PELVIC EXAMINATION INSTRUCTION AND EXPERIENCE - A COMPARISON OF LAYWOMAN-TRAINED AND PHYSICIAN-TRAINED STUDENTS

Purpose. To evaluate medical student performances of pelvic examinatio ns after completion of the obstetrics-gynecology (ob-gyn) clinical cle rkship in order to compare the effectiveness of training by laywomen s erving as both teachers and patients with the effectiveness of trainin g by an attending physician as teacher, with a laywoman serving only a s the patient. The study also examined whether students were given add itional training and opportunities for practice during their clinical clerkships in other disciplines. Method. Following completion of their ob-gyn clerkships in 1993 and 1994, a total of 81 students at two Nor th Carolina medical schools answered a questionnaire eliciting demogra phic information, pelvic examination experience, and the content of th e training they had received. The students then performed a pelvic exa mination on a standardized patient (SP). Their performances were evalu ated by the SP using a 35-item scale, subdivided into technical and in terpersonal skills. The data were analyzed by two-tailed t-tests, anal ysis of variance, and chi-square tests. Results. The laywoman-trained students demonstrated better interpersonal skills than did the physici an-trained students (p =.01). No significant difference was found in t echnical skills. Nearly one-fourth of the students reported that commu nication skills had not been taught during their ob-gyn clerkships. Th e students reported performing pelvic examinations often on their ob-g yn rotation but infrequently on other rotations. Conclusion. The autho rs recommend that teaching by laywomen be incorporated into the teachi ng of pelvic examinations and other aspects of a women's health curric ulum. Interpersonal skills taught by laywomen in preclinical courses o n pelvic examination may have a lasting effect that can be demonstrate d after exposure to clinical clerkships. Clinical clerkships should th en reinforce these skills.