O330 GYNAECOLOGY TRAINING ASSOCIATES(GTAS): THE FUTURE IN THE TRAINING OF FINAL YEAR MEDICAL STUDENTS?

A cross-sectional study on teaching pelvic examination in medical schools in the UK (the COTES study)

Gynaecological teaching associates (GTAs) appear to be effective in aiding medical students to acquire core skills in female pelvic examination (FPE). The aim was to explore the current provision for teaching and assessment of FPE in Obstetric and Gynaecological (O&G) placements across UK medical schools and in particular, the use of GTAs. An online survey was sent to undergraduate academic leads for O&G, representing 29 of the 30 UK medical schools. The response rate was 21/29 (72%). The average placement was 6.7 weeks and teaching of FPE varied including training on manikins (20/21, 95%), instruction in outpatient clinics (17/21, 81%) and instruction on anaesthetised patients (17/21, 81%). The survey revealed that anatomic pelvic models are combined with supervised instruction in outpatient clinics and operating theatres. GTAs are used by less than a third of medical schools, and where used are thought to enhance teaching in this core skill in contrast to those universities not using GTAs. Short placements, a reluctance to use GTAs and a lack of formal assessment may adversely impact upon the competency of newly qualifying medical students in FPE. Impact statement What is already known on this subject: Experience of female pelvic examination intimate is limited. Expert patients, known as Gynaecological Teaching Associates (GTAs), have been suggested as a potential solution to improve teaching of gynaecological examination, but the last survey of medical schools in the United Kingdom (UK) conducted in 1989 reported that only two were using GTAs in an average clinical placement length of 11.5 weeks. What the results of this study add: Twenty-five years after the last survey, Obstetrics and Gynaecology (O&G) clinical placements have been reduced to an average of 6 weeks with one-third requiring only an informal impression of competence in female pelvic examination. Despite published evidence since 1989 supporting the effectiveness of GTAs, just six medical schools are using GTAs for teaching and assessment with all believing them to be effective. What the implications are of these findings for clinical practice and/or further research: A combination of short placements, an apparent reluctance to use GTAs and a lack of uniform formal assessment may mean that the competency of newly qualifying medical students in basic gynaecological examination is compromised.

Medical students' experiences learning intimate physical examination skills: a qualitative study

BACKGROUND

Intimate physical examination skills are essential skills for any medical graduate to have mastered to an appropriate level for the safety of his or her future patients. Medical schools are entrusted with the complex task of teaching and assessing these skills for their students. The objectives of this study were to explore a range of medical students' experiences of learning intimate physical examination skills and to explore their perceptions of factors which impede or promote the learning of these skills.

METHODS

Individual semi-structured interviews (N = 16) were conducted with medical students in years two to five from the University of Newcastle, as part of a larger research project investigating how medical students develop their attitudes to gender and health. This was a self-selected sample of the entire cohort who were all invited to participate. A thematic analysis of the transcribed data was performed.

RESULTS

Students reported differing levels of discomfort with their learning experiences in the area of intimate physical examination and differing beliefs about the helpfulness of these experiences. The factors associated with levels of discomfort and the helpfulness of the experience for learning were: satisfaction with teaching techniques, dealing with an uncomfortable situation and perceived individual characteristics in both the patients and the students. The examination causing the greatest reported discomfort was the female pelvic examination by male students.

CONCLUSIONS

Student discomfort with the experience of learning intimate physical examination skills may be common and has ongoing repercussions for students and patients. Recommendations are made of ways to modify teaching technique to more closely match students' perceived needs.