Female Pelvic Examination Research Articles

Learning of Intimate Area Examination Amongst Pakistani Medical Students: Knowledge, Attitudes, and Practices Study

Background: Intimate area examination (IAE) is an integral part of clinical examination skills and must be mastered by medical students before they start their careers. This study explores the experiences of Pakistani medical students regarding learning of IAE, the associated barriers and their effects on students’ learning. Methods: This cross-sectional study, based on a self-designed questionnaire, was conducted at two Pakistani medical colleges, which included final year students and postgraduate trainees. Results: During their undergraduate training, 74.9% of the respondents had not conducted a female pelvic examination, 51.9% had not examined a female groin, 79.7% had not examined a female rectum, and 72.7% had not examined a male rectum. From the 65 postgraduate doctors, 48.4% reported that they were not prepared to perform an IAE at the start of their clinical career. Regarding barriers to IAE learning, more than half of the respondents felt that the opposite gender of the patient (64.7%) and patient’s refusal (63.1%) had a strong negative effect on IAE learning. A high percentage of respondents reports that they were not taught IAE during their undergraduate years. Among the currently used pedagogical techniques, 71.1% of the respondents opted for real patient-based learning, followed by clinical simulations (21.9%), and videos (7.0%). No one thought examination should be taught theoretically. A significant difference between male and female experience in IAE learning was also observed. Conclusion: Learning of IAE remains unsatisfactory and poses a major challenge for the Pakistani Medical Students in the institutes included in this study.

Deep learning-accelerated T2-weighted imaging versus conventional T2-weighted imaging in the female pelvic cavity: image quality and diagnostic performance.

The deep learning (DL)-based reconstruction algorithm reduces noise in magnetic resonance imaging (MRI), thereby enabling faster MRI acquisition. To compare the image quality and diagnostic performance of conventional turbo spin-echo (TSE) T2-weighted (T2W) imaging with DL-accelerated sagittal T2W imaging in the female pelvic cavity. This study evaluated 149 consecutive female pelvic MRI examinations, including conventional T2W imaging with TSE (acquisition time = 2:59) and DL-accelerated T2W imaging with breath hold (DL-BH) (1:05 [0:14 × 3 breath-holds]) in the sagittal plane. In 294 randomly ordered sagittal T2W images, two radiologists independently assessed image quality (sharpness, subjective noise, artifacts, and overall image quality), made a diagnosis for uterine leiomyomas, and scored diagnostic confidence. For the uterus and piriformis muscle, quantitative imaging analysis was also performed. Wilcoxon signed rank tests were used to compare the two sets of T2W images. In the qualitative analysis, DL-BH showed similar or significantly higher scores for all features than conventional T2W imaging (P <0.05). In the quantitative analysis, the noise in the uterus was lower in DL-BH, but the noise in the muscle was lower in conventional T2W imaging. In the uterus and muscle, the signal-to-noise ratio was significantly lower in DL-BH than in conventional T2W imaging (P <0.001). The diagnostic performance of the two sets of T2W images was not different for uterine leiomyoma. DL-accelerated sagittal T2W imaging obtained with three breath-holds demonstrated superior or comparable image quality to conventional T2W imaging with no significant difference in diagnostic performance for uterine leiomyomas.

Learning of Intimate Area Examination Amongst Pakistani Medical Students: KAP Study

BACKGROUND: Intimate area examination (IAE) is an integral part of clinical examination skills and must be mastered by medical students before they start their careers. This study explores the experiences of Pakistani medical students regarding learning of IAE, the associated barriers and their impacts on students’ learning. METHODS: This cross-sectional study, based on a self-designed questionnaire was conducted at two Pakistani medical colleges which included final year students, and post graduate trainees. RESULTS: During their undergraduate training, 74.9% of the respondents had not conducted a female pelvic examination, 51.9% had not examined a female groin, 79.7% had not examined a female rectum and 72.7% had not examined a male rectum. From the 65 postgraduate doctors, 48.4% reported that they were not prepared to perform an IAE at the start of their clinical career. Regarding barriers to IAE learning more than half of the respondents felt that the opposite gender of the patient (64.7%) and patient’s refusal (63.1%) had a strong negative impact on IAE learning. A high percentage of respondents reported that they were not taught IAE during their undergraduate years. Among the currently used pedagogical techniques, 71.1% of the respondents opted for real patient-based learning, followed by clinical simulations (21.9%), and videos (7.0%). No one thought examination should be taught theoretically. A significant difference between male and female experience in IAE learning was also observed. CONCLUSION: Learning of IAE remains unsatisfactory and poses a major challenge for the Pakistani Medical Students in the institutes included in this study.

2024 Current Procedural Terminology Updates: Female Pelvic Examination

An equity initiative of the Current Procedural Terminology® Editorial Panel includes recognition that female pelvic examinations have a greater practice expense (eg, the cost of providing speculums and chaperones) than evaluation and management (E/M) services that do not include a female pelvic examination. To provide a means of reporting the increased practice expense, new add-on code 99459 (pelvic examination) may be reported for services provided on and after January 1, 2024. This article reviews the appropriate use of code 99459. Reporting in conjunction with a preventive medicine E/M service Reporting in conjunction with a problem-oriented E/M service Utilization instructions Assigned relative value units (RVUs) for 99459

Design, implementation and assessment of a novel, introductory curriculum into female, neurological and urodynamic urology: a 7-year experience of urology simulation bootcamp course.

To present the seven-year experience of a multi-component and interactive module on female, neurological and urodynamic urology (FNUU) training at the UK National Urology Simulation Bootcamp Course (USBC) and demonstrate trainee satisfaction and competency progression. During the week-long USBC, a four-hour module on FNUU was designed which consisted of short interactive presentations with an emphasis on practical stations in urodynamics, intravesical botulinum toxin injection, urethral bulking injection, female pelvic examination and, initially, mid-urethral tapes (subsequently replaced with percutaneous sacral nerve evaluation). The trainee's level of knowledge, operative experience and confidence were assessed pre- and post-course. The practical assessment consisted of preparation and intravesical administration of botulinum toxin, female pelvic examination, urodynamic trace interpretation or mid-urethral tape simulation. Trainee feedback was also collected. Two-hundred sixty-one newly appointed urology trainees participated in the USBC during this period. A high level of satisfaction was constantly reported. The highest rated session was urethral bulking with 72% being very satisfied, followed by Botox and urodynamics. The final assessment showed 70% had achieved level 4 competency in cystoscopy and Botox. Qualitative feedback was also obtained. To our knowledge, this is the first module of its kind, and it shows that it is feasible to develop, implement and evaluate an introductory curriculum into FNUU that is reproducible over a 7-year period with very positive feedback.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Evaluating the value of a 3D printed model for hands-on training of gynecological pelvic examination

BackgroundSimulation 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.MethodsWe 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).ResultsTwo 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.ConclusionThe 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.

The "Carousel": a new simulation model for assessing the female pelvic examination in medical education.

The authors developed a simulator device to teach and improve the comprehension and accuracy of the pelvic examination during obstetric trainee education.

