Cost-effective analysis of teaching pelvic examination skills using Gynaecology Teaching Associates (GTAs) compared with manikin models (The CEAT Study)

Aisha Janjua, Tracy Roberts, Nicola Okeahialam, T Justin Clark, Aisha Janjua, Tracy Roberts, Nicola Okeahialam, T Justin Clark

Abstract

Objective: 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.

Methods: 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.

Outcome measures: Cost per student competent in pelvic examination at completion of a 5-week clinical O&G placement.

Results: 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.

Conclusions: 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.

Trial registration number: NCT01944592.

Keywords: competence; cost effectiveness; gynaecology teaching associates (gtas); medical student; pelvic examination; undergraduate medical education.

Conflict of interest statement

Competing interests: GTAs are currently employed by BWH where TJC is Director of Academy.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Programme of teaching (manikin and GTA). GTA, Gynaecology Teaching Associate.
Figure 2
Figure 2
Cost-effectiveness acceptability curves for 50%, 60% and 70% competence.

References

    1. Broadmore J, Hutton JD, Langdana F. Medical students' experience of vaginal examinations of anaesthetised women. BJOG 2009;116:731–3. 10.1111/j.1471-0528.2008.02069.x
    1. Iyengar S, Raut N, Clark J. O330 Gynaecology Training Associates(GTAs): the future in the training of final year medical students? Int J Gynaecol Obstet 2012;119:S377 10.1016/S0020-7292(12)60760-7
    1. Powell HS, Bridge J, Eskesen S, et al. . Medical students' self-reported experiences performing pelvic, breast, and male genital examinations and the influence of student gender and physician supervision. Acad Med 2006;81:286–9. 10.1097/00001888-200603000-00022
    1. General Medical Council (GMC), 2016. Outcomes for graduates pages 4 – 5 [Online]. (Accessed 31 mar 2016).
    1. Kretzschmar RM. Evolution of the Gynecology Teaching Associate: an education specialist. Am J Obstet Gynecol 1978;131:367–73. 10.1016/0002-9378(78)90409-X
    1. Kretzschmar RM, Guthrie DS. Why not in every school? JAMWA 1983;39:43–5.
    1. Smith PP, Choudhury S, Clark TJ. The effectiveness of gynaecological teaching associates in teaching pelvic examination: a systematic review and meta-analysis. Med Educ 2015;49:1197–206. 10.1111/medu.12816
    1. Pickard S, Baraitser P, Rymer J, et al. . Comparative study. BMJ 2003;327:1389–92.
    1. Pradhan A, Ebert G, Brug P, et al. . Evaluating pelvic examination training: does faculty involvement make a difference? A randomized controlled trial. Teach Learn Med 2010;22:293–7. 10.1080/10401334.2010.512831
    1. Siwe K, Wijma B, Silén C, et al. . Performing the first pelvic examination: female medical students' transition to examiners. Patient Educ Couns 2007;69:55–62. 10.1016/j.pec.2007.07.002
    1. Wånggren K, Fianu Jonassen A, Andersson S, et al. . Teaching pelvic examination technique using professional patients: a controlled study evaluating students' skills. Acta Obstet Gynecol Scand 2010;89:1298–303. 10.3109/00016349.2010.501855
    1. Black B, Marcoux BC. Feasibility of using standardized patients in a physical therapist education program: a pilot study. Journal of Physical Therapy Education 2002;16:49–56.
    1. Aamodt CB, Virtue DW, Dobbie AE. Trained standardized patients can train their peers to provide well-rated, cost-effective physical exam skills training to first-year medical students. Fam Med 2006;38:326–9.
    1. Drummond MF, Sculpher MJ, Claxton K, et al. . Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 2015.
    1. Allen SS, Miller J, Ratner E, et al. . The educational and financial impact of using patient educators to teach introductory physical exam skills. Med Teach 2011;33:911–8. 10.3109/0142159X.2011.558139
    1. Hasle JL, Anderson DS, Szerlip HM. Analysis of the costs and benefits of using standardized patients to help teach physical diagnosis. Acad Med 1994;69:567–70. 10.1097/00001888-199407000-00013
    1. Pugh CM, Salud LH. Association for Surgical Education. Fear of missing a lesion: use of simulated breast models to decrease student anxiety when learning clinical breast examinations. Am J Surg 2007;193:766–70. 10.1016/j.amjsurg.2006.12.033
    1. Claxton K, Martin S, Soares M, et al. . Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess 2015;19:1–504. 10.3310/hta19140

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere