Undergraduate obstetrics and gynaecology in the United Kingdom and the Republic of Ireland, 1989

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.

Postgraduate obstetrics and gynaecology experience: The role for early exposure

BACKGROUND

The early postgraduate years provide the opportunity for junior doctors to gain a range of experience and determine their focused areas of interest. Internship thus requires experience in medicine, surgery and the emergency department. Obstetrics and gynaecology (O & G) is not offered as an internship rotation, despite its suitability as such. A cross-sectional analysis of junior doctors was performed to assess residents' views on the suitability of an O & G rotation for career decision-making and for achieving sufficient clinical experience.

METHODS

Fifty-two resident medical staff in their second postgraduate year were recruited and each was given an anonymous survey for completion. Visual analogue scales (VAS) were used for participant responses.

RESULTS

For whether internship without an O & G rotation provides sufficient experience to include or exclude O & G as a career choice, the average participant response was 2.1 (on a VAS out of 10) (P<0.0001). For whether an O & G internship rotation would provide adequate medical, surgical or emergency department experience, the average response was 7.9 (on the VAS out of 10) (P<0.0001). As to whether participants would have preferred to undergo an O & G rotation during internship, the average response was 7.7 (P<0.0001).

CONCLUSION

The present study demonstrated a perception by residents that an O & G rotation during internship would achieve adequate clinical competencies and assist in career decision-making in O & G, with residents preferring to have undergone an O & G rotation during internship.

Can gynaecology teaching associates provide high quality effective training for medical students in the United Kingdom? Comparative study

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.

Pelvic manikins as learning aids

The use of pelvic trainers in undergraduate teaching was evaluated, using a questionnaire based on examination findings of a series of four pelvic trainers by 20 medical students and 34 gynaecologists. The main outcome measures were the ability to correctly identify pelvic findings in the trainers, and the numbers of false positive findings. There were two adnexal masses in two of the trainers. One was correctly identified by 33 (14 (70%) medical students and 19 (56%) doctors) in one trainer, whereas the other was missed by 52 of 54 examiners. Prolapse was missed by 41 of 54. The normal pelvis was correctly identified by 30 (16 (80%) medical students and 20 (59%) doctors. There were 15 false positive identifications of adnexal masses (6 by medical students and 9 by doctors) and 22 false positive identification of uterine enlargements (5 by medical students and 17 by doctors). The pelvic trainers were of value in demonstrating the process of pelvic and speculum examination. Some of the clinical conditions emulated were missed by most of the gynaecologists, suggesting that they were not suitable for training students in abnormal findings. Although the figures were not statistically significant, there was a trend for qualified doctors rather than medical students to make false positive findings.

Obstetric and neonatal competence of medical students

During 1991-1992 a confidential questionnaire was administered to a sample of United Kingdom medical students to determine if undergraduate education improved students' perceived competence at eight practical procedures. Of 2521 students given questionnaires, 1483 (58.8%) replied; 948 (65.5%) had had some obstetric and 866 (60.8%) some neonatal education. Such education did improve students' perceived competence (P < 0.001) on self-assessed Likert scales, but most still believe themselves not to be competent when they have completed their obstetric and neonatal education. Regression models were able to explain much (38.7-65.1%) of the variability in perceived competence at obstetric procedures: obstetric education, performing practical procedures, and witnessing deliveries in a general practitioner unit were all associated with higher competence; but less (4.8-20.8%) of the variability in perceived neonatal competence. It is suggested that undergraduate experience should be congruent with the aims and objectives of obstetric and neonatal education, and that these need to be reviewed in the light of the recent General Medical Council proposed changes to medical education.