospital, Columbia, USA
- Department of Medical Education and Academic Affairs, School of Medicine, University of South Carolina, Columbia, USA
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Kiesel M, Beyers I, Kalisz A, Wöckel A, Quenzer A, Schlaiß T, Wulff C, Diessner J. Evaluating the value of a 3D printed model for hands-on training of gynecological pelvic examination. 3D Print Med 2022; 8:20. [PMID: 35793005 PMCID: PMC9261074 DOI: 10.1186/s41205-022-00149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Simulation in the field of gynecological pelvic examination with educational purposes holds great potential. In the current manuscript we evaluate a 3D printed model of the female pelvis, which improves practical teaching of the gynecological pelvic examination for medical staff. Methods We evaluated the benefit of a 3D printed model of the female pelvis (Pelvisio®) as part of a seminar (“skills training”) for teaching gynecological examination to medical students. Each student was randomly assigned to Group A or B by picking a ticket from a box. Group A underwent the skills training without the 3D printed model. Group B experienced the same seminar with integration of the model. Both groups evaluated the seminar by answering five questions on Likert scales (1–10, 1 = “very little” or “very poor”, 10 equals “very much” or “very good”). Additionally, both groups answered three multiple-choice questions concerning pelvic anatomy (Question 6 to 8). Finally, Group B evaluated the 3D printed model with ten questions (Question 9 to 18, Likert scales, 1–10). Results Two of five questions concerning the students’ satisfaction with the seminar and their gained knowledge showed statistically significant better ratings in Group B (6.7 vs. 8.2 points and 8.1 vs. 8.9 points (p < 0.001 and p < 0.009). The other three questions showed no statistically significant differences between the traditional teaching setting vs. the 3D printed model (p < 0.411, p < 0.344 and p < 0.215, respectively). The overall mean score of Question 1 to 5 showed 8.4 points for Group B and 7.8 points for Group A (p < 0.001). All three multiple-choice questions, asking about female pelvic anatomy, were answered more often correctly by Group B (p < 0.001, p < 0.008 and p < 0.001, respectively). The mean score from the answers to Questions 9 to 18, only answered by Group B, showed a mean of 8.6 points, indicating, that the students approved of the model. Conclusion The presented 3D printed model Pelvisio® improves the education of female pelvic anatomy and examination for medical students. Hence, training this pivotal examination can be supported by a custom designed anatomical model tailored for interactive and explorative learning.
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Affiliation(s)
- Matthias Kiesel
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany.
| | - Inga Beyers
- Institute of Electric Power Systems (IfES), Leibniz Universität Hannover, Appelstraße 9A, 30167, Hannover, Germany
| | - Adam Kalisz
- Department of Electrical, Electronic and Communication Engineering, Information Technology (LIKE), Friedrich-Alexander-Universität Erlangen-Nürnberg, Am Wolfsmantel 33, Erlangen, Germany
| | - Achim Wöckel
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Anne Quenzer
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Tanja Schlaiß
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Christine Wulff
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
| | - Joachim Diessner
- University Hospital Würzburg department of Gynecology, Josef-Schneider-Str. 4, 97080, Würzburg, Germany
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A 3D printed model of the female pelvis for practical education of gynecological pelvic examination. 3D Print Med 2022; 8:13. [PMID: 35511353 PMCID: PMC9069962 DOI: 10.1186/s41205-022-00139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pelvic palpation is a core component of every Gynecologic examination. It requires vigorous training, which is difficult due to its intimate nature, leading to a need of simulation. Up until now, there are mainly models available for mere palpation which do not offer adequate visualization of the concerning anatomical structures. In this study we present a 3D printed model of the female pelvis. It can improve both the practical teaching of gynecological pelvic examination for health care professionals and the spatial understanding of the relevant anatomy. Methods We developed a virtual, simplified model showing selected parts of the female pelvis. 3D printing was used to create a physical model. Results The life-size 3D printed model has the ability of being physically assembled step by step by its users. Consequently, it improves teaching especially when combining it with commercial phantoms, which are built solely for palpation training. This is achieved by correlating haptic and visual sensations with the resulting feedback received. Conclusion The presented 3D printed model of the female pelvis can be of aid for visualizing and teaching pelvic anatomy and examination to medical staff. 3D printing provides the possibility of creating, multiplying, adapting and sharing such data worldwide with little investment of resources. Thus, an important contribution to the international medical community can be made for training this challenging examination.
