Female Pelvic Examination Clinical Trial
Official title:
Gynaecology Teaching Associates Versus Teaching on Manikins: a Randomised Controlled Trial
Physical examination of the pelvis is an important core skill that medical students need to
acquire. However, due to its intimate nature some students are graduating unable to perform
competent pelvic examinations. Gynaecological Teaching Associates (GTA's) are women who have
been trained to be examined and give valuable feedback to the students. In North America
GTA's are quite commonly used in the medical curriculum and they have also been used in
Canada, Australia and Scandinavia. In the UK pelvic examination is mainly taught using a
combination of clinic patients, pelvic models and patients anaesthetised for surgery. In
Birmingham we have already started using GTA's and like other Universities such as Oxford
the students have given positive feedback.
GTA's are paid professionals and hence introducing this method of teaching has financial
implications for Universities. Unless it is proven to be worthwhile it is unlikely that
academic institutions will introduce and maintain GTA programs. One UK study did show that
those who had been trained with a GTA's and pelvic models were significantly better than
those who had been trained with pelvic models alone. However, in this study the GTA training
was supplementary to the normal curriculum so the amount of teaching rather than the style
of teaching may have acted as a confounding factor. Therefore, a large randomised trial of
trainees on the Obstetrics and Gynaecology (O&G) programme comparing those given an initial
teaching session on a pelvic model and those taught by GTA's is needed to assess the
effectiveness of GTA's on confidence and competence of the students by the end of the
training programme is needed.
Introduction Physical examination of the pelvis is an important core skill that medical
students need to acquire. However, the experience of undergraduates to vaginal examination
is becoming increasingly limited such that medical students in Birmingham can qualify
without ever performing a vaginal examination in an outpatient setting (personal
communication, Raut N). It is well recognised that the intimate nature of the examination
poses additional challenges to medical students and their teachers in gaining consent for
supervised training. However, other factors may now be affecting student experience. These
include competing pressures on contemporary undergraduate medical curricula resulting in
traditional clinical placements, such as obstetrics and gynaecology (O&G), becoming
shortened in many academic medical institutions. Empowerment of patients combined with
changes in their expectations of interactions with medical professionals may have further
restricted access to clinical cases. Changes in attitudes to teaching gynaecological
examination may not be restricted to patients; medical educationalists may also have become
more conservative or less experienced such that they find teaching vaginal examination an
increasing challenge.
Whatever the reasons underlying the diminishing exposure of medical students to
gynaecological examination are, the current status quo is unacceptable. Teaching innovations
are urgently required to enhance teaching of a skill which is fundamental to both
gynaecological and general medical practice. A strategy becoming increasingly popular is the
use of "gynaecological teaching associates" or GTA's for short. These women are 'expert
patients' who have been trained to undergo and teach gynaecological examination, giving
valuable and immediate feedback to the students. In North America GTA's are quite commonly
used in the medical curriculum and they have also been used in Canada, Australia and
Scandinavia. In the UK pelvic examination is still mainly taught through simulation on
pelvic models (manikins) combined with experience gained from supervised teaching on women
attending outpatient clinics and those anaesthetised for surgery within clinical
attachments. However, the length of these placements varies in length throughout UK medical
schools and the quality of experience is likely to be inconsistent even within medical
schools. In 2011 at the Birmingham Women's Hospital (BWH), we instituted a GTA teaching
programme. Final year medical students from the University of Birmingham Medical School
allocated clinical placements in O&G at the BWH undergo GTA teaching within the first week
of their five week attachment. To date, in keeping with other Universities with GTA
programmes experience, such as Oxford University and Kings College, London (1), our students
have given universally positive feedback (Clark TJ, Personal Communication).
Anecdotal qualitative data from our students is reassuring but whether the GTA programme in
its current design is effective and indeed cost-effective in key educational outcomes is
unclear. The published data available are generally descriptive studies of the process and
institution of GTA programmes into the undergraduate medical curriculum (2-7). Studies
addressing student competence and confidence are limited to small, observational series. One
non-randomised controlled study from the UK demonstrated that students who had been trained
with GTA's were significantly better than those who had been trained with pelvic models
alone (1). However, in this study the GTA training was supplementary to the normal
curriculum so the amount of teaching rather than the style of teaching may have acted as a
confounding factor. Moreover, a valid assessment tool was not used to assess clinical
performance. Evaluating the educational benefit of GTAs is also important if we are to
allocate scarce undergraduate educational resources efficiently. Gynaecological teaching
associates are paid professionals and introducing this method of teaching has financial
implications for Universities.
At present, the University of Birmingham has not fully incorporated GTA teaching into its
final year O&G curriculum with 150/400 students placed at the BWH being taught in this way.
Thus, with opinion as to the value of GTAs not yet solidified and in the absence of rigorous
scientific assessment of the educational and economic benefits of GTAs, we propose a large
randomised controlled trial. The RCT will compare the effectiveness and cost-effectiveness
of teaching female pelvic examination to medical students using GTAs with traditional
teaching using pelvic manikins.
Objectives
The TARGET RCT has been designed to answer the following research questions:
Principal Research Question
• Do gynaecological teaching associates improve the level of confidence of medical students
in performing gynaecological pelvic examination compared to manikin based teaching?
Secondary Research question
- Do Gynaecological Teaching Associates improve the level of competence of medical
students in performing gynaecological pelvic examination compared to manikin based
teaching?
- Do the following factors affect the competence and confidence of medical students in
performing gynaecological pelvic examination: student gender; ethnicity; perception of
clinical placement; number of supervised vaginal examinations conducted during clinical
placement?
- Are Gynaecological Teaching Associates cost-effective?
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor)
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT01725581 -
A Study to Test a New Pelvic Examination Assessment Tool
|
N/A |