Simulation-based training for pelvic and breast physical examination: Effect on the anxiety and self-confidence of medical students / Treinamento baseado em simulação para exame físico pélvico e de mamas: Efeito na ansiedade e autoconfiança dos estudantes de medicina

Abstract Objective: To evaluate factors associated with anxiety and the effect of simulation-based training (SBT) on student anxiety, self-confidence and learning satisfaction in relation to pelvic and breast examination. Methods: A longitudinal study was conducted with 4th year medical students at the Universidade José do Rosário Vellano. A 12-item, self-report questionnaire on student anxiety at performing gynecological examinations was applied before and after SBT, with answers being given on a Likert-type scale. After training, the self-confidence levels and satisfaction of the students related to the learning process were also evaluated. Results: Eighty students with a mean age of 24.1 ± 4.2 years were included in the study. Of these, 62.5% were women. Pre-SBT evaluation showed that students were more anxious at performing a pelvic examination than a breast examination (2.4 ± 1.0 versus 1.7 ± 0.8, respectively; p < 0.001). The primary reason for anxiety regarding both pelvic and breast examination was fear of hurting the patient. SBT significantly reduced student anxiety (2.0 ± 0.8 versus 1.5 ± 0.5, respectively; p < 0.001). The satisfaction and self-confidence of the students were found to be high (6.8 ± 0.3 and 6.0 ± 0.9, respectively), with no difference between genders. Conclusion: The use of SBT in teaching students to perform pelvic and breast examinations resulted in reduced anxiety and increased self-confidence in a group of medical students of both genders, with high levels of satisfaction in relation to the training.

Resumo Objetivo: Avaliar os fatores relacionados à ansiedade e ao efeito do treinamento baseado em simulação (TBS) na ansiedade, autoconfiança e satisfação do estudante em relação ao aprendizado do exame pélvico e de mamas. Métodos: Estudo longitudinal com alunos do quarto ano de medicina da Universidade José do Rosário Vellano, utilizando questionário autorrespondido com 12 itens em escala tipo Likert sobre a ansiedade em relação ao exame ginecológico, pré e pós-TBS. Após o treinamento, avaliou-se também o grau de autoconfiança e satisfação com o processo de aprendizado. Resultados: Foram incluídos 80 alunos com média etária de 24,1 ± 4,2 anos, dos quais 62,5% eram mulheres. Na avaliação pré-treinamento, a ansiedade dos alunos em relação ao exame pélvico foi maior do que a ansiedade em relação ao exame das mamas (2,4 ± 1,0 versus 1,7 ± 0,8, respectivamente; p < 0,001). O principal motivo de ansiedade em relação tanto ao exame pélvico quanto ao de mamas foi o receio de machucar a paciente. O TBS reduziu significativamente a ansiedade dos alunos (2,0 ± 0,8 versus 1,5 ± 0,5, respectivamente; p < 0,001). A satisfação e autoconfiança dos estudantes foram elevadas (6,8 ± 0,3 e 6,0 ± 0,9, respectivamente), sem diferença entre gêneros. Conclusão: O uso de TBS no ensino de exame pélvico e mamário resultou em uma diminuição na ansiedade e elevada autoconfiança em um grupo de estudantes de medicina, de ambos os gêneros, e bons níveis de satisfação em relação ao treinamento.

Multiple vaginal examinations and early neonatal sepsis

Background: Early onset neonatal sepsis (EONS) is caused mainly by organisms present in the genital tract. Maternal risk factors increase the incidence of EONS. This study was done to find out the association between one such risk factor i.e., multiple vaginal examinations and EONS.Methods: Case control study. 114 patients with three or more vaginal examinations after rupture of membranes were taken as cases and 114 patients with less than three vaginal examinations after rupture of membranes were taken as controls. All these babies were followed up for the development of EONS.Results: Of the 114 cases, 6 babies developed EONS. None of the babies in the control group developed EONS. So, 3 or more vaginal examinations after rupture of membranes in labour is significantly associated with early onset neonatal sepsis with p-value of 0.01305.Conclusions: Multiple vaginal examinations after rupture of membranes is a risk factor for early onset neonatal sepsis.

Problems in the Introduction of Clinical Clerkship in Obstetrics and Gynecology / 医学教育

To clarify the problems in the introduction of clinical clerkship in obstetrics and gynecology, inquiries were sent to medical schools in Japan. Most schools offer traditional types of clinical education, in which students participate little in clinical works, such as clerkships. Informed consent was usually not obtained when students worked with doctors doing vaginal examinations or vaginal deliveries. Even fewer schools thought that students need to perform vaginal examinations. At many schools are short of cases for students to experience deliveries. With traditional clinical education, students may have fewer and fewer chances to perform gynecologic examinations. We suggest that introduction of clinical clerkships should be considered in obstetrics and gynecology.