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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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Kirubarajan A, Li X, Got T, Yau M, Sobel M. Improving Medical Student Comfort and Competence in Performing Gynecological Exams: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1353-1365. [PMID: 33883396 DOI: 10.1097/acm.0000000000004128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Abirami Kirubarajan
- A. Kirubarajan is a fourth-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Xinglin Li
- X. Li is a fourth-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Got
- T. Got is a fourth-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Yau
- M. Yau is a third-year medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mara Sobel
- M. Sobel is assistant professor, Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Qureshi AA, Zehra T. Simulated patient's feedback to improve communication skills of clerkship students. BMC MEDICAL EDUCATION 2020; 20:15. [PMID: 31941466 PMCID: PMC6964074 DOI: 10.1186/s12909-019-1914-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/19/2019] [Indexed: 05/29/2023]
Abstract
BACKGROUND The changing trends of the society and revisions to medical education have changed the way medical students are trained to adroitly care for patients hence, patient centered care has become need of today's society and communication skills are imperative in developing patient physician relationship. Increasingly, simulations are being used to aid medical students to incorporate theoretical knowledge into practice. There are innumerable studies regarding communication skills in terms of reliability, validity and feasibility but no such study has been documented using simulated patient's feedback in improving communication skills in Pakistan. The aim of this study is to explore whether simulated patients' feedback improves the communication skills of undergraduate medical students. METHODS During a randomized control trail a group of eighty students in the final year clerkship at Al-Nafees Medical College have participated in pre-post Objective Structured Clinical Exam (OSCE) on communication skills. The students were selected through convenience sampling technique. Four Objective Structured Clinical Exam (OSCE) stations based on different scenarios of communication skills were developed. Each station of fifteen minutes duration was assessed by both simulated patients and faculty using a validated tool LCSAS (Liverpool Communication Skills Assessment Scale). The difference between the pre and post-tests of two groups was explored by applying independent t-test. Cronbach's alpha was used to check the reliability of scores and effect size was calculated. RESULTS Results of this study have showed that there is significant improvement in communication skills after receiving feedback from simulated patients (p value ≤0.05) was observed. An overall Cronbach α = 0.83 on LCSAS reveal a high internal consistency and there was adequate demonstration of effect size(r = 0.8). CONCLUSION The results on the scores of the students on the Liverpool Communication Skills Assessment Scale confirm that simulated patient's feedback is essential to enhance the communication skills of the medical students. This study offers significant evidence towards successful conduction of a formal communication skills development initiative at Al-Nafees Medical College using simulated patient feedback during teaching and assessments.
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Affiliation(s)
- Ayesha Aleem Qureshi
- Department of Health Professions Education, Al-Nafees Medical College & Hospital, Isra University, Islamabad Campus, Islamabad, Pakistan
| | - Tabassum Zehra
- Department of Educational Development, Aga Khan Medical College, Aga Khan University, Karachi, Pakistan
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Janjua A, Smith P, Chu J, Raut N, Malick S, Gallos I, Singh R, Irani S, Gupta JK, Parle J, Clark TJ. The effectiveness of gynaecology teaching associates in teaching pelvic examination to medical students: a randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 2016; 210:58-63. [PMID: 27940395 DOI: 10.1016/j.ejogrb.2016.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/30/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Aisha Janjua
- Birmingham Heartlands Hospital, Bordesley Green, Birmingham B9 5SS, United Kingdom
| | - P Smith
- Birmingham Women's Hospital, Mindelsohn Way, Birmingham B15 2TG, United Kingdom
| | - J Chu
- Birmingham Women's Hospital, Mindelsohn Way, Birmingham B15 2TG, United Kingdom
| | - N Raut
- University Hospitals of North Midlands, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - S Malick
- Corniche Hospital, Corniche Road, Abu Dhabi, United Arab Emirates
| | - I Gallos
- Birmingham Women's Hospital, Mindelsohn Way, Birmingham B15 2TG, United Kingdom
| | - R Singh
- Birmingham Women's Hospital, Mindelsohn Way, Birmingham B15 2TG, United Kingdom
| | - S Irani
- Birmingham Heartlands Hospital, Bordesley Green, Birmingham B9 5SS, United Kingdom
| | - J K Gupta
- Birmingham Women's Hospital, Mindelsohn Way, Birmingham B15 2TG, United Kingdom; University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - J Parle
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - T J Clark
- Birmingham Women's Hospital, Mindelsohn Way, Birmingham B15 2TG, United Kingdom; University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
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Sörensdotter R, Siwe K. Touching the private parts: how gender and sexuality norms affect medical students' first pelvic examination. CULTURE, HEALTH & SEXUALITY 2016; 18:1295-1308. [PMID: 27250511 DOI: 10.1080/13691058.2016.1182214] [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] [Indexed: 06/05/2023]
Abstract
Gynaecologists are in a position to challenge norms about gender and sexuality in relation to female genitals. Through their work they have the opportunity to educate patients, which is why teaching medical students to perform examinations in a gender sensitive way is significant. Medical students performing their first pelvic examination often experience the examination as uncomfortable because it is a body part that is connected to sex and to something private. This paper uses medical students' interpretations of performing their first pelvic examination as a means to discuss how cultural norms for gender, sexuality and female genitals affect these examinations. Issues raised include how cultural connotations of female genitals affect the pelvic examination, how female and male students relate differently to examining female genitals and the interpretations they make in relation to themselves. Findings show that the female genitals are perceived as a special body part connected to sexuality and intimacy. Students' gender also affects the interpretations they make during pelvic examinations. Norms of gender, sexuality and female genitals need to be challenged in the teaching and performance of pelvic examination in order to demystify this experience.
