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 and gynaecology (O&G) curriculum.MethodsAn economic evaluation was carried out alongside a randomised controlled trial involving 492 final year medical students. 240 students received manikin teaching, and 241 GTA-led teaching. 418 (85%) students completed their assessment. Proficiency in gynaecological pelvic examination on GTAs was estimated by a senior clinical examiner, blinded to the method of teaching, using a standardised assessment tool. University of Birmingham Medical School thresholds were applied to determine proficiency levels; competence (pass) 50%, merit 60% and distinction 70%. Costs incurred in the delivery of both the educational pathways (control and intervention) were combined. All costs are reported in 2013–2014 prices and earlier costs adjusted using inflation indices.Outcome measuresCost per student competent in pelvic examination at completion of a 5-week clinical O&G placement.ResultsGTA teaching was more effective compared with conventional teaching with 12 more students considered competent at pass level and 28 more students competent at merit and distinction levels, respectively. However, the average cost of GTA teaching was £45.06 per student compared with £7.40 per student for conventional teaching, with an increased cost of £37.66 per student. The incremental cost-effectiveness ratio demonstrated that it cost an additional £640.20 per competent student and £274.37 per student competent at merit level and £274.37 at distinction level compared with conventional manikin-based teaching.ConclusionsGTA teaching of female pelvic examination at the start of undergraduate medical student O&G clinical placements is shown to cost more and be more effective. GTA teaching is likely to be considered cost-effective in the context of other tests, and over the lifespan of a competent doctor’s career.Trial registration numberNCT01944592.

What are the novel findings of this work?Transperineal ultrasound (TPUS) had excellent agreement with endoanal ultrasound in diagnosing the presence of anal sphincter defects. However, there was poor-to-moderate agreement between the two modalities in the measurement of defect angle, with a standard error of measurement of 16 • and 27 • for external and internal anal sphincter defects, respectively. What are the clinical implications of this work?A cut-off angle of 30 • should not be used for the diagnosis of a significant residual anal sphincter defect on TPUS. Further research is required to determine the cut-off angle for a significant defect on TPUS.

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