HF01-21 THE FEMALE'S PENIS AND MICHELANGELO'S SURGEON

You have accessJournal of UrologyHistory of Urology Forum I (HF01)1 Sep 2021HF01-21 THE FEMALE'S PENIS AND MICHELANGELO'S SURGEON Reilly Carr, and Michael Moran Reilly CarrReilly Carr More articles by this author , and Michael MoranMichael Moran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001992.21AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The male’s penis has taken so much attention historically that the lowly clitoris of the female has received not enough attention. A more complete historiography reveals that Realdo Columbo, Vesalius’s protégé and eventually Michelangelo’s surgeon would describe and detail the anatomy of the clitoris. This is a history of Columbo's and Michelangelo's collaboration. METHODS: A review of the literature of all aspects of the works and writings of Realdo Columbo and his involvement with Michelangelo were pursued. Any works on the history of female anatomical dissection were also discovered and utilized. RESULTS: Realdo Columbo was Vesalius’s chosen student who assumed his master’s duties while he was away and publishing his magnum opus in Basel. Upon his return the two had an acrimonious fallout and Columbo moved on to Pisa and then Rome. He met and befriended the legendary Michelangelo and planned on collaborating upon a combined anatomy work together. Columbo accomplished over 1,000 autopsies and collected famous men which he wrote up their pathological findings, including Ignatious Loyola. He published his famed textbook De re anatomica posthumously in 1559 where he proclaims, he is the first “discoverer” of the clitoris in females. He called it the amor Veneris or the sublime organ of female pleasure. CONCLUSIONS: Others would follow in the wake of Columbo including the next Professor at Padua Grabriele Fallopio in 1561. Thomas Bartholin would actually use the terms de clitrode and suggested that it might have been mentioned by earlier anatomists such as Albucasis and Rufus of Ephesus might have known of its existence. The famed Parisian Jean Riolan performed more detailed anatomical female pelvic examinations as did Regnier de Graaf and Govard Bidloo in Leiden. Columbo struggled mightily to publish an illustrated anatomy with Michelangelo but failed, like da Vinci before him. But Michelangelo also was unable to complete his anatomical illustrations for a famed anatomist, though Columbo did complete much of his text which was utilized widely, but sadly without the genius of his famed artist collaborator. The lowly clitoris would have had an epic illustration if it had been drawn and printed by Michelangelo and Realdo Columbo, perhaps competing with da Vinci's own copulation figure! Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e236-e236 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Reilly Carr More articles by this author Michael Moran More articles by this author Expand All Advertisement Loading ...

Addressing Anxiety and Fear during the Female Pelvic Examination.

To review the anxiety and fear risk factors, pathophysiology, symptoms, screening and diagnosis while highlighting treatment considerations for women undergoing a pelvic examination.Methods:We reviewed the literature pertaining to anxiety and fear surrounding the pelvic examination to help guide health care providers’ on available screening options and to review options for individualized patient management.Results:Anxiety and fear are common before and during the pelvic examination. In fact, the pelvic exam is one of the most common anxiety-provoking medical procedures. This exam can provoke negative physical and emotional symptoms such as pain, discomfort, anxiety, fear, embarrassment, and irritability. These negative symptoms can interfere with preventative health screening compliance resulting in delayed or avoided care and significant health consequences.Conclusion:Assessing women for anxiety related to pelvic examinations may help decrease a delay or avoidance of examinations. Risk factor and symptom identification is also a key component in this. General anxiety questionnaires can help identify women with anxiety related to pelvic examinations. Strategies to reduce anxiety, fear and pain during a pelvic examination should routinely be implemented, particularly in women with high-risk factors or those identified with screening techniques as having anxiety, fear or pain with examinations. Treatment options should be targeted at understanding the patient’s concerns, starting conversations about pelvic examinations early, educating patient’s about the examination and offering the presence of a chaperone or support person. During an examination providers should ensure the patient is comfortable, negative phrases are avoided, the correct speculum size is utilized and proper lubrication, draping, dressing and positioning are performed. Treating underlying gynecologic or mental health conditions, consideration of cognitive behavioral therapy and complementary techniques such as lavender aromatherapy and music therapy should also be considered when appropriate.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.

International survey finds majority of gynecologists are not aware of and do not utilize ultrasound techniques to diagnose and map endometriosis.

