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

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.