Janjua Aisha, Roberts Tracy, Okeahialam Nicola, Clark T Justin
Obstetrics and Gynaecology, Birmingham Heartlands Hospital, Birmingham, UK.
Department of Health Economics Unit, School of Health and Population Science, The Public Health Building, University of Birmingham, Birmingham, UK.
BMJ Open. 2018 Jun 22;8(6):e015823. doi: 10.1136/bmjopen-2017-015823.
To determine the cost-effectiveness of Gynaecology Teaching Associate (GTA) teaching versus conventional pelvic model (manikin) teaching of pelvic examination skills for final year medical students within a UK undergraduate obstetrics and gynaecology (O&G) curriculum.
An economic evaluation was carried out alongside a randomised controlled trial involving 492 final year medical students. 240 students received manikin teaching, and 241 GTA-led teaching. 418 (85%) students completed their assessment. Proficiency in gynaecological pelvic examination on GTAs was estimated by a senior clinical examiner, blinded to the method of teaching, using a standardised assessment tool. University of Birmingham Medical School thresholds were applied to determine proficiency levels; competence (pass) 50%, merit 60% and distinction 70%. Costs incurred in the delivery of both the educational pathways (control and intervention) were combined. All costs are reported in 2013-2014 prices and earlier costs adjusted using inflation indices.
Cost per student competent in pelvic examination at completion of a 5-week clinical O&G placement.
GTA teaching was more effective compared with conventional teaching with 12 more students considered competent at pass level and 28 more students competent at merit and distinction levels, respectively. However, the average cost of GTA teaching was £45.06 per student compared with £7.40 per student for conventional teaching, with an increased cost of £37.66 per student. The incremental cost-effectiveness ratio demonstrated that it cost an additional £640.20 per competent student and £274.37 per student competent at merit level and £274.37 at distinction level compared with conventional manikin-based teaching.
GTA teaching of female pelvic examination at the start of undergraduate medical student O&G clinical placements is shown to cost more and be more effective. GTA teaching is likely to be considered cost-effective in the context of other tests, and over the lifespan of a competent doctor's career.
NCT01944592.
在英国本科妇产科（O&G）课程中，确定妇科教学助理（GTA）教学与传统盆腔模型（人体模型）教学对医学专业最后一年学生进行盆腔检查技能教学的成本效益。
在一项涉及492名医学专业最后一年学生的随机对照试验的同时进行了一项经济评估。240名学生接受了人体模型教学，241名学生接受了GTA主导的教学。418名（85%）学生完成了评估。一名资深临床考官使用标准化评估工具，在对教学方法不知情的情况下，评估学生在GTA上进行妇科盆腔检查的熟练程度。应用伯明翰大学医学院的阈值来确定熟练程度水平；合格（通过）为50%，优秀为60%，卓越为70%。将两种教育途径（对照组和干预组）在教学过程中产生的成本进行了汇总。所有成本均按2013 - 2014年的价格报告，早期成本使用通胀指数进行了调整。
在为期5周的临床O&G实习结束时，每名能够胜任盆腔检查的学生的成本。
与传统教学相比，GTA教学更有效，分别有12名更多的学生达到合格水平，28名更多的学生达到优秀和卓越水平。然而，GTA教学的平均成本为每名学生45.06英镑，而传统教学为每名学生7.40英镑，每名学生成本增加了37.66英镑。增量成本效益比表明，与基于传统人体模型的教学相比，每名合格学生额外花费640.20英镑，每名优秀水平的学生额外花费274.37英镑，卓越水平的学生额外花费274.37英镑。
在本科医学生O&G临床实习开始时，GTA进行女性盆腔检查教学成本更高但更有效。在其他测试的背景下以及在一名合格医生的职业生涯中，GTA教学可能被认为具有成本效益。
NCT01944592。