162. Male Genitourinary Exam Assessment: A Tool Validation

Providers often cite lack of training and knowledge as primary reasons for omitting the male genitourinary (GU) examination during routine visits. Therefore, male patients are typically not engaged in their sexual and reproductive health. Also, no standard tools exist for assessment of male genitourinary exams although multiple instruments for female pelvic examinations are readily available. The objective of our study was to create and validate a male GU examination assessment instrument to evaluate resident knowledge and skill level. An original first-author created 18-item assessment instrument was reviewed by a 7-member expert panel of Adolescent Medicine providers with the instruction to review each item based on relevance to the subject matter using a 4-point Likert scale (1=not relevant; 4 highly relevant). The edited tool was subsequently piloted in a learner-based Adolescent Medicine clinic. Adolescent faculty/senior fellows completed the instrument (n=48) for residents and fellows conducting male genitourinary exams; multiple instruments could be completed for each learner. The instrument addressed preparation (washing hands, using gloves), examination steps (e.g. inspecting pubic hair, inspecting and palpating testes, palpating inguinal canals for hernias with Valsalva maneuver), communication/interpersonal skills (e.g. displaying concern for patient’s comfort, avoiding jargon, and explaining exam findings). Differences in exam conduct were analyzed utilizing chi-square (SPSS, v. 24.0 p<.05). Exempt status was granted by the Institutional Review Board. Nineteen residents and fellows (13 female, 6 male) completed the instrument one or more times with six assessing providers. There were no significant assessment differences between male and female learners. Learners who completed the assessment two or more times inspected the glans/meatus (chi-sq[df] = 6.2[2]; p=.045), palpated the inguinal canals (chi-sq[df] = 7.8[2]; p=.02) and informed the steps of the exam (chi-sq[df] = 6.7[2]; p=.04) well compared to first assessment. There were differences between how providers assessed learners on several items: washing hands(chi-sq[df] =, 23[6]; p=.001), inspecting pubic hair (chi-sq[df] = 66.8[12]; p=.000), glans (chi-sq[df] =31.8[12]; p=.001), penis shaft (chi-sq[df] =30.7[12]; p=.002), palpating inguinal canals (chi-sq[df] =39.3[12]; p=.000), explaining exam steps (chi-sq[df] =52.8[12]; p=.000), being professional (chi-sq[df] =48[12]; p=.000), and explaining exam findings (chi-sq[df] =40[12]; p=.000). The assessment creator rated washing hands (chi-sq[df] =5.6[1]; p=.018), inspecting pubic hair (chi-sq[df] =8.6[2]; p=.013) and glans (chi-sq[df] =9.4[2]; p=.009) as done well higher than other providers; palpating inguinal canal (chi-sq[df] = 8.0[2]; p=.018) and explaining exam findings (chi-sq[df] =12.8[2]; p=.002) were rated done well less often. With the assessment creator excluded, only professionalism was rated differently among providers (chi-sq[df] =13[5]; p=.023); inspecting pubic hair (chi-sq[df] =16.9[10]; p=.07), explaining exam steps (chi-sq[df] =17.3[10]; p=.07) were marginally significant. The male GU exam assessment was validated by an expert panel as highly relevant to the exam itself. Assessment is not affected by learner gender and shows learner improvement over time. Differences between providers underline increased discussion and agreement should be established if using the instrument for global learner instruction. Male genital health is a vital component of adolescent care, and a universal screening tool could be essential to improving provider skill and subsequent clinical outcomes for our adolescent patients.

Hydrosalpinx in patients with hysterectomy without salpingo-oophorectomy referred for pelvic magnetic resonance imaging

ObjectiveWomen with ovarian-sparing hysterectomy before 2007 are more likely to have retained Fallopian tube remnants which can become fluid-filled, distended masses, potentially mistaken for a cystic adnexal neoplasm on imaging. Here we assess the prevalence and appearance of hydrosalpinx in women with ovarian-sparing hysterectomy prior to 2007 referred for pelvic MRI. MethodsA total of 3044 consecutive pelvic MRI exams performed over a two-year period (2003–2004) were selected from our radiology database and retrospectively reviewed. Examinations performed on male patients (N = 858), duplicate examinations on the same patient (N = 675) and examinations performed for MR guided biopsy (N = 1) were excluded from the study. From the remaining female pelvic MRI examinations (N = 1510), patients with hysterectomy without oophorectomy were identified. The frequency of hydrosalpinx in this population was then determined visually by two experienced radiologists and kappa analysis was then performed to assess for interobserver agreement. ResultsOf the 3044 pelvic MRI examinations, 1510 were performed on females and 76 (5%) of these women had ovarian-sparing hysterectomy. Of these 76 women, 14 patients (18%) had hydrosalpinx (kappa = 0.8) of which 11 were unilateral and 3 bilateral. A total of 9 of the 14 cases positive for hydrosalpinx in patients with ovarian-sparing hysterectomy were referred to MRI for evaluation of cystic adnexal masses detected on other modalities. ConclusionHydrosalpinx should be considered in the differential diagnosis of cystic adnexal lesions in women with prior hysterectomy and retained ovaries.

