title: The effectiveness of gynaecological teaching associates in teaching pelvic examination: a systematic review and meta-analysis.
abstract: BACKGROUND
  An increasing number of graduating students are unable to competently and confidently perform a pelvic examination. Gynaecology teaching associates (GTAs) teach technical and communication skills and offer immediate feedback. The objective was to perform a systematic literature review to assess whether teaching pelvic examinations using real women who are trained to give instructions on technique and feedback improves the competence, confidence and communication skills of trainees when compared with traditional teaching methods.
  
  
  METHODS
  MEDLINE, EMBASE, the Cochrane Library, CINAHL and the ISRCTN Register of Clinical Trials were searched using selected terminology. No language restrictions were applied. The selection criteria were randomised clinical trials (RCTs) and controlled studies that investigated the use of GTAs to teach students or health-related professionals the pelvic examination. Data evaluating study outcomes, along with methodological details, were extracted in duplicate. The outcomes measured were: self-reported confidence, assessed competence and assessed communication skills. The standard mean difference (SMD) was derived for each study where possible and heterogeneity across studies was quantified using the I(2) statistic. In the presence of substantial variation, the data were pooled using a random effects model.
  
  
  RESULTS
  Eleven studies with 856 participants were included: five RCTs and six observational studies. GTA training improved competence compared with other teaching methods and the finding of enhanced competence was consistent when the pooled analysis was restricted to RCTs. Communication skills were also improved with GTA teaching, but to a lesser degree, whereas no effect on student confidence was observed. Statistical heterogeneity was present for all outcomes when data were pooled.
  
  
  CONCLUSIONS
  Our findings suggest that GTA-based teaching of pelvic examination is associated with improvement in the competence and communication skills of trainees. However, further larger-scale studies with standardised relevant educational outcomes are needed to confirm these findings.
authors.affiliation: School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Smith
authors.affiliation: School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
authors.forename: Shelina
authors.initials: S
authors.lastname: Choudhury
authors.affiliation: Birmingham Women's Hospital, School of Clinical and Experimental Medicine, Birmingham, UK.
authors.forename: T Justin
authors.initials: TJ
authors.lastname: Clark
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D058869:Gynecological Examination; D006176:Gynecology / Q000193:education*; D006801:Humans; D017063:Outcome Assessment, Health Care; D016544:Patient Simulation