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Affiliation(s)
| | - Karin Siwe
- b Faculty of Health Sciences, Department of Obstetrics and Gynaecology and Department of Experimental Medicine , Linköping University , Linköping , Sweden
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Siwe K, Wijma K. Validation of the Fear of Pelvic Examination Scale (F-PEXS)--measuring students' fear of performing a pelvic examination. J Psychosom Obstet Gynaecol 2015; 36:23-8. [PMID: 25541215 DOI: 10.3109/0167482x.2014.994500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Karin Siwe
- Department of Obstetrics and Gynecology and
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Smith PP, Choudhury S, Clark TJ. The effectiveness of gynaecological teaching associates in teaching pelvic examination: a systematic review and meta-analysis. MEDICAL EDUCATION 2015; 49:1197-1206. [PMID: 26611185 DOI: 10.1111/medu.12816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/12/2015] [Accepted: 06/16/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT An increasing number of graduating students are unable to competently and confidently perform a pelvic examination. Gynaecology teaching associates (GTAs) teach technical and communication skills and offer immediate feedback. The objective was to perform a systematic literature review to assess whether teaching pelvic examinations using real women who are trained to give instructions on technique and feedback improves the competence, confidence and communication skills of trainees when compared with traditional teaching methods. METHODS MEDLINE, EMBASE, the Cochrane Library, CINAHL and the ISRCTN Register of Clinical Trials were searched using selected terminology. No language restrictions were applied. The selection criteria were randomised clinical trials (RCTs) and controlled studies that investigated the use of GTAs to teach students or health-related professionals the pelvic examination. Data evaluating study outcomes, along with methodological details, were extracted in duplicate. The outcomes measured were: self-reported confidence, assessed competence and assessed communication skills. The standard mean difference (SMD) was derived for each study where possible and heterogeneity across studies was quantified using the I(2) statistic. In the presence of substantial variation, the data were pooled using a random effects model. RESULTS Eleven studies with 856 participants were included: five RCTs and six observational studies. GTA training improved competence compared with other teaching methods and the finding of enhanced competence was consistent when the pooled analysis was restricted to RCTs. Communication skills were also improved with GTA teaching, but to a lesser degree, whereas no effect on student confidence was observed. Statistical heterogeneity was present for all outcomes when data were pooled. CONCLUSION Our findings suggest that GTA-based teaching of pelvic examination is associated with improvement in the competence and communication skills of trainees. However, further larger-scale studies with standardised relevant educational outcomes are needed to confirm these findings.
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Affiliation(s)
- Paul P Smith
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Shelina Choudhury
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - T Justin Clark
- Birmingham Women's Hospital, School of Clinical and Experimental Medicine, Birmingham, UK
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Dilaveri CA, Szostek JH, Wang AT, Cook DA. Simulation training for breast and pelvic physical examination: a systematic review and meta-analysis. BJOG 2013; 120:1171-82. [PMID: 23750657 DOI: 10.1111/1471-0528.12289] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Breast and pelvic examinations are challenging intimate examinations. Technology-based simulation may help to overcome these challenges. OBJECTIVE To synthesise the evidence regarding the effectiveness of technology-based simulation training for breast and pelvic examination. SEARCH STRATEGY Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, and key journals and review articles; the date of the last search was January 2012. SELECTION CRITERIA Original research studies evaluating technology-enhanced simulation of breast and pelvic examination to teach learners, compared with no intervention or with other educational activities. DATA COLLECTION AND ANALYSIS The reviewers evaluated study eligibility and abstracted data on methodological quality, learners, instructional design, and outcomes, and used random-effects models to pool weighted effect sizes. MAIN RESULTS In total, 11 272 articles were identified for screening, and 22 studies were eligible, enrolling 2036 trainees. In eight studies comparing simulation for breast examination training with no intervention, simulation was associated with a significant improvement in skill, with a pooled effect size of 0.86 (95% CI 0.52-1.19; P < 0.001). Four studies comparing simulation training for pelvic examination with no intervention had a large and significant benefit, with a pooled effect size of 1.18 (95% CI 0.40-1.96; P = 0.003). Among breast examination simulation studies, dynamic models providing feedback were associated with improved outcomes. In pelvic examination simulation studies, the addition of a standardised patient to the simulation model and the use of an electronic model with enhanced feedback improved outcomes. AUTHOR'S CONCLUSIONS In comparison with no intervention, breast and pelvic examination simulation training is associated with moderate to large effects for skills outcomes. Enhanced feedback appears to improve learning.
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Affiliation(s)
- C A Dilaveri
- General Internal Medicine, Mayo Clinic School of Graduate Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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Pelvic examination skills training with genital teaching associates and a pelvic simulator: does sequence matter? Simul Healthc 2012; 7:95-101. [PMID: 22333882 DOI: 10.1097/sih.0b013e31823b9e46] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Siwe K, Berterö C, Wijma B. Unexpected enlightening of a "female world". Male medical students' experiences of learning and performing the first pelvic examination. SEXUAL & REPRODUCTIVE HEALTHCARE 2012; 3:123-7. [PMID: 22980738 DOI: 10.1016/j.srhc.2012.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 07/09/2012] [Accepted: 07/13/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To gain a deeper understanding of how undergraduate male medical students experience a pelvic examination learning concept and performing the first pelvic examination (PE) on a professional patient. STUDY DESIGN A qualitative study. In-depth interviews with 12 male medical students' after their involvement in a learning session about the PE, with professional patients and a supervising gynecologist as instructors. The interviews were analyzed according to the constant comparative method, a variety of content analysis, to acquire a deeper understanding of the students' experiences and the ongoing social processes. RESULTS The essence of the entire analysis was "Unexpected enlightening of a 'female world'" and was identified from the three categories; "Not just any exam", "Professional supportive interaction" and "Humble awareness". The male students' most prominent concern was how to establish a professional rapport with the patient in the PE situation. Beneficial active support from the professional patient and the gynecologist assisted the students to overcome inherent barriers and facilitated the examination procedure. The informants gained "inside information" from the patients' perspective of being examined leading to a new awareness about an earlier unknown "female world" that is what women might go through before and during a PE and an humble understanding of how vulnerable it is to be placed in the examination position. CONCLUSION The beneficial PE learning concept promoted an unexpected insight in what a woman might experience during a PE, creating a humble awareness of this vulnerable intimate situation and ideas for how to establish professional rapport.