Cost-effective analysis of teaching pelvic examination skills using Gynaecology Teaching Associates (GTAs) compared with manikin models (The CEAT Study)

ObjectiveTo determine the cost-effectiveness of Gynaecology Teaching Associate (GTA) teaching versus conventional pelvic model (manikin) teaching of pelvic examination skills for final year medical students within a UK undergraduate obstetrics...

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 statementWhat 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' experience of performing female pelvic examinations: Opportunities and barriers

Teaching and learning female pelvic examination within the undergraduate medical curriculum offers some potential challenges. One such is the extent to which students are provided practice opportunities with patients in the clinical setting. To quantify how many pelvic examinations, on real patients, have been performed by medical students at the point of graduation, and to explore opportunities and barriers to performing these examinations. A retrospective study using a self-completed, anonymous, electronic survey was developed as part of a multi-centre study. Data were collected in the immediate period after graduation from the medical programs at the University of Auckland and Flinders University in 2013. An ordinal set of range categories was used for recording numbers of examinations. The combined response rate for the survey was 42.9% (134/312). The median range category for the number of pelvic examinations performed in patients who were not in labour was 6-9 and in labour was 2-3. Thirty-three percent of medical students had never performed a pelvic examination in labour. Male medical students performed significantly fewer pelvic examinations compared with female students. Self-reported barriers to performing the pelvic exam include: gender of the student, 'gate-keeping' by other health professionals, lack of confidence and patient factors. The majority of medical students have performed several pelvic examinations on real patients at graduation. Male gender and access being limited by midwives were the main barriers to performing female pelvic examinations. Medical curricula need to address these issues in the learning environment.

Measuring competence: Validating a new Pelvic Assessment Tool (The PEAT Study)

This article was migrated. The article was not marked as recommended. IntroductionMedical students are required by the General Medical Council to be proficient in performing a full female pelvic examination (FPE) prior to graduating as doctors. However, many UK medical schools do not conduct a formal summative assessment. Exploration of three electronic databases found no citations evaluating an assessment tool for pelvic examination. Methods The 'PEAT' was developed with an evidence-based literature search and consists of six domains, evaluating attitudes; inspection; bimanual palpation; adnexal examination; speculum; communication; and a global score using a 10cm visual analogue scale. 60 participants including final year medical students and junior doctors were divided into three groups of 20 according to their experience in performing gynaecological examination. Each participant performed a pelvic examination with a role player and pelvic model, which was video recorded. 20 Consultant assessors, who were blinded to the level of experience, used the PEAT for 15 video clips with a mix of participants from each group. Assessors also completed a questionnaire about the utility, relevance and face validity of the PEAT. The inter-assessor reliability of the PEAT was calculated using Cronbach's alpha. Statistical analysis was performed for continuous variables using the Student t-test.Results8/20 (40%) assessors returned their assessment packs. There was a significant increase in the mean score in the 'inspection' domain for novice compared with experienced students (p=0.02). A significant decrease was seen in the mean score for 'adnexal examination' for novice and experienced students compared with junior doctors (p=0.04;p=0.05 respectively). The mean assessor score for the ease of use and perceived effectiveness of PEAT was 7.4 (SD ±1.32) and 6.6 (SD ±1.19) on a 10cm VAS respectively. The PEAT had good or excellent internal consistency (α≥ 0.7) in 4/8 assessors (50%).ConclusionsThe PEAT appears to be easy to use and have face validity. However, further refinements are necessary for this PEAT to establish construct validity and improve reliability.

