Learning from Consumers: Can Gynaecology Teaching Associates Deliver Effective Training for Medical Students?

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There are considerable challenges in training undergraduate medical students to perform the pelvic examination. These difficulties are due to several factors including the potential embarrassment to patients, discomfort of medical students and limited opportunities to train in clinical settings because of time constraints and unwilling patients. Traditional training methods have included manikins, videos and patients within clinical settings including anaesthetised patients. Medical students who have learnt by these methods achieve poor training outcomes. As a qualified doctor this lack of confidence results in increased discomfort for women and reduced reliability of the results obtained which ultimately affects patient care. Training utilising manikins only develops technical skills with no emphasis on communication or interpersonal skill development. Training involving ‘real patients’ in clinical settings is associated with high levels of medical student anxiety and discomfort, difficulties in finding willing patients associated with the possibility of patient right infringement and lack of patient feedback on performance. These difficulties have resulted in increasing volumes of training involving anaesthetised patients. Utilising anaesthetised patients presents difficulties in obtaining informed consent, lack of patient feedback with training entirely focused on technical skills with little duplication of the conditions where the majority of pelvic examinations are performed as a doctor. Gynaecological Teaching Associates (GTAs) have been employed for many years in the Netherlands and USA with the first programme described in 1978. In the United Kingdom many medical schools, notably Kings College London and The University of Birmingham, have developed comprehensive GTA programs to train medical students. GTAs are women trained to teach pelvic examination with themselves being examined. They work in pairs, with one acting as a patient and the other as an instructor. It is anticipated the introduction of GTAs as active teachers could assist medical students in the gaining new clinical skills, improved confidence in counselling, development of complex communication skills with a reduction in anxiety associated with training. In the future it is likely any improvement will have a direct impact on patient care and improved patient outcomes. GTAs are an established component of undergraduate training in many counties and becoming more widespread in the United Kingdom. Many low quality studies have reported positive outcomes for both GTAs and medical students. Further high quality research is required to objectively assess the positive and negative outcomes for both students and patients. The study objective is to provide robust evidence to evaluate the GTA program for the delivery of undergraduate pelvic examination training. Evaluation themes include: 1. Competence to perform pelvic examination Technical skills Communication skills Interpersonal skills Patient experience 2. Student anxiety 3. Student evaluation of program

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