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

Abstract

Objective 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.Design Randomised controlled trial.Setting Nine university teaching hospitals.Population Ninety-four medical students recruited prior to commencing a 4-week obstetrics and gynaecology rotation.Methods 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). Results 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].Conclusions 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.

Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review: BEME Guide No. 58

“…Results of the studies in this category suggest that utilising patients as teachers and assessors works best when it is possible to construct standardised assessment checklists and scoring criteria. This finding was more or less consistent across all of the Level 4 studies, with a further finding that, when tested, the improvements weren't sustained at Objective Structured Clinical Examination (OSCE) or follow up (Duffy 2016, Gruppen 1996, Livingstone 1980, Smith 2000.…”

“…Of these, two (Duffy 2016 andHendry 1999) concluded that patient led teaching had a moderate effect on learning outcomes, Jha (2015) concluded that patient-led teaching was no more effective than faculty-led teaching and Humphrey-Murto (2014) found that faculty-led teaching was more effective in MSK examination than patient-led teaching.…”

“…No studies reported outcomes at levels 3 or 4 of Kirkpatrick's hierarchy of patient or user involvement -transferal of skills into practice or leading to a change in practice across an organization. Some studies attempted to follow up the participants sometime after the intervention (Anderson 1978, Duffy 2016, Gruppen 1996, but still only assessed the outcomes relating to the participants -they did not assess the benefit of the intervention on organizational attitudes to patient involvement in medical education or the benefit to patients that resulted from the study.…”

“…Outcomes of the comparison studies in this category demonstrated that teaching by patients / service users is at least as effective (Anderson 1978, Duffy 2016, Hendry 1999, Kleinman 1996, Schreiber 2000, Smith 2000 as teaching by faculty and, in some studies, was shown to be more effective (Branch 1999, Haq 2006, Livingstone 1980. Of the studies which used a pre-and post-test outcome measure, these also showed an increase in skill/ knowledge attainment.…”

Standardizing bimanual vaginal examination using cognitive task analysis

“…Thirdly, obtaining clinical experience is increasingly difficult as patients are reluctant to undergo intimate examinations for teaching purposes. Training with gynecological teaching associates is a viable alternative, but can be expensive. As a consequence, education is shifting toward simulation‐based training.…”