A Qualitive Study of the Impact and Acceptability of Gynaecological Teaching Associates

This article was migrated. The article was marked as recommended. ObjectivesDeclining clinical exposure in female pelvic examination, increasing student numbers and the intimate nature of the examination poses challenges for medical student training. This study explores the experience and acceptability of all stakeholders involved in a novel method of pelvic examination teaching with the use of expert patients called 'Gynaecological Teaching Associates' (GTAs). An additional aim was to ascertain the motivation of lay women to become GTAs.MethodsA qualitative study was conducted with participants including medical students, teaching and non-teaching faculty members and GTAs. Data was collected through semi-structured interviews, a group interview with a supplemental interview, and non-participant observation (NPO). Twenty students, eight faculty staff, and four GTAs were interviewed, and NPO was accomplished during teaching sessions.AnalysisSequential thematic analysis was conducted on all transcripts. Data from both field notes and interview transcripts was triangulated to establish the validity of findings.ResultsMedical students found GTA teaching acceptable and reported an increased confidence in undertaking female pelvic examinations. They reported a lack of opportunities for male medical students to obtain exposure to, and experience of, gynaecological examination prior to the introduction of the GTA teaching. Other themes included overcoming the intimate nature of the examination, comparing manikin to GTA teaching, and the positive impact on clinical practice. Potential drawbacks included the perception of this "abnormal" teaching method amongst the general public. Lay women volunteered due to the rewarding nature of teaching and the benefit provided to the students.ConclusionGTA teaching has been described as a positive experience by all stakeholders. Acceptability has been established with positive outcomes noted for students. GTA motivation was noted to be altruistic. There are some concerns documented, especially the ability to recruit and monitor an effective GTA teaching programme, as well as to ensure the safety of the GTAs themselves.

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

ObjectivesTo 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 designRandomised controlled trial. SettingTen University of Birmingham (UoB) affiliated teaching hospitals in the UK. Population492 final year medical students. MethodsGTA 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 measuresStudent’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. Results407/492 (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). ConclusionsGTA 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.

Educational effectiveness of gynaecological teaching associates: a multi-centre randomised controlled trial.

To evaluate, among medical students learning the female pelvic examination, the added benefits of training by gynaecological teaching associates compared with training involving a manikin only. Randomised controlled trial. Nine university teaching hospitals. Ninety-four medical students recruited prior to commencing a 4-week obstetrics and gynaecology rotation. The control training consisted of lectures, demonstration of the pelvic examination on a manikin, and opportunities to practise on this low-fidelity simulation (n = 40). The experimental group received additional gynaecological teaching associate training, delivered by pairs of experienced associates to groups of four medical students (n = 54). Outcomes measured at the end of the rotation included knowledge of the correct order of examination components (Yes/No), and student comfort [Likert scales anchored between 1 (very uncomfortable) and 4 (very comfortable) on four items] and confidence [Likert scales anchored between 1 (No) and 3 (Yes) on six items]. The primary outcome, measured at the end of the academic year, was the objective structured clinical examination of a female pelvis (score range 0-54). At baseline, the groups were similar in age, gender, and ethnicity. At the end of the clinical rotation, when compared with the control intervention, the experimental intervention had a moderate effect on student knowledge [difference 29.9% (95% CI 11.2-48.6%); P = 0.002] and confidence [difference 1 (95% CI 0-2); P < 0.001], and a large effect on student comfort [difference 1.8 (95% CI 0.6-3.0); P = 0.004]. At the end of the academic year, the experimental intervention had no impact on skills compared with the control [difference 2 (95% CI-1 to 4); P = 0.26]. Among medical students taught the female pelvic examination by low-fidelity simulation, additional training by gynaecology teaching associates improved knowledge, comfort, and confidence at the end of the clinical rotation but did not improve examination skills at end of the academic year.