The experience of UK medical/physician associate students in the acquisition of intimate physical examination skills, and the role of technology-enhanced simulators in facilitating learning
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Saudi Digital Library
Abstract
Intimate physical examinations (IPEs) are challenging examinations to learn. IPEs such as male
genital, male and female rectal, female breast, and female pelvic examinations are essential
components of physical examination and are potentially challenging for medical students to
acquire experience and competence. There are limited data evaluating the impact of students’
ethnicity and gender on the acquisition of IPEs skills and the role of mixed reality simulators
in facilitating learning. This thesis appraises the factors that may impact or facilitate IPE skills
acquisition among novice learners.
A systematic review narrative synthesis was conducted to evaluate the effectiveness of the
currently used technology enhanced simulation (TES) in teaching digital rectal examination.
The Medical Education Research Study Quality Instrument was modified to facilitate better
quality assessment for the included studies. The systematic review showed that TES training is
associated with improved digital rectal examination (DRE) skills. Two online surveys which
assessed medical students (1st study) and physician associated students (2nd study) showed the
number of IPEs performed was low. Also, the studies show students’ gender and ethnicity
correlated with the acquisition of IPE skills and with self-reported competence.
The degree of fidelity (a true representation of intended learning goals) used in mixed reality
(MxR) simulators could impact the learning process and may be associated with better learning
outcomes. A learning model including simulation is presented that aims to improve learning
outcomes by adjusting the simulation scenario to match learners’ needs. The model shows that
fidelity should be maintained as high as possible for all types of learners. However, the
complexity and difficulty level should be adjusted to match the learners’ educational level. A
protocol for a randomised educational superiority trial has been developed to assess the
educational effectiveness of MxR simulators. The protocol describes the intervention (Bristol
DRE- MxR simulator), methods and design, and outcomes. The learning objectives and
outcomes for novice learners were identified using a Delphi study.