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Affiliation(s)
- Karin Siwe
- Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
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14
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Abstract
Patient instructors are patients trained to teach students in focussed history taking and/or examination in the context of the patient's specific illness. Their espousal has been quite extensively reported in rheumatology. The majority of studies show that patient instructors are effective in enhancing the knowledge and skills relevant to practice concerned with patients with the given conditions (in this case, typically rheumatoid arthritis and osteoarthritis). Most studies show patient instructors to be as effective as clinicians in this respect. They are especially effective at enhancing students' understanding of the impact of living with a chronic condition. With appropriate (quite extensive) training, they can also assess the examination skills of students, both undergraduate and postgraduate. Students value them, and the patient instructors themselves derive benefit from the activity. There are issues to be aware of regarding the adoption of patient instructors. The training required is significant. If employed as described in the literature, quite significant selection criteria come into play. In some cases, patient instructors feel under-rewarded financially; they should not be seen as medical education on the cheap. Nonetheless, patient instructors represent an excellent, relatively under-utilised, resource for the aiding of student learning in many areas of medicine.
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Affiliation(s)
- Andrew Hassell
- School of Medicine, Keele University, and Haywood Hospital, Keele, Staffs, UK.
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Pugh CM, Iannitelli KB, Rooney D, Salud L. Use of mannequin-based simulation to decrease student anxiety prior to interacting with male teaching associates. TEACHING AND LEARNING IN MEDICINE 2012; 24:122-7. [PMID: 22490092 DOI: 10.1080/10401334.2012.664534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Previous studies have compared the usefulness of teaching associates versus mannequin trainers for learning physical exam skills. Little work has been done to assess the usefulness of mannequin trainers prior to students' interaction with teaching associates. PURPOSE We studied the effects of mannequin-based simulators on student comfort levels toward learning the male genitourinary examination. METHODS First-year medical students (N = 346) were surveyed before and after a mannequin-based curriculum to assess their comfort levels toward learning the male genitourinary examination. RESULTS The mannequin-based curriculum significantly increased (p < .001) student comfort levels toward the male genitourinary exam. However, the pre-post improvements were small, and on average students only progressed from being "very uncomfortable" to "somewhat comfortable." The intimate nature of the examination was the top cause of anxiety toward learning the male genitourinary exam. Students were least comfortable with the digital rectal examination at the beginning of class. CONCLUSIONS We suggest that mannequin-based simulators be used prior to students' experience with male teaching associates when learning the male genitourinary exam.
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Affiliation(s)
- Carla M Pugh
- Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA.
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Oswald AE, Bell MJ, Wiseman J, Snell L. The impact of trained patient educators on musculoskeletal clinical skills attainment in pre-clerkship medical students. BMC MEDICAL EDUCATION 2011; 11:65. [PMID: 21939562 PMCID: PMC3190339 DOI: 10.1186/1472-6920-11-65] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 09/23/2011] [Indexed: 05/15/2023]
Abstract
BACKGROUND Despite the high burden of musculoskeletal (MSK) diseases, few generalists are comfortable teaching MSK physical examination (PE) skills. Patient Partners® in Arthritis (PP®IA) is a standardized patient educator program that could potentially supplement current MSK PE teaching. This study aims to determine if differences exist in MSK PE skills between non-MSK specialist physician and PP®IA taught students. METHODS Pre-clerkship medical students attended 2-hour small group MSK PE teaching by either non-MSK specialist physician tutors or by PP®IA. All students underwent an MSK OSCE and completed retrospective pre-post questionnaires regarding comfort with MSK PE and interest in MSK. RESULTS 83 students completed the OSCE (42 PP®IA, 41 physician taught) and 82 completed the questionnaire (42 PP®IA, 40 physician taught). There were no significant differences between groups in OSCE scores. For all questionnaire items, post-session ratings were significantly higher than pre-session ratings for both groups. In exploratory analysis PP®IA students showed significantly greater improvement in 12 of 22 questions including three of five patient-centred learning questions. CONCLUSIONS PP®IA MSK PE teaching is as good as non-MSK specialist physician tutor teaching when measured by a five station OSCE and provide an excellent complementary resource to address current deficits in MSK PE teaching.
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Affiliation(s)
- Anna E Oswald
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Mary J Bell
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jeffrey Wiseman
- Centre for Medical Education and Department of Medicine, McGill University, Montreal, Canada
| | - Linda Snell
- Centre for Medical Education and Department of Medicine, McGill University, Montreal, Canada
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Allen SS, Miller J, Ratner E, Santilli J. The educational and financial impact of using patient educators to teach introductory physical exam skills. MEDICAL TEACHER 2011; 33:911-918. [PMID: 21592023 DOI: 10.3109/0142159x.2011.558139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Physical exam skills are essential to core competencies for physicians in training. It is increasingly difficult to secure time and funding for physician faculty to teach these critical skills. This study was designed to determine whether Patient Educators (PE) (non-physician instructors) in an introductory clinical medicine (ICM) course (1) were as effective as physician faculty in teaching the physical exam, (2) impacted consistency of student performance on a final practical exam, and (3) whether this model was cost effective. METHOD PE were introduced into an ICM course at the University of Minnesota from 2006 to 2008. Each year, students' physical exam competencies were evaluated by a performance-based head-to-toe examination and 6 months later by an objective structured clinical examination (OSCE). Differences in test scores between years and variability (i.e., consistency) among yearly scores were assessed. The cost per student was calculated by considering a stable compensation cost per hour for the required number of physician faculty, standardized patients, and PE in each year. RESULTS Mean student performance was statistically lower with PE, but only by two percentage points. The amount of variation within the medical student classes' physical exam skills remained stable as the use of PE expanded. Total educator salary costs per student declined from $449 in 2006 to $196 in 2008. CONCLUSIONS In terms of sustainability and student performance, the use of trained lay educators has equivalent outcomes and is less costly for physical exam instruction in the pre-clinical years.
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Affiliation(s)
- Sharon S Allen
- Department of Family Medicine, University of Minnesota Medical School, USA.
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Pradhan A, Ebert G, Brug P, Swee D, Ananth CV. Evaluating pelvic examination training: does faculty involvement make a difference? A randomized controlled trial. TEACHING AND LEARNING IN MEDICINE 2010; 22:293-7. [PMID: 20936577 DOI: 10.1080/10401334.2010.512831] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
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.
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Affiliation(s)
- Archana Pradhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA.
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Jha V, Setna Z, Al-Hity A, Quinton ND, Roberts TE. Patient involvement in teaching and assessing intimate examination skills: a systematic review. MEDICAL EDUCATION 2010; 44:347-357. [PMID: 20444070 DOI: 10.1111/j.1365-2923.2009.03608.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
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.
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Affiliation(s)
- Vikram Jha
- Department of Medical Education Unit, Leeds Institute of Medical Education, University of Leeds, Leeds, UK.
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Pugh CM, Obadina ET, Aidoo KA. Fear of causing harm: use of mannequin-based simulation to decrease student anxiety prior to interacting with female teaching associates. TEACHING AND LEARNING IN MEDICINE 2009; 21:116-120. [PMID: 19330689 DOI: 10.1080/10401330902791099] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND There is a paucity of research assessing the potential benefits of mannequin trainers when preparing students to interact with teaching associates. PURPOSE The goal of this study was to better understand the effects of mannequin-based simulators on student comfort toward learning specific aspects of the clinical female pelvic exam. METHODS First-year medical students (N = 344) were surveyed before and after a mannequin-based simulation curriculum to assess their comfort levels toward learning the female pelvic exam. RESULTS Causing harm was the top cause of student anxiety toward learning the pelvic exam. Although the mannequin-based simulation curriculum was effective in significantly increasing (p < .001) student comfort levels toward learning the pelvic exam, the majority of students progressed from being "very uncomfortable" with the exam to being "somewhat comfortable." CONCLUSION We suggest that mannequin-based simulators be used prior to students' learning experience with pelvic exam teaching associates.
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Affiliation(s)
- Carla M Pugh
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 201 East Huron Street, Chicago, IL 60611-2908, USA.
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Bokken L, Linssen T, Scherpbier A, van der Vleuten C, Rethans JJ. Feedback by simulated patients in undergraduate medical education: a systematic review of the literature. MEDICAL EDUCATION 2009; 43:202-10. [PMID: 19250346 DOI: 10.1111/j.1365-2923.2008.03268.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Although the importance of feedback by simulated patients (SPs) is generally recognised, knowledge is scarce about the most effective ways in which SPs can provide feedback. In addition, little is known about how SPs are trained to provide feedback. This study aimed to provide a systematic overview of the ways in which SPs provide feedback to undergraduate medical students, the domains in which SPs provide feedback and the ways in which SPs are trained to provide feedback. METHODS We performed a systematic search of the literature using PubMed, PsychINFO and ERIC and searched for additional papers cited in reference lists. Papers were selected on the basis of pre-established inclusion and exclusion criteria and were classified, using a pre-established form, according to three aspects of SP feedback: training in giving feedback; the process of delivering feedback, and the domain(s) in which feedback is given. RESULTS A total of 49 studies were included and described in detail on the basis of the three aspects of SP feedback described above. The ways in which SPs were trained to give feedback were largely heterogeneous, as were the processes by which feedback was provided by SPs. Only a few studies described feedback processes that were in accordance with general recommendations for the delivery of effective feedback. Although feedback from the patient's perspective is generally recommended, most SPs provided feedback on clinical skills and communication skills. DISCUSSION There appear to be no clear standards with regard to effective feedback training for SPs. Furthermore, the processes by which feedback is provided by SPs and the selection of domain(s) in which SPs give feedback often seem to lack a solid scientific basis. Suggestions for further research are provided.
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Affiliation(s)
- Lonneke Bokken
- Department of Educational Development and Research, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands.
