Pelvic examination instruction and experience: a comparison of laywoman-trained and physician-trained students.

PURPOSE

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.

METHOD

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.

RESULTS

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.

CONCLUSION

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.