title: 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.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Nine university teaching hospitals.
  
  
  METHODS
  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).
  
  
  METHODS
  Outcomes measured at the end of the rotation included knowledge of the correct order of examination components (Yes/No), and student comfort [Likert scales anchored between 1 (very uncomfortable) and 4 (very comfortable) on four items] and confidence [Likert scales anchored between 1 (No) and 3 (Yes) on six items]. The primary outcome, measured at the end of the academic year, was the objective structured clinical examination of a female pelvis (score range 0-54).
  
  
  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.
authors.affiliation: Balliol College, University of Oxford, Oxford, UK.
authors.forename: J M N
authors.initials: JM
authors.lastname: Duffy
authors.affiliation: Lister Hospital, Hertfordshire, UK.
authors.forename: S
authors.initials: S
authors.lastname: Chequer
authors.affiliation: Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: A
authors.initials: A
authors.lastname: Braddy
authors.affiliation: Department of Primary Care and Population Health, UCL Medical School, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mylan
authors.affiliation: Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Royuela
authors.affiliation: Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Zamora
authors.affiliation: Department of Obstetrics and Gynaecology, Homerton University Hospital NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Ip
authors.affiliation: Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hayden
authors.affiliation: Cochrane Menstrual Disorders and Subfertility Group, University of Auckland, Auckland, New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Showell
authors.affiliation: Institute of Medical Education, Cardiff University, Cardiff, UK.
authors.forename: P
authors.initials: P
authors.lastname: Kinnersley
authors.affiliation: Women's Health Research Unit, Queen Mary, University of London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Chenoy
authors.affiliation: Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: O M
authors.initials: OM
authors.lastname: Westwood
authors.affiliation: Women's Health Research Unit, Queen Mary, University of London, London, UK.
authors.forename: K S
authors.initials: KS
authors.lastname: Khan
authors.affiliation: Clinical and Communication Skills Learning Unit, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Cushing
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D058869:Gynecological Examination; D006176:Gynecology / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008348:Manikins; D020377:Self Efficacy; D013663:Teaching / Q000379:methods*; D055815:Young Adult
keywords: Gynaecological teaching associates; medical student; patient participation; pelvic examination; speculum examination