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Strengths and weaknesses of simulated and real patients in the teaching of skills to medical students: a review. Simul Healthc 2009; 3:161-9. [PMID: 19088660 DOI: 10.1097/sih.0b013e318182fc56] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this review was to identify the strengths and weaknesses of the roles of real and simulated patients in undergraduate medical education. The literature was reviewed in relation to four patient roles: real patients as educational "resource" (passive role), real patients as teachers (active role), and simulated patients as educational resource and teachers. Each of the four patient roles was found to have specific advantages and disadvantages from the perspectives of teachers, students, and patients. For example, advantages of real patients as educational resource were patient-centered learning and high patient satisfaction. Disadvantages were their limited availability and the variability in learning experiences among students. Despite the considerable amount of literature we found, many gaps in knowledge about patient roles in medical education remain and should be addressed by future studies.
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Barley GE, Fisher J, Dwinnell B, White K. Teaching foundational physical examination skills: study results comparing lay teaching associates and physician instructors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:S95-7. [PMID: 17001147 DOI: 10.1097/00001888-200610001-00024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND The purpose of this pilot study was to determine differences in the physical exam skills of first-year medical students learning physical exam exclusively from standardized physical examination teaching associates (SPETAs) or physician faculty. METHOD In all, 144 first-year medical students were randomized to receive SPETA or physician-led physical examination instruction. Students participated in an OSCE assessment immediately following the end of the curriculum block. RESULTS SPETA-trained students performed equivalently to physician faculty trained students across all stations with a mean of 82.9% versus 81.2% (p = .226). Students taught by SPETAs performed significantly better on the abdominal OSCE with a mean score of 88.8%, while physician faculty taught students had a mean score of 85.4% (p = .03). CONCLUSION Findings from this study suggest that SPETAs can effectively teach foundational physical examination skills to medical students at a similar and sometimes better performance level as physician faculty.
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Affiliation(s)
- Gwyn E Barley
- Center for Advancing Professional Excellence, University of Colorado at Denver and Health Sciences Center, School of Medicine, P.O. Box 6508, Mail Stop F495, Aurora, CO 80045, USA.
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Pickard S, Baraitser P, Rymer J, Piper J. Can gynaecology teaching associates provide high quality effective training for medical students in the United Kingdom? Comparative study. BMJ 2003; 327:1389-92. [PMID: 14670887 PMCID: PMC292994 DOI: 10.1136/bmj.327.7428.1389] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To train laywomen to become professional patients in order to teach medical students speculum and bimanual examination, to assess their effectiveness in this role, and to incorporate this method of teaching into the undergraduate curriculum of a medical school in the United Kingdom. DESIGN Comparative study. SETTING Guy's, King's, and St Thomas's School of Medicine, London. PARTICIPANTS 44 medical students trained by gynaecology teaching associates; 48 control students. MAIN OUTCOME MEASURE Skills in pelvic examination. RESULTS Six laywomen were recruited and all successfully graduated to become gynaecology teaching associates. At assessment 1, in the third week of the reproductive and sexual health block, the mean score achieved by students trained by gynaecology teaching associates was 155, compared with 104 for control group students (difference in mean scores 51 (95% confidence interval 41 to 61), P < 0.001). Similar results were obtained at assessment 2, at the end of the attachment-the mean score for trained students was 148, compared with a mean score of 114 for control group students (difference in mean scores 34 (21 to 46), P < 0.001). CONCLUSIONS Laywomen can be trained to teach pelvic examination to medical students in the United Kingdom. Students who receive this training have better skills than students who receive the traditional training alone.
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Affiliation(s)
- Sally Pickard
- Department of Reproductive Health Care, Lewisham Primary Care Trust, London, SE5 7RN.
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25
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Herbers JE, Wessel L, El-Bayoumi J, Hassan SN, St Onge JE. Pelvic examination training for interns: a randomized controlled trial. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2003; 78:1164-1169. [PMID: 14604881 DOI: 10.1097/00001888-200311000-00019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE To evaluate the effectiveness of pelvic examination training for internal medicine interns conducted by instructors who also serve as models for the examination. METHOD In 2001, 80 interns from three university internal medicine residencies completed questionnaires about their experiences with pelvic examinations. Interns who were available for training underwent baseline assessment of their pelvic examination skills and were randomized to training or to a control group that received only educational literature. Skills were assessed with a 29-item checklist at baseline and at follow-up by evaluators blinded to group assignment, and interrater agreement was estimated by review of audiotapes. RESULTS Seventy-two interns were randomized and underwent baseline skills assessment. Seventy interns returned for follow-up assessment after approximately 14 weeks (range, 10-17 weeks). The 39 interns randomized to training and 33 randomized to the control group did not differ with respect to age, gender, or prior pelvic examination training. In both groups there was substantial variability in skills at baseline, with graduates of U.S. medical schools scoring significantly higher than did graduates of non-U.S. medical schools (0.66 versus 0.41, p < 10(-5)). Interns randomized to training had significantly higher scores at follow-up than did interns in the control group (0.79 versus 0.57, p < 10(-6)). For seven items verifiable by audiotape, interrater agreement was good (overall kappa, 0.54; range among items, 0.3-0.85). CONCLUSION Specialized trainers can reliably evaluate and improve the pelvic examination skills of interns, and improvements are demonstrable three months after training. Further research is needed to ascertain whether training efficiency can be improved and to measure the impact of training on patient satisfaction and clinical outcomes.
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Pugh CM, Youngblood P. Development and validation of assessment measures for a newly developed physical examination simulator. J Am Med Inform Assoc 2002; 9:448-60. [PMID: 12223497 PMCID: PMC346632 DOI: 10.1197/jamia.m1107] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Define, extract and evaluate potential performance indicators from computer-generated data collected during simulated clinical female pelvic examinations. DESIGN Qualitative and quantitative study analyzing computer generated simulator data and written clinical assessments collected from medical students who performed physical examinations on three clinically different pelvic simulators. SETTING Introduction to patient care course at a major United States medical school. PARTICIPANTS Seventy-three pre-clinical medical students performed 219 simulated pelvic examinations and generated 219 written clinical assessments. MEASUREMENTS Cronbach's alpha for the newly defined performance indicators, Pearson's correlation of performance indicators with scored written clinical assessments of simulator findings. RESULTS Four novel performance indicators were defined: time to perform a complete examination, number of critical areas touched during the exam, the maximum pressure used, and the frequency at which these areas were touched. The reliability coefficients (alpha) were time = 0.7240, critical areas = 0.6329, maximum pressure = 0.7701, and frequency = 0.5011. Of the four indicators, three correlated positively and significantly with the written clinical assessment scores: critical areas, p < 0.01; frequency, p < 0.05; and maximum pressure, p < 0.05. CONCLUSION This study demonstrates a novel method of analyzing raw numerical data generated from a newly developed patient simulator; deriving performance indicators from computer generated simulator data; and assessing validity of those indicators by comparing them with written assessment scores. Results show the new assessment measures provide an objective, reliable, and valid method of assessing students' physical examination techniques on the pelvic exam simulator.
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Affiliation(s)
- Carla M Pugh
- Stanford University School of Medicine, Stanford, California 94305-5466, USA.
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Pickard S, Baraitser P, Herns M, Massil H. Fitting contraceptive diaphragms: can laywomen provide quality training for doctors? JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2001; 27:131-4. [PMID: 12457492 DOI: 10.1783/147118901101195524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To test the feasibility of training laywomen as professional patients to teach doctors to fit the contraceptive diaphragm. DESIGN Semi-structured interviews with instructing doctors and questionnaires to DFFP trainees. These documented current teaching practice and the acceptability of professional patients. The Delphi technique was used to establish a curriculum for the professional patients' training programme. RESULTS The results show that there is currently a lack of standardisation in teaching methods and content with respect to diaphragm fitting. All instructing doctors and DFFP trainees involved had experienced difficulties in recruiting women for training, and the majority would be happy to work with professional patients. After three rounds of the Delphi procedure, consensus was reached and a curriculum developed. Five women were recruited on to a training programme, and four successfully completed it. CONCLUSION Lack of standardisation and difficulty recruiting patients are current problems when training doctors to fit diaphragms. Our study shows that the use of professional patients would be acceptable to both DFFP trainees and instructing doctors, and that it is possible to recruit and train women for this purpose.
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Affiliation(s)
- S Pickard
- Department of Reproductive Health, Community Health South London NHS Trust, St Giles Road, London SE5 7RN, UK
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Cain JM. Undergraduate and graduate education in women's health care: reconsidering faculty, setting, and content. Womens Health Issues 1993; 3:104-9. [PMID: 8374306 DOI: 10.1016/s1049-3867(05)80195-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The concept of women's health care redefines departmental boundaries and requires expansion of scholarship styles in faculty. Whatever discipline we come from, the setting for patient care and education must allow the staff and patient the experience of another framework for medical care. The curriculum must synthesize knowledge from different departments and disciplines. Problem-based learning and professional patient models can expand on the clinical experience to enhance the educational process.
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Affiliation(s)
- J M Cain
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle
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Mayo-Smith MF, Gordon V, Gillie E, Brett A. Teaching physical diagnosis in the nursing home: a prospective, controlled trial. J Am Geriatr Soc 1991; 39:1085-8. [PMID: 1753046 DOI: 10.1111/j.1532-5415.1991.tb02873.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE To investigate the suitability of the nursing home as a site for teaching physical diagnosis to second-year medical students. DESIGN Prospective comparison of teaching sessions in the nursing home to concurrent control sessions in acute care wards. SETTING Nursing Home Care Unit (NHCU) and acute care hospital wards of a Veterans Affairs Medical Center. PATIENTS Sessions with 38 NHCU patients and 68 hospital patients. MEASUREMENTS AND MAIN RESULTS Patient interviews and student questionnaires were used to obtain responses on a 1-10 scale (1 = poor, 10 = excellent). Patient responses were very favorable in both settings for overall quality of experience (mean score NHCU vs control: 8.8 vs 8.6) and willingness to participate again (8.4 vs 8.2). Student ratings showed no significant differences for patient attitude (7.4 vs 8.4) or quality of exam (7.2 vs 7.7) while quality of history (6.0 vs 7.6) and overall quality of session (7.6 vs 8.6) were rated higher (P less than 0.05) for the control sessions. Students rated both environments highly (8.6 vs 8.4) but reported that fewer NHCU sessions were interrupted (15% vs 25%) or disrupted by noise (6% vs 30%, P less than 0.005). CONCLUSIONS Advantages of the nursing home include readily available patients who view participation favorably, instructive physical findings, and a suitable environment. However, students rate the quality of the histories obtained there lower. This problem could be addressed by more careful patient selection and greater emphasis by course instructors on other goals of the history in addition to exploring the chief complaint.
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Beckmann CR, Sharf BF, Barzansky BM, Spellacy WN. Student response to gynecologic teaching associates. Am J Obstet Gynecol 1986; 155:301-6. [PMID: 3740146 DOI: 10.1016/0002-9378(86)90814-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Gynecologic teaching associates teach the communication and psychomotor skills for breast and pelvic examinations in most medical schools in the United States and Canada. Evaluations of these gynecologic teaching associate programs have included faculty impressions of program effectiveness and measurement of student retention of skills but not student evaluations of the effectiveness and value of such programs. At the University of Illinois at Chicago students evaluated their gynecologic teaching associate program. High ratings were given to program organization and content; the knowledge, ability, and professionalism of the teaching associates; and the outcomes of the sessions with respect to the learning skills needed to perform the examinations. Students emphasized the importance of the ability of the teaching associates to provide immediate informative feedback and to reduce anxiety during the teaching sessions. Students tended to view their ability to perform breast examination to be greater than for the pelvic examinations but felt they learned more about both in the sessions. This information supports the value of the gynecologic teaching associate model in medical education.
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Beckmann CR, Spellacy WN, Yonke A, Barzansky B, Cunningham RP. Initial instruction in the pelvic examination in the United States and Canada, 1983. Am J Obstet Gynecol 1985; 151:58-60. [PMID: 3966506 DOI: 10.1016/0002-9378(85)90424-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Initial instruction in the pelvic examination in the United States and Canada was reviewed by questionnaire. Seventy-two percent of the 116 responding medical schools taught this material in the second year, two-thirds with a specific course devoted to the subject. Ninety-three percent used "live models" or "teaching associates" in place of, or in addition to, traditional methods such as the examination of clinic patients. The use of teaching associates was uniformly rated as an extremely effective educational method. A continued trend toward use of an educational methodology that emphasizes communication as well as psychomotor skill instruction is identified.
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Olson BK. Patient comfort during pelvic examination. New foot supports vs metal stirrups. JOGN NURSING; JOURNAL OF OBSTETRIC, GYNECOLOGIC, AND NEONATAL NURSING 1981; 10:104-7. [PMID: 6907498 DOI: 10.1111/j.1552-6909.1981.tb00842.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
One hundred women patients at a midwestern university health center were randomly assigned to a control or experimental group to measure statistically comfort levels of new foot supports vs. traditional metal stirrups during pelvic examinations. Written comments were also obtained. Analyses using the t test demonstrated a significant positive change in attitude in the experimental group.
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Kent GG, Clarke P, Dalrymple-Smith D. The patient is the expert: a technique for teaching interviewing skills. MEDICAL EDUCATION 1981; 15:38-42. [PMID: 7464588 DOI: 10.1111/j.1365-2923.1981.tb02313.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Aspects of a teaching development intended to encourage patient-centredness in medical interviewing is discussed. Patients are asked by their local general practitioner to volunteer their time in order to be interviewed by medical students and then to stay on afterwards to discuss their impressions of the students' behaviour. It is argued that this approach to teaching interviewing skills enables students to examine the assumptions they make about the patient and to become aware of their difficulties in discussing sensitive issues.
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Aune SL. College women's gynecological health care practices and preferences. JOURNAL OF THE AMERICAN COLLEGE HEALTH ASSOCIATION 1980; 29:149-50. [PMID: 7204779 DOI: 10.1080/01644300.1980.10392989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Anderson KK, Meyer TC. Using instructor-patients to teach physical examination skills. MEDICAL TEACHER 1979; 1:244-251. [PMID: 24483263 DOI: 10.3109/01421597909012613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the last issue of Medical Teacher, Dr Jack Marshall provided an overview of the methods being used to teach students basic clinical skills and to evaluate their performances (Medical Teacher, 1979, 1, 190-194). Here, the authors describe the use of instructor-patients to teach and evaluate physical examination techniques. The main emphasis is on the recruitment, training and performance of these non-physician instructors. It is concluded that the introduction of lay instructors in any phase of the teaching of physical diagnosis leads to great precision in identifying what has to be learned, what are the optimum techniques and what constitutes an acceptable performance.
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Affiliation(s)
- K K Anderson
- Program Coordinator, Instructor-Patient Program, University of Wisconsin School of Medicine, 427 Lorch St, Madison, WI, 53706, USA
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Abstract
The traditional pelvic examination instruction methods were reviewed and found to be deficient: the student learning experience was compromised by the triangular setting of patient, student, and instructor for early pelvic examination instruction. Over the past decade, a new education specialist, the Gynecology Teaching Associate (GTA), has evolved to help improve the initial gynecology teaching experience. The evolution of the GTA is described. The qualities she brings to the instructional system include sensitivity as a woman, educational skill in pelvic examination instruction, knowledge of female pelvic anatomy and physiology, and, most important, sophisticated interpersonal skills to help medical students learnin in a nonthreatening environment. Reinforcement learning theory is the foundation of this educational system. Student acceptance of this system is documented.
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