UTILIZATION OF SIMULATION TO TEACH PELVIC EXAMINATION SKILLS TO MEDICAL STUDENTS: IMPLICATIONS FOR MEDICAL EDUCATION

摘要

Medical education is changing. Physicians have less time for teaching clinical skills and for direct observation of medical students, due to sicker patients in the hospital, shorter hospital stays, competing demands of research and patient care, and implementation of the eighty hour work week for residents. The consumer movement increased awareness of medical errors, patient safety and quality of healthcare. Teaching the pelvic examination is ethically complex. Questions have arisen about medical students learning to conduct the pelvic examination on actual patients. This study utilizes the pelvic examination simulator and genital teaching associates (GTAs) to teach pelvic exam skills to optimize limited resources, as well as address safety and ethical concerns. The purpose of the study was to provide medical students with more practice in pelvic examination skills, to test a pelvic examination simulator, and to explore a new model for teaching pelvic examination skills to second year medical students. After IRB approval, one hundred sixty eight second year medical students at Virginia Commonwealth University School of Medicine participated in the study. A two-armed trial design provided all medical students with pelvic exam training on the pelvic exam simulator and genital teaching associate. Data were gathered via an experience and demographic questionnaire, blood pressure readings, the Fear of Pelvic Examination Scale scores and performance scores after the training. Data analysis consisted of descriptive statistics, paired and independent sample t-tests and the linear mixed model. Statistical tests determined the relationship between fear, blood pressure and performance. The findings revealed that the GTA training group had significantly more fear than the pelvic exam simulator group and significantly higher performance scores than the simulator group. The gender analysis indicated that males had significantly more fear than females. Prior experience with pelvic exam simulators did not appear to reduce anxiety among medical students when first conducting pelvic exams with humans. Completion of pelvic exam training with a GTA may reduce fear substantially and make later training with the pelvic exam simulator the optimal first experience. Use of simulation in medical education reduces ethical concerns, optimizes limited resources and reduces patient safety issues.