Kleinman D E, Hage M L, Hoole A J, Kowlowitz V
University of North Carolina (UNC), Chapel Hill School of Medicine, USA.
Acad Med. 1996 Nov;71(11):1239-43. doi: 10.1097/00001888-199611000-00021.
To evaluate medical student performances of pelvic examinations after completion of the obstetrics-gynecology (ob-gyn) clinical clerkship in order to compare the effectiveness of training by laywomen serving as both teachers and patients with the effectiveness of training by an attending physician as teacher, with a lay-woman serving only as the patient. The study also examined whether students were given additional training and opportunities for practice during their clinical clerkships in other disciplines.
Following completion of their ob-gyn clerk-ships in 1993 and 1994, a total of 81 students at two North Carolina medical schools answered a questionnaire eliciting demographic information, pelvic examination experience, and the content of the training they had received. The students then performed a pelvic examination on a standardized patient (SP). Their performances were evaluated by the SP using a 35-item scale, subdivided into technical and interpersonal skills. The data were analyzed by two-tailed t-tests, analysis of variance, and chi-square tests.
The laywoman-trained students demonstrated better interpersonal skills than did the physician-trained students (p = .01). No significant difference was found in technical skills. Nearly one-fourth of the students reported that communication skills had not been taught during their ob-gyn clerkships. The students reported performing pelvic examinations often on their ob-gyn rotation but infrequently on other rotations.
The authors recommend that teaching by laywomen be incorporated into the teaching of pelvic examinations and other aspects of a women's health curriculum. Interpersonal skills taught by laywomen in preclinical courses on pelvic examination may have a lasting effect that can be demonstrated after exposure to clinical clerkships. Clinical clerkships should then reinforce these skills.
评估医学生在完成妇产科临床实习后进行盆腔检查的表现，以比较由担任教师和患者的外行人女性进行培训的效果与由主治医师担任教师、外行人女性仅担任患者进行培训的效果。该研究还调查了学生在其他学科的临床实习期间是否获得了额外的培训和实践机会。
1993年和1994年，北卡罗来纳州两所医学院的81名学生在完成妇产科实习后，回答了一份问卷，问卷内容包括人口统计学信息、盆腔检查经验以及他们所接受培训的内容。然后，学生们对一名标准化患者（SP）进行盆腔检查。SP使用一个35项的量表对他们的表现进行评估，该量表分为技术技能和人际技能。数据通过双尾t检验、方差分析和卡方检验进行分析。
接受外行人女性培训的学生在人际技能方面比接受医师培训的学生表现更好（p = 0.01）。在技术技能方面未发现显著差异。近四分之一的学生报告说，在妇产科实习期间没有教授沟通技能。学生们报告说，他们在妇产科轮转期间经常进行盆腔检查，但在其他轮转期间很少进行。
作者建议将外行人女性的教学纳入盆腔检查及女性健康课程其他方面的教学中。外行人女性在盆腔检查临床前课程中教授的人际技能可能会产生持久的影响，在经历临床实习后仍能体现出来。然后临床实习应强化